• Fresh Views

    Association of Diabetes Care and Education Specialists 2021 Virtual Annual Meeting Preview

    We hope your summer has been going well! We’ve been busy with work and spending time with family.  Here @AFreshPOVforYo we are getting excited for the upcoming ADCES21 Virtual conference. For those of you that are attending, we have highlighted 13 presentations that are interesting to us and align with our thinking around behavior change, person-centered care, use of language, and of course use of technology.  While there are many, many more sessions we plan to join, we are showcasing just a few!

    We hope you’ll attend our session on Saturday 8/14/21 at 3:15 pm CT, S30 – Adopt A Fresh Point of View: A Solution-Focused Approach to the ADCES7 Self-Care Behaviors™.  We presented two years ago at #AADE19 and shared an overview of what a solution-focused approach is all about. This year we’ll go a little farther and address the ADCES7 self-care behaviors. We’ll be sharing more info about our program in two weeks, so stay tuned for that!

    While we wish we were connecting with our colleagues in person this August, we appreciate the great program put together virtually. We’re crossing our fingers that we’ll be grabbing a coffee or a glass of wine at ADCES22 in Baltimore next year!

    Enjoy the meeting if you’re attending! We’ll share some of our thoughts about the meeting in a future post. We’ll also be Tweeting during the conference to share some pertinent information!

    T02 – Help People With Diabetes Shift Their Mindset and Change Their Approach to Self-Care Behaviors

    Mark Heyman, PhD, CDCES

    Thursday 8/12/21 10:35-11:05 am 

    In this session, presenters will show a framework for how diabetes care and education specialists can empower people with diabetes to take a new relationship approach to change their entire emotional experience with diabetes to improve self-care behaviors.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Describe a framework for empowering people with diabetes to change their emotional experience with diabetes
    • Describe how different types of relationships with diabetes impacts psychosocial and emotional functioning
    • Utilize practical tools to help people change their relationship with diabetes

    T10 – Achieve Better Outcomes by Using Individually Customized Messages

    Marlisa Brown, MS, RDN, CDCES, CDN

    Thursday, August 12, 2021

     12:45 PM – 1:15 PM

    This session will discuss how to achieve better results by combining smart goals, virtual programs, motivational interviewing, coaching, stages of change and behavioral strategies with customized messages designed individually to improve outcomes.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Combine behavior change techniques with customized messaging designed to improve individual outcomes
    • Embrace fears and help an individual to overcome barriers
    • Identify a starting point and build an action plan

    T17 – Collaborative Psychosocial Care for Youth With Diabetes

    Korey Hood, PhD

     Thursday, August 12, 2021

    1:20 PM – 1:50 PM

    Psychosocial care for youth with diabetes presents challenges for the care team. This presentation will cover engagement and treatment strategies that optimize diabetes care in youth and collaborative care provided by diabetes care and education specialists and mental health professionals.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Identify psychosocial care opportunities in youth with diabetes
    • Select validated surveys and screening formats for identifying psychosocial issues in youth with diabetes
    • Adopt concrete strategies to help youth with diabetes

    T18 – Language in Diabetes Care From a Personal and Professional Perspective

    Lauren Plunkett, RDN, LD, CDCES

     Thursday, August 12, 2021

    1:20 PM – 1:50 PM

     Living with a disease that focuses on numerical values and patterns can be physically and mentally exhausting. Presenters will examine statements that trigger sensitive emotions and how to replace them with optimistic, inspirational coaching.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Collaborate with individuals to understand how they approach management of their diabetes
    • Articulate optimistic coaching methods to encourage individuals to live in partnership with diabetes
    • Reframe the standard clinical approach to a perspective that focuses on the individual experience

    T27 – Diabetes Stigma: Causes and Consequences for the Concerned Clinician

    Lauren B. Beach, JD, PhD

     Thursday, August 12, 2021

    3:25 PM – 3:55 PM

     In this session, participants will learn how diabetes stigma at individual, interpersonal and structural levels intersect and can compound other forms of social marginalization, contributing to health disparities and poorer outcomes.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Define diabetes stigma and name at least four dimensions of stigma
    • Name pathways by which diabetes stigma is associated with medication taking among people with diabetes
    • Promote diabetes pride in your practice and across the interdisciplinary diabetes care team

    F04 – Too Good? The Potential Dangers of Perfectionism in Diabetes

    Kersti Spjut, PhD

    Alexis Skelley, LISW-CP, LCSW, CDCES

     Friday August 13, 2021

    10:05 AM – 10:35 AM

     This session will provide ways to recognize signs of unhealthy perfectionism in diabetes management, its medical and emotional risks, and tangible steps for helping individuals become more flexible, mindful and compassionate approach.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Explain how perfectionism exhibits in diabetes management
    • List possible consequences of perfectionism in people with diabetes
    • Utilize strategies for preventing perfectionism pitfalls among people with diabetes

    F17 – Practical Approaches for Addressing Behavioral Health Needs

    Nicole Bereolos, PhD, MPH, MSCP, CDCES, FADCES

    Friday, August 13, 2021

    12:40 PM – 1:10 PM

    Performing an assessment of behavioral health needs in individuals with diabetes can be limited by lack of training, resources and time. This session will provide practical tools, resources and real-world examples to augment learning in this area for diabetes care and education specialists.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Identify the importance of addressing the behavioral health needs of PWD
    • Demonstrate real-world applications of addressing behavioral health needs
    • Utilize tools and resources appropriately to help address behavioral health needs in practice

     

    D07 – Diabetes Care and Education Specialists and Behavioral Coaching For Mental Health: Creating Successful Partnerships

    Korey Hood, PhD,

    Brooke Benton, CDCES, MS, RD, LDN

    Sunday, August 15, 2021

     10:05 AM – 10:35 AM

    Mental health issues can prove challenging to address for diabetes care and education specialists. This session will discuss how a behavioral coach can work alongside them to screen for mental health issues, recognize when individuals are struggling and connect them to available support resources.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Highlight models that promote partnership between the diabetes care and education specialist and the mental health specialist
    • Discuss the relationship between diabetes and mental health
    • Incorporate screening tools and identify referring sources to collaborate with for providing mental health care

    D19 – Diabetes Distress: An Overview of Prevalence, Assessment and Treatment

    Lawrence Fisher, PhD, ABPP

    Sunday, August 15, 2021

     11:15 AM – 11:45 AM

    This presentation will review the definition, clinical presentation, prevalence, assessment and treatment of diabetes distress due to its high prevalence and consistent links with self-management, making it an important target of clinical care.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Perform a clinical assessment for diabetes distress
    • Utilize recommended tools for clinical assessment of diabetes distress
    • Discuss the treatment of diabetes distress

     D25 – Optimize Support During Crises With Supplemental Peer Support

    Anna Norton, MS

    Sunday, August 15, 2021

     11:50 AM – 12:20 PM

    During the COVID-19 pandemic, peer support communities can serve as a supplemental resource for people with diabetes to maintain their mental health well-being. This session will provide strategies for diabetes care and education specialists to connect people with diabetes to these communities.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Recognize the need for psychosocial support for people with diabetes during a crisis
    • Provide suggestions and strategies for connecting people in their practice to peer support communities
    • Identify reputable resources for diabetes management outside of the healthcare environment

    Here are a few technology sessions you may be interested in as well.  

    T24 – Facebook Collaborative To Improve Diabetes Management

    Lorena Drago, MS, RDN, CDN, CDCES

    Miguel Johns, BS

    Thursday, August 12, 2021

     2:50 PM – 3:20 PM

    Sharing diabetes challenges and engaging with peers through Facebook groups helps people with diabetes make connections and learn/reinforce actionable self-care behaviors. This session will discuss how to use social media to teach, reinforce and support people with diabetes.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Discuss how sharing diabetes challenges fosters connections and improves self-care habits
    • Increase diabetes education support outside of the provider’s office using social media marketing strategies
    • Create engaging social media content to obtain measurable results

    ET07 – Powered by Dexcom: Continuous Glucose Monitoring Empowers Self-Management and Expands the Horizons for Connected Care

    Moderator: Deborah Greenwood, PhD, RN, BC-ADM, CDCES, FADCES
    Clinical Education, Dexcom

    Panelists:
    Malinda Peeples, RN, MS, CDCES, WellDoc

    Denise MacKenzie, RPh, PharmD, CDCES, OnDuo

    Aimée José, RN, CDCES, Steady Health

    LaurieAnn Scher, MS, RD, CDCES, Fitscript

    Lindsay Vettleson, RDN, CDCES, ACE-CPT, ACE-CHC, One Drop

    Friday, August 13, 2021

     10:45 AM – 11:30 AM
    Join the discussion with DCES digital health experts that are leading the development and implementation of digital platforms to support people with type 2 diabetes to engage in personalized, data-driven, self-management and support coaches and HCPs to inform therapeutic decisions.

    S04 – Technology Interventions in High-Risk Populations: The Identify, Configure, and Collaborate (ICC) Framework in Action!

    Donna M. Rice, MBA, BSN, RN, CDCES, FADCES

    Deborah A. Greenwood, PhD, RN, BC-ADM, CDCES, FADCES

    Saturday, August 14, 2021

     10:05 AM – 10:35 AM

     This presentation will describe the ADCES technology framework Identify, Configure and Collaborate (ICC) using a program that delivers care with technology-enabled devices in high-risk communities.

    Learning Objectives:

    At the completion of this activity, participants should be able to:

    • Describe the Identify, Configure, and Collaborate (ICC) framework and its application to high risk populations
    • Discuss the role of the diabetes care and education specialist in evaluating technology interventions within their practice
    • Discuss a technology assessment tool that can be utilized to assess specific technology needs

    We’ll see you in two weeks with a more detailed description of our Saturday educational session!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Summer 2021 Fresh Views

    Wedding shower floral arrangement and cranberry mimosa from Deb’s niece’s COVID delayed bridal shower

    Happy Summer from us here @A Fresh POV for you! We are taking a little break to refresh and recharge. As we continue towards our Mission to guide healthcare professionals in a solution-focused approach so clients can embrace possibilities, opportunities, and a fresh vision for the future, you will not want to miss our next post on interesting educational sessions we’re excited about during the upcoming Association of Diabetes Care and Education Specialist ASCES21 Annual conference August 12-15, 2021! 

    In the meantime, we thought you might want to revisit this blog we posted on healthy eating following the  Mediterranean style eating plan or this post on Keeping Friends Close!

    If you’ve followed our blog, you know that we enjoy sharing a fresh inspiring view with each post. Here are a few fresh views that we have enjoyed this summer!

    Deb’s family and friends relaxing at Lake Champlain, Cholchester, Vermont
    The beautiful Popponesset Beach, Mashpee, Cape Cod, MA

    We hope you are enjoying your summer and have the opportunity to “Imprint” some Fresh Views of your own! See you back on July 28!

    Tami & Deb

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Diabetes Technology and Solution-Focused Practice: Online Peer Support Community Intervention to Address Health Disparities

      “I realized that my sugar was like a rollercoaster. It would go up and down very clearly. So I started to go for walks. Not light walks, but fast-paced ones.” ~Study participant

    Since the COVID-19 pandemic began the disparities in diabetes technology use in underserved populations has risen to the forefront. During the recent American Diabetes Association (ADA) Scientific Sessions data were shared about a novel use of an online peer support community combined with continuous glucose monitoring (CGM) use to educate, engage and empower people with type 2 diabetes. Since Deb was a co-investigator on this study, we reached out to Dr. Michelle Litchman, PI, Assistant Professor, University of Utah, College of Nursing to discuss the study findings and impact.

    The ADA abstract: 151-O Using a CGM plus Online Peer Support Community Intervention to Address Health Disparities

    Dr. Litchman, what makes this study unique and important?

    This study was developed based on two separate PCORI-funded projects that incorporated community-based participatory research principles and community advisory boards (CAB). The first CAB partnered with individuals within the Hispanic community to better understand diabetes technology needs and desires. The second CAB included diabetes online community partners to best understand how online peer support could reinforce diabetes technology use and healthy behaviors.

    What were the components of the study?

    We developed an intervention that combined continuous glucose monitoring (CGM) plus an online peer support community (OPSC). To support the needs of Hispanic and Spanish-speaking adults with type 2 diabetes not using insulin, the CGM+OPSC intervention was optimized to be culturally and linguistically appropriate. Participants wore CGM to visualize their daily glucose patterns and engaged in weekly personal experiments. Personal experiments included health behavior challenges related to general diabetes topics (being active, healthy eating, etc.) and were posted to the OPSC weekly. The OPSC were managed by trained Spanish/English bilingual peer facilitators who also lived with diabetes and used CGM. This mixed method study assessed how participants used the intervention.

    Participants completed a 1-week blinded baseline CGM recording (N=31) then engaged in the CGM+OPSC intervention for 12 weeks. Of those that continued into unblinded phase (n=22) study engagement was excellent (N=21).

    What were some of the key outcomes of the study?

    We analyzed exit interviews and identified 3 themes: (1) CGM “personal experiments” helped participants gain knowledge about how diet, exercise, medications, stress, and sleep impacted glucose levels; (2) the OPSC reinforced healthy behaviors through personal experiments, collective learning and social support; and (3) CGM engagement increased OPSC participation and participation in the OPSC resulted in greater CGM utilization, suggesting a positive feedback loop.

    We also found that self-efficacy levels significantly improved when comparing pre to post intervention.

    Tell us about the figure you presented.

    The figure above describes a positive feedback loop in which CGM could help see how glucose levels changed when they engaged in health behaviors, and the OPSC provided structure (personal experiments) and emotional and informational support to reinforce healthy behaviors. The promise of diabetes technology can only be seen with continued use. This study showed that an OPSC is one way to enhance CGM use. It is possible that OPSC could support other diabetes technologies and in other populations or languages.  

    Tell us more about the peer facilitators.

    We hired and trained five Hispanic Spanish/English bilingual individuals who were living with diabetes and using CGM. Having a group of peers that the participants could relate to was critical to the study’s success. The peer facilitators could provide tips and tricks from their own lived experience while also providing encouragement to those who might be struggling. All peer facilitators were supported by the research team and a bilingual certified diabetes care and education specialist. After the study completed, the peer facilitators helped develop training videos to support future research.

    What is the key message you would like readers to take away today?

    Hispanic, Spanish-speaking adults with type 2 diabetes have a great desire to use diabetes technology. However, diabetes technology must be optimized for language, cultural and social support needs. The CGM+OPSC intervention provided participants with the tools necessary to learn, problem-solve, and make healthy behavior changes and is a promising intervention to address health disparities.

    Is there anything else you would like us to know?

    This study would not have been possible without important community partners. We thank the CABs from both PCORI studies who helped guide us to developing this novel intervention.

    Of note, this abstract was awarded “Best Abstract” in the Glucose Monitoring and Sensing presentation group! We congratulate and thank Dr. Litchman for sharing the ADA presentation with us and look forward to future publications.

    Stop back by in 2 weeks to see what we write about as we continue to share about a variety of other technologies that impact and influence diabetes care and education!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients.

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Diabetes Technology and Solution-Focused Practice: Applied to Blood Glucose Monitoring Discussions

    A field of flowers representing multiple fingersticks associated with monitoring via a meter

    As we continue our series on Diabetes Technology and Solution-Focused Practice, this week we’re focused on conversations around interpreting blood glucose data obtained via monitoring with a blood glucose meter. (You can find a post a few weeks back on continuous glucose monitor (CGM) data discussions here.) While more and more people are using CGM to stay in touch with their glucose levels, monitoring via a blood glucose meter and fingerstick or alternate site blood sample, continues to be an important diabetes technology for many individuals. 

    Focus first on blood glucose in target, rather than the outliers

    How was that accomplished? When evaluating blood glucose logs and patterns, a typical first response may be to focus on the glucose values out of range and try to identify what went wrong at those times. However, what if the first focus was on blood glucose in the target range, and what was going on to accomplish that?

     If we only focus on times that are not working well, we miss identifying successes.

    There are at least 42 identified factors that can impact blood glucose (while in reality there are likely even more if you include mental health and other daily issues). 

    Monitoring is helpful, for instance, to learn how a meal affects blood glucose. By “checking in pairs” pre and 1 ½-2 hours post meal when blood glucose is generally peaking, it’s easy to see and learn the impact of the type of food and portions eaten.There’s so much to learn!

    Glucose numbers provide information

    From our years in practice we’ve learned that people who live with diabetes have different perceptions around monitoring. For some, it can become an obsession – they need to know where their blood glucose is all the time. It can certainly be a mental burden. And others may not want to focus on their blood glucose. Knowing their number may create negative feelings, fear of judgement and guilt. So, they choose to not check their blood glucose to provide a sense of safety and self-preservation.

    We know that glucose numbers are simply that……they are numbers, and numbers provide information.  The goal of monitoring is to generate data to help people make choices and changes. Numbers are not good or bad and are certainly not a test score. You may have recently seen this image below on Twitter and/or the discussion around it. This is NOT a solution-focused approach! 

    Photo credit: Renza Scibllia’s Twitter account

    When working with clients instead of focusing on what is not working well or what is “wrong”, here are 3 illustrations of how to apply a solution-focused twist to the conversation:

    Try this: You’ve been working hard to fit in physical activity (…or fill in the blank). In looking at your blood glucose checks, what small steps can you take in the direction toward the goal of seeing more values in target?

    Try this: You mentioned you’ve had a lot going on and a really stressful few weeks. Yet you were still able to check your blood glucose twice this past week. How did you manage to accomplish that?

    Try this: I see that your A1C is in your target range. How did you manage to do that? (Instead of your A1C is outstanding, A+ as in the above image!)

    We challenge you each week to try incorporating some flips or twists into your conversations and let us know what impact they have. Stop back by in 2 weeks to see what we write about next in this series of technologies that impact and influence diabetes care and education. 

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Diabetes Technology and Solution-Focused Practice: Words are Powerful

    Word cloud from participants with diabetes in some of our research

    “Words are, of course, the most powerful drug used by mankind.” – Rudyard Kipling

    Words are powerful! Consider these famous brands whose whole identity is defined by a few  words. 

    • Bounty: The Quicker Picker Upper. 
    • American Express: Don’t leave home without it. 
    • United Airlines: Fly the friendly skies. 
    • Disney: The happiest place on earth. 

    We remember these words. These words have power. These words have certainly left an imprint!

    In our series on diabetes and technology, today we’re revisiting a previous post about the power of language. When using technology tools, especially for virtual visits, the words we choose are just as important, if not more so than with in-person conversation. It’s hard (or even impossible) to read body language, voice tone and inflection, etc. So choosing person-centered, strength-based language during technology discussions is critical. 

    If you’ve followed our blog over the last 3 years, you’ve seen that we’ve focused a lot on the power of words. Words can define how people view themselves and their situations. Words can empower. Or words can stigmatize and judge. Our belief and practice @AFreshPOVforYou centers around using words that focus on strengths and create solutions, instead of words that dwell on the past and on problems. 

    Changing the conversation

    You may know that we partnered to help create the Telly Award winning video, Changing the Conversation (you can find it here), that focuses on the impact words have when living with a chronic medical condition. The video begins with Words are powerful!  We’ve watched this video hundreds of times and yet, it still brings a tear to our eyes. Why? Because the words resonate with our emotions and what we believe to be true, but most importantly, the words came directly out of the mouths of individuals who live with diabetes – Every. Single. Day. They shared their thoughts, feelings and emotions with us to create the inspiring words incorporated in the video.

    Now what if the same thing happened with healthcare communication? If careful thought was given to words used in conversation with clients; choosing words that resonated with people living with diabetes. Words that mattered. We can change the way they feel. Words that empowered them. Words that could transform them for the better. 

    Over the course of writing our blog, engaging in research, and connecting with the diabetes community we have been compiling words that align with the tenets of a solution-focused approach to care and education. You see some of those in the word cloud above. Words spoken by people with diabetes in surveys, research and focus groups. Words expressed during Twitter chats. You can read a few of our blogs about strengths, exceptions and possibilities here.

    How are your words impacting others today? 

    Together, we can slowly evolve our vocabulary and ultimately change our messages. Together we can embrace possibilities, opportunities and create a fresh vision for the future.

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a healthcare professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Follow us on Twitter and Instagram @AFreshPOVforYou

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Diabetes Technology and Solution-Focused Practice: Smart Insulin Pens

    Sunrise dawning over the hills of Central Kentucky

    Let’s go invent tomorrow instead of worrying about what happened yesterday. – Steve Jobs

    When we discuss technology and the opportunity for technology to support person-centered, strength-based discussions, we always return to the impact of person (patient) generated health data (PGHD). As technology evolves, more PGHD are appearing and creating new opportunities to identify things that are working well and identify successes to build upon. With older technology, when individuals were using traditional insulin pens and syringes, we were unable to rely on PGHD to help people in their diabetes management.

    So, as part of our series on diabetes technology and solution-focused practice, this week we’re focusing on one of the newer technologies, Smart Insulin Pens.

    We reached out to our friend and colleague Janice MacLeod, MA, RD, CDCES, FADCES, Director of Clinical Advocacy at Medtronic Diabetes, to share her experience and knowledge about how the diabetes care and education specialist (DCES) can incorporate solution-focused techniques into their practice when using Smart Insulin Pens and discussing PGHD.

    Here is what Janice shared with us….

    Smart insulin pens (SIPs) are bringing the millions of people who rely on insulin therapy into the digital age making possible a connected diabetes care ecosystem for people with diabetes and their providers. The first FDA-cleared commercially available SIP in the United States, InPen™ is designed to automatically record doses, track active insulin, send missed dose alerts and provide meal and correction dose recommendations. The user is also able to share integrated data reports with their care team allowing users and their care team to coll

    aborate in real-time or asynchronously to make data-informed adjustments in the care plan as needed. Data visibility leads to more collaborative conversations.

    The DCES can lead the team in helping people who rely on insulin to IDENTIFY the best method of insulin delivery for them. If the individual prefers injection therapy but would like the smart dosing support previously only available through pumps, a SIP is a great option. Next, it is important to get the patient off to a strong start by helping them CONFIGURE the SIP for their specific needs. This includes providing individualized insulin therapy settings. Finally, the DCES can lead the care team to COLLABORATE with the user by providing a plan for sharing and reviewing the data together on an ongoing basis. (You can read about the ICC framework in our blog here.) Partner with the individual to uncover and resolve barriers to taking insulin.  Next, optimize the long-acting insulin dose before fine-tuning meal and correction dosing factors. 

    DATAA Counseling Strategy

    The DATAA counseling strategy was introduced by Isaacs et al (Isaacs D, et al. Technology Integration.  TDE, 2020;46(4):323-333). Here is an example of using this approach with integrated glucose, insulin dose and meal data available for the first time through SIPs:

    D – DATA: Thank the individual for sharing their data report and acknowledge their diabetes care efforts

    A – ASSESS SAFETY: Review the glucose stats and graph assessing and resolving any issues with hypoglycemia as a priority 

    T – TIME IN RANGE:  Note times of day or days of the week where the care plan seems to be working well. Discuss ways to replicate this success at other times of day or days of the week. 

    A – AREAS TO IMPROVE:  Note if there are missed doses, a need to check glucose prior to dosing or to use the dose calculator recommendations or to set reminders to check if a correction dose is needed. Maybe it is a dose timing issue. Having a conversation about the data leads to problem solving!

    A – ACTION PLAN:  Together with the patient determine the next steps to take, for example: 

    • Set dose reminder in app for lunch dose
    • Take my dinner time dose 15 minutes prior to eating
    •  Send report prior to my next scheduled visit

    Learn more about building a data-driven practice model for MDI therapy including a case study using the DATAA approach with a patient using SIP in the The Reference Guide To Integrate Smart Insulin Pens Into Data-Driven Diabetes Care and Education.

    We thank Janice for the information she shared with us and our readers in this week’s blog.

    Stop back by in 2 weeks to see what we write about as we continue to share about a variety of other technologies that impact and influence diabetes care and education!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Diabetes Technology and Solution-Focused Practice: Meditation and Mindfulness Apps

    Mindfulness is a way of befriending ourselves and our experience.- Jon Kabat-Zinn

    Lake Como in Italy. This view from our travels there a few years back we always find calm, peaceful, and a reminder to live in the moment and be mindful.

    This week in our Diabetes Technology and Solution-Focused Practice series we’re discussing the value of meditation and mindfulness apps in solution-focused practice. You may have seen the results of a meta-analysis recently published in Diabetic Medicine which showed that mindfulness and acceptance-based approaches to diabetes education may more effectively reduce A1C levels, anxiety, depression, and diabetes distress than education as usual. This impact was noted both immediately and up to 1-month post intervention. In helping your clients find what works for them, and build on that, meditation and mindfulness apps can be another tool in your solution-focused “tool box”. 

    Do you encourage your clients with diabetes to use meditation and mindfulness apps? There’s certainly no shortage of options these days! Over the last few years, more than 2000 new meditation apps have rolled out, with even more new options as a result of increased demand during the pandemic. And who doesn’t welcome those that are free! 

    5 FABULOUS FREE MEDITATION AND MINDFULNESS APPS

    These 5 apps are free, with several of them also having premium paid versions with extra content and capability. We find that the free versions are helpful to be able to get a taste of the app and it’s approach, with the option to move on to the premium version with expanded content options, if desired.

    Smiling mind. (Available for iOS) This app not only provides opportunity to take a break from life stresses through meditation, it guides in incorporating mindfulness practice throughout the day through “activities” like journaling or audio prompts bringing attention to your senses by counting things that can be seen, felt, heard, smelled and tasted. Pretty cool! There are a number of “programs” related to stress management and sleep.

    UCLA Mindful. (Available for iOS and Android). The name says it all. Heavily grounded in the science of mindfulness, this app developed by the Mindful Awareness Research Center at the University of California, Los Angeles (UCLA), features a variety of meditations in English and Spanish. There are sessions as short as 3 minutes long and some up to a half hour long that they refer to as “podcasts”. This app can help one practice self-kindness, work through challenging emotions, as well as focus on other areas.

    MyLife Meditation. (Available for iOS and Android). You may have been familiar with this award-winning app as Stop, Think, & Breathe, which it was formerly named. There is a section focused on what mindfulness is and why it’s beneficial. We’re fans of the fact that each day when you open the app, you’re asked to “take a breath” and check in with yourself, then rate how your mind and body are on a scale of “rough” to “great”. Based on emotions you’re feeling that you select from lists of words, the app then recommends guided sessions according to those feelings. (Premium paid version also available).

    Insight Timer. (Available for iOS, Android, and web) Tami uses this on her phone. This app offers over 90,000 free guided meditations. Topics covered include anxiety, stress, sleep, mindfulness, relationships, insightful talks, and much, much more. Sometimes for quieter mindfulness and focus, she’ll use the feature where you can simply set a timer and focus or meditate to  calming ambient noise or calming music. (Premium paid version also available)

    Calm. (Available for iOS, Android, and web) Tami downloaded this free during an offer early into the pandemic. There currently is a free trial with a premium paid version.  Calm includes meditation and sleep stories focused on improving sleep quality, reducing stress and anxiety, improving focus, and overall self-improvement. Deb uses the Premium version specifically for the nightly sleep stories. She really enjoys the simple yet calming stories to help her fall asleep. Yes, they are not stories that are engaging and exciting, but that’s the plan. The goal is to not have your brain try to engage, but to relax and prepare to sleep.  

    During this crazy and chaotic year, creating opportunities to calm your mind and create opportunities to support a peaceful bedtime or a stress-free break in the middle of the work  day is very important.  

    How can you support your clients to develop positive mindfulness habits?

    We suggest striving for open and frank discussions with clients when meeting with them. Ask about their mental and emotional health to identify if a mindfulness app might help them.

    1. An easy way to move towards this conversation is to ask about their sleep patterns and quality? If they are having trouble sleeping you might ask them if an app might be an option they would consider.
    2. Ask about their anxiety level. Is Anxiety impacting their ability to make healthy behavior changes? If the answer is yes, continue to ask probing questions to identify what they are willing to do to make health behavior changes.  Remember, one small change in the direction of their goals will lead to more changes in the future.

    It may be beneficial to revisit this past year, explore how they’ve grown and changed, and consider what’s next and how to move forward. Mindfulness and meditation apps can be helpful in managing stress, diabetes distress, anxiety, and depression to ultimately help impact blood glucose and improve happiness and quality of life. 

    May is Mental Health Awareness month so a great opportunity to think about ways to encourage healthy habits.

    We plan to continue to write about a variety of other technologies that impact and influence diabetes care and education including diabetes apps, digital health tools, diabetes devices, online peer support and online coaching. Stop back by in 2 weeks to see what’s up next!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Diabetes Technology and Solution-Focused Practice: Applied to Activity Tracker Conversations

    Tami walked the length of the Sahara Desert!

    Just keep taking the next step and keep having excellence in the ordinary. – Dave Ramsey

    In this week’s Diabetes Technology and Solution-Focused Practice post we’re discussing taking a solution-focused approach to activity tracker and physical activity conversations. We are both huge advocates of activity trackers, and have used several different versions ourselves over the years. Currently, Deb relies on her Apple Watch, while Tami likes her Fitbit (although it’s on it’s last leg…so something new will be coming soon!)  Recent estimates are that about 1 in 5 Americans use a smartwatch or fitness tracker. Whether a smart watch, wrist band, clip on pedometer, smartphone app, or other variety, activity trackers can give extra incentive to get active. They also provide a wealth of statistics on workouts and general health to have the data needed to achieve fitness goals. Many track not only steps and movement, but distance, activity intensity, calories burned, mindfulness, sleep, heart rate, and more. There are even fitness trackers for children with a variety of fun functions beyond tracking activity.

    A Facebook memory popped up the day we were posting the blog – Tami and Deb walking 10,000 steps along the Chicago lakefront with their husbands!

    Focus on “exceptions”, rather than gaps

    When reviewing physical activity frequency, duration, step counts etc with clients, there is  opportunity to implement a solution-focused approach (rather than focusing on “gaps” in activity). For example, when reviewing fitness tracker logs such as the one below, where this individual’s goal was to get 10,000 steps each day – rather than focusing on 3/10, 3/11, and 3/12 where step counts were far below their goal, turn instead to focus on 3/7 where they achieved 7016 steps, and 3/13 where they got 8681 steps. If we focus on the days where activity was low, we miss out on identifying successes

    4 questions we could ask when acknowledging those “successful” days are:

    1. How did you work that many steps into your day? 
    2. What were you doing differently than on 3/10-3/12, for instance?
    3. How can you do that more often? 
    4. What are some other ways you can be more active?   

    A case example from Tami…

    Years back, I worked with a client that was a dentist, and as such was fairly sedentary most of the day. When I began seeing her, she had recently learned that she had type 2 diabetes and was trying to increase her activity, in addition to managing her weight and blood glucose. Over the course of several visits we talked about the huge benefits of physical activity and the value of activity trackers in raising awareness around physical activity. While initially resistant to “exercising”, she eventually agreed to purchase a wrist band activity tracker with an initial goal of wearing it for 2 weeks to learn what her average movement and step count was during the day. She learned that she averaged 1200-1500 steps/day. She found that information enlightening, and immediately started considering how she could be more intentional to increase her movement. When she returned a month later for her follow-up visit with me, she had already increased her average step count to 5000-6000 steps each day. Wow! 

    I acknowledged her mindfulness, intentionality, time, and hard work. In applying the 4 questions above with her, I learned that to increase her activity, she was getting up between appointments and walking around the office. Then, she decided that at home in the evenings while watching TV and knitting, she would get up and walk around the house during commercials. From there, she went on to take-up swimming laps, then added doing a circuit work out at a local gym. She built upon her successes and leveraged those. 

    She was one of those special people you never forget. She had a fantastic sense of humor! She  enjoyed traveling and I frequently would have photos show up in my email of her swimming in a pool on a cruise, swimming in the lake at her lake house, or getting a “hydro massage” after working out at her local gym.  Applying a solution-focused approach to activity and activity tracker conversations assisted her in self-discovery and leveraging her successes in moving more for even greater successes.

    While activity tracking apps can help motivate individuals to make health behavior changes, just like anything else, if we focus on the negatives, success will be more difficult to achieve. When working with clients, help them set realistic goals to achieve to set them up for success, then build upon their achievements in a slow and steady process.

    We plan to continue to write about a variety of other technologies that impact and influence diabetes care and education including diabetes apps, digital health tools, diabetes devices, online peer support and online coaching. Stop back by in 2 weeks to see what’s up next!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Deb is employed by Dexcom, but her words and opinions in this blog are her own.

    Tami is employed by the University of Kentucky HealthCare Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Diabetes Technology and Solution-Focused Practice: Applied to Mobile Apps

    “You`re only as weak as you let yourself become, and you`re only as strong as you allow yourself to be.”

    Daniel Hansen

    Beautiful bougainvillea, Palm Desert, CA

    In this week’s installment of Diabetes Technology and Solution-Focused Practice we’re discussing mobile apps. In our last blog we focused on using a solution-focused approach to interpreting and discussing continuous glucose monitor (CGM) data. This week’s blog we’ll focus on a new discovery for us – the WW mobile app. We will share insights on other apps in future blogs. We believe that using solution-focused language within mobile applications can improve user engagement with the app, as well as encourage individuals to make progress towards their health behavior goals.

    WW App: Deb’s experience…

    As you may know, Weight Watchers is now known as WW. I have been using their app, the WW app, to help  stay on track during the COVID-19 lockdown. You can learn about the different WW programs and pricing here. There are several options to choose from, I only use the app for logging and motivation.  I was encouraged to continue using the app because of the nature of the messaging. Then I began to wonder if they were incorporating a solution-focused approach? 

    From a weekly in-App push a few weeks ago, the headline was “Why you should do what works: You might already have more tools in your toolbox than you think.” If that doesn’t sound like solution-focused messaging, I’m not sure what does! The post reminds us that people typically focus on what isn’t working well and how to deal with challenges. Of course, that is not motivating, and not helpful when trying to make hard health behavior changes.

    But, what if you “Flip the switch” so to speak? (See our many blog posts from 2019 about “Flipping the paradigm” –  here’s one on healthy eating, and here’s one on healthy coping). The WW message goes on to encourage focusing on the things that come naturally and leverage strengths or what’s worked in the past! Wow! We’ve written about strengths in this blog multiple times (you can read about strengths here), and so believe in focusing on what one does well,  building confidence, and increasing happiness by doing so. 

    Make Strengths your Secret Weapon. According to WW, leveraging your strengths will help you be successful. They suggest asking 3 questions to uncover strengths:

    1. When do I feel like my best self?
    2. What makes me unique?
    3. What comes most naturally to me?

    Those are questions that diabetes care and education specialists (DCES) can easily incorporate into diabetes-related conversations with clients as well. Once those questions are answered, WW suggests creating an “affirmation” to help remember to focus on personal strengths. You can read their post here. One exercise that helps people think through writing their own affirmation includes showing a word cloud to help direct thinking about potential ideas of strengths (including humor, cleverness, bravery, creative etc.). What a powerful visual tool, that would be so easy to employ in any diabetes care and education program! Finally they suggest saying the affirmation out loud every morning or posting on your computer so it will be visible every day. For instance, “I am strong.” “I am resilient.” You get the idea

    I loved this way of thinking about making healthy choices, and reading and engaging with the content. I created my own affirmation and have it posted on my computer with a sticky note so I  glance at it multiple times during the day! Tami has affirmations on her desk and in the kitchen that she sees when making coffee in the morning to start the day off.

    Helping clients create their own affirmation using solution-focused principles is a great opportunity to highlight what is working well already and focusing on their strengths, as well as supporting the development of resilience. 

    Do you recommend mobile apps to your clients? 

    If you have a client interested in weight loss or adopting healthy eating habits, the WW mobile app might be a good option. (We are not endorsed by WW and do not receive any compensation from WW). Knowing the positive strength-based language that is being used is so encouraging. Also of note, WW recently hired Adam Kauffman, formerly of Canary Health,  to head their diabetes program (read the press release here) so we’re excited to see what’s to come in the future.

    We plan to continue to write about a variety of other technologies that impact and influence diabetes care and education including diabetes apps, digital health tools, diabetes devices, online peer support and online coaching. Stop back by in 2 weeks to see what’s up next!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Deb is employed by Dexcom but her words and opinions in this blog are her own. Tami is employed by the University of Kentucky Barnstable Brown DIabetes Center, but her words and opinions in this blog are her own.

  • Fresh Views

    Diabetes Technology and Solution-Focused Practice: Applied to CGM

     “The future depends on what we do in the present.” – Mahatma Gandhi

    Views of the Sierra Nevada Mountains from Folsom Lake, Granite Bay, CA

    In this week’s installment of Diabetes Technology and Solution-Focused Practice we’re discussing continuous glucose monitoring or CGM. If you’ve been reading our blog, you know we’ve written about CGM before in our posts about Exceptions and Possibilities and also in our series on “Flipping the Paradigm” when applying a solution focused approach to Monitoring

    Focus on “exceptions” rather than “problems”

    When we think about applying a solution-focused approach to CGM, Bright Spots and Landmines by Adam Brown comes to mind. It’s a framework for evaluating diabetes habits and decisions. (You can read our 2019 interview with him here.) As we were identifying our technology themed blog posts, Deb happened to watch a North Carolina JDRF Chapter presentation by Adam (see slides here) that really highlighted the approach we encourage  diabetes care and education specialists (DCES) to take when discussing CGM data. 

    When evaluating CGM data similar to that below, the typical first response may be to focus on the glucose spike and try to identify what went wrong.

    However, when taking a solution-focused approach, we want to turn focus to all of the things that are working well (rather than what went “wrong”). Similar to Adam’s “Bright Spots”, we call them “Exceptions” or times when the problem did NOT occur and when things were going well. Below you can see where Adam focuses on his Exceptions, instead of his “landmines” and identifies all of his successes during the day. If we only focus on times that are not working well, we miss identifying successes.

    CGM creates a great opportunity for discovery learning!

     When CGM was first incorporated as a management tool, the focus was typically on hypoglycemia, and preventing serious events from happening. As CGM has evolved and more individuals with type 2 diabetes are incorporating it into their diabetes care, the focus has broadened and now includes focus on making healthy behavior changes. CGM creates a great opportunity for discovery learning, where people can try different foods or activities and personally experiment to learn what works well for them. While Adam identifies 42 factors that can impact blood glucose, he stated that there are more likely more than 60-100 factors if you include mental health and other daily issues. There’s so much to learn!

    As DCES use CGM in practice with clients with type 2 diabetes, applying a solution-focused approach to CGM data can be motivating and help reinforce habits and choices that result in increased time in range (TIR) and overall quality of life. (The recommended goal for TIR is > 70% of glucose values between 70 and 180 mg/dL) Focusing on their “best day” pattern (the day with the greatest TIR) and working towards increasing TIR is a positive goal to strive for because they can “do more of what’s working” instead of giving up or stopping something they enjoy. Our “fresh view” photo today was taken by Deb on an easy hike near her home. Physical activity is one of many factors that can help one see more TIR. Applying a solution-focused mindset with CGM can help your clients want to learn to use their own data to learn about their diabetes and create a plan that works for them, where they can be successful.

    Do you use CGM in your practice and with your clients? If you do, try focusing on times when they are in their goal range and inquire about their actions and activities during that time. Help them identify what’s working well and what choices will move them towards more TIR. 

    • One mnemonic to facilitate conversation is MGLR, which stands for “more green, less red” when looking at the TIR bar. The goal is to see more green (time between 70-180 mg/dL) and less red (< 70 mg/dL). Talking about TIR can be a great way to have a solution-focused discussion and to help clients identify opportunities to succeed instead of focusing on past failures. 
    • A second mnemonic is FNIR, or “flat, narrow and in-range”, which is a goal for the trend graph. When viewing the trend graph the goal is to have the majority of the data fall within the target range, again typically 70-180 mg/dL without extreme variability swinging from below range to above range. CGM creates an opportunity to move towards a clients goals while providing constant, non-judgemental feedback on their progress.

    We plan to continue to write about a variety of other technologies that impact and influence diabetes care and education including diabetes apps, digital health tools, diabetes devices, online peer support and online coaching. Stop back by in 2 weeks to see what’s up next!

    We welcome anyone interested in our approach to Subscribe to our blog and we’ll email you when a new post is published!

    If you are a health care professional and interested in learning more about our solution-focused practice and approach, when you subscribe to our blog, we’ll send you in return a FREE resource of 10 Solution-Focused Questions to start a solution-focused discussion with your clients. 

    Deb is employed by Dexcom but her words and opinions in this blog are her own.

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