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!
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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.