• 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.

  • Fresh Views

    Diabetes Technology and Solution-Focused Practice: A Telehealth Experience

     It’s not what you look at that matters; it’s what you see. – Henry David Thoreau

    Joshua Tree National Park, California

    Back in January we shared the top 10 things that 2020 taught us (you can read it here) and #5 was to Keep a mindset focused on finding solutions, rather than focusing on problems. Little did we know that we would be applying that lesson to many aspects of our lives throughout the year. In some ways it’s difficult to believe that an entire year has passed since the world first shut down and the new concept of “social distancing” became the norm. And with that the need to quickly find a solution to no longer being able to meet with clients in person. Tami works with a dually accredited Diabetes Self-Management Education and Support program (DSMES) in public health which quickly became part of a statewide pilot to pivot to online virtual delivery. Rather than fixating on the “problem” at hand (no longer being able to meet in person), she and the team focused on creating solutions, leveraging the ideas, input, skills and expertise of the team she works with. To echo the Thoreau quote above, it’s all about what you envision and see in looking to the future.

    Here’s Tami’s telehealth experience…

    I will never forget hearing people say, “What’s so hard about switching to facilitating online. You just open up your computer and talk!” But it quickly became evident that virtual delivery is SO much more than that…my home office rapidly transformed into a small studio complete with green screen for virtual background (to hide the chaos of working from home), a webcam (for clear image and sound), a ring light (for proper lighting), a second device to log-in (to see what the participants are seeing), elevating my laptop (so it was the right height), rigging up my desk so all props were within reach, placing my notes where I could see them and still look in the camera, plus learning how to use Zoom and Docusign!  And not to mention adapting the entire curriculum and mode of delivery to be interactive and engaging. Many times I told my husband I not only had to be a content expert, but also be engaging, be entertaining, and be my own IT. It seemed that each day new considerations and challenges popped up (after all, I didn’t know what I didn’t know), but we kept a mindset focused on building solutions. And thank goodness for technology in these days of “social distancing”! The photo above from Joshua Tree is reflective of the many pieces and aspects that together built a successful telehealth program and required us to rely on a strong network of people, technology and new ideas to be resilient. (If you’ve followed our blog, you know we enjoy sharing a fresh view through an inspiring photo with each post!)

    Tami’s office set-up for virtual delivery

    Engaging differently through virtual visits

    One quick learning with the transition to virtual DSMES delivery was that engagement is significantly different through virtual visits. Engaging virtually can bring an added level of stress…How do I connect to Zoom? My internet is unstable. How do I mute myself? Can you hear me? How do I turn off my camera? Can you see me? How do I position my laptop because I don’t like what’s in my background or how I look?…I bet you can relate to some of these! In an effort to reduce stress, and start each encounter on a positive note, I started each session in a solution-focused manner with the questions: What’s 1 thing that went well this past week (no matter how big or small)? What’s 1 change you were able to make? How were you able to do that?  Whether unmuting and sharing, or replying in the chat, this helped acknowledge each individual’s hard work and guide the discussion toward finding solutions. At the conclusion of each DSMES series when setting post-program goals, again we turned focus to areas each individual was already achieving some success and how they could leverage that for future benefit.

    Telehealth virtual delivery was a success!

    I’m happy to share that after facilitating multiple cohorts our program has had a 100% completion rate for most of the cohorts! Much higher engagement and completion than in-person delivery. That’s a huge win!

    How has technology changed your practice or your thinking? We’d love to hear from you!

     Over the next few posts we’ll 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.

  • Fresh Views

    Bring A Fresh Perspective to Diabetes Technology Through Solution-Focused Conversations & Principles

    Perspective is everything when you are experiencing the challenges of life. – Joni Earackson Tada

    Arch Rock, Joshua Tree National Park, California

    In this new year, are you looking to add a fresh perspective to your diabetes care and education conversations?

    Over the past two years, through this blog and our research publications and presentation we’ve been sharing tips and guidance to help diabetes care and education specialists incorporate principles of solution-focused practice into their conversions with clients. At its core, solution-focused practice is based on relationship building between the client and the clinician who acts as a “think partner.” The overarching themes of most of our blogs help the diabetes care and education specialist to view their interactions with a new perspective and challenge them to think differently. (With the mention of “overarching” we thought the photo above as fitting for our “fresh view” for this post.)

    With the rapid evolution of technology-enabled care during the COVID-19 pandemic, we’ve been discussing the need to focus some of our learnings to support the use of solution-focused principles when incorporating technology into care and education. So, we’ve decided to launch a series of blog posts focused on different aspects of technology-enabled diabetes care and education and incorporating solution-focused principles. Over the next few posts we’ll write  about various technologies that impact and influence diabetes care and education including diabetes apps, digital health tools, diabetes devices, online peer support and online coaching.

    In the meantime, there are two papers focused on incorporating technology into practice that we encourage you to check out. They were published by colleagues (including Deb) in August 2020 in The Diabetes Educator journal (now The Science of Diabetes Self-Management and Care):

    • The second paper used continuous glucose monitoring (CGM) as an exemplar for integrating technology into practice. In this paper a simplified process for evaluating CGM data was presented. This DATAA model (an acronym for download data, assess for safety, time in range, areas to improve and action plan) not only simplifies data interpretation, but also includes solution-focused principles along with strength-based language practices to empower people to use their data for learning and behavior change.

    Stop back by in two weeks to see which technology to impact and influence diabetes care and education that we focus on first!  

    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.

  • Fresh Views

    ADCES 2020 goes virtual: 8 sessions you don’t want to miss!

    Tami & Deb at ADCES 2019

    With the Association of Diabetes Care and Education Specialists Annual meeting (formerly AADE) right around the corner, we’re taking a brief break from our solution-focused word of the week series to highlight some of the sessions that will be presented at the ADCES meeting on psychosocial and behavioral health and technology. They align with our thinking and approach, and we thought might be of interest to you too. 

    This typically in-person meeting is always one of our favorite times of the year! It is such a great opportunity to reconnect with friends and colleagues while being energized about the work we do in diabetes care and education. However, in light of the pandemic, this year’s meeting (like many others) has gone virtual. So it is with mixed emotions that we share this ADCES preview. While we  look forward to learning from colleagues in the comfort of our homes this year, we so wish times were different and we could share coffee or lunch together, catch up on everyone’s lives over a glass of wine, give a lot of hugs, and dance the night away at the annual Sunday night dance party. Especially for the two of us, we have not been together in person since last October. One of our hopes in collaborating on this blog together was that we’d have the opportunity to spend more in-person time together. While we engage via Zoom, it’s just not the same.

    We’re excited to share that  we had an abstract accepted to present as an oral session at the originally scheduled in-person meeting in Atlanta on “Flipping the Paradigm: Applying a Solution-Focused Approach to the AADE7 Self-Care Behaviors”! But due to the condensed nature of the virtual meeting we opted out, with the hope that we can share our full presentation next year (fingers crossed!). In the meantime, we’ve had our first research paper incorporating a solution-focused approach published! You can find it online, Applying a Solution-Focused Approach to Life With Diabetes: Insights Gleaned via Twitter. This paper resulted from our presentation at the European Association for the Study of Diabetes last fall. We report the findings of our online study where we employed the Miracle Question approach during a Twitter chat. 5 themes evolved of a desired future state: more of living life; laughter and humor; self-compassion; resilience; and support.  

    Here are 6 of the sessions of interest that you may want to check out (all times are central time zone): 

    GS02 – Mobilizing for Health Equity (Friday, Aug 14 9:00 AM, 1 hour)

    This session will provide the participant with an understanding of the history and impact of structural racism on health equity. Throughout the presentation, Dr. Blackstone will define structural racism and how it relates to the social determinants of health. The participant will leave the session with key strategies to make individual steps toward interacting with equity.

    F06 – Empowering African Americans With Diabetes Through Positive Thinking (Friday, Aug 14 2:05 PM, 30 minutes)

    African Americans face many challenges associated with diabetes self-management and it is common for them to fall into negative thinking patterns. Researchers suggest that positive thinking can lead to improved diabetes management and empowerment to foster independence, self-management and the ability to question and make informed choices. This presentation offers 6 positive thinking strategies that can be utilized to assist in empowering the African American participant.

    F05 – Integrating Diabetes Technology Into the Clinical Paradigm (Friday, Aug 14 1:00 PM,  (1 hour)

    New and emerging technologies can help people with diabetes optimize glucose levels, reduce diabetes burden, achieve improved quality of life, and reduce the risk of acute and chronic complications. Diabetes care and education specialists and clinical practices are struggling to keep up with the pace of technological change. While essential, expertise in diabetes technology is not enough. There must also be processes in place to streamline paperwork and documentation, optimize clinical flow, educate staff and providers, and obtain reimbursement. This session will provide an overview of how diabetes technology can be effectively integrated into the clinical paradigm and discuss the role of the diabetes care and education specialist as the clinic’s technology expert and champion.

    F12 – COVID-19 Update: Protecting Adults with Diabetes (Friday, Aug 14 3:45 PM, 30 minutes)

    A significant portion of the U.S. population is vulnerable to severe complications, including death, from COVID-19. In addition, social disruptions secondary to the pandemic response are creating new vulnerabilities in the provision of chronic disease care and self-management for non-pandemic illnesses. This presentation will expand foundational knowledge of the impact of COVID-19 on people with diabetes and provide strategies through education and technology to protect adults with diabetes from COVID-19 while reducing gaps in diabetes care and self-management.

    S06 – Diabetes Psychology and Diabetes Services: Similarities and Differences (Saturday, Aug 15 10:40 AM, 30 minutes)

    This presentation will explain how diabetes psychology is used to help people implement new behaviors, navigate social stressors and manage the feelings of anxiety, depression and stress that often accompany diabetes. A discussion of similarities and differences between diabetes psychology and diabetes services will be provided. A model for integrating diabetes psychology with diabetes services will be described with examples of implementation at the San Diego VA hospital.

    D09 – Using Mindfulness in Veterans to Lower Diabetes Distress (Sunday, Aug 16 12:05 PM, 30 minutes)

    Mindfulness benefits veterans with depression and PTSD, but little is known about the impact of mindfulness in those with diabetes. This presentation will share our experiences and participant perspectives of a mindfulness-based diabetes education intervention that utilizes a digital application to support daily mindfulness in everyday life. Additionally, we will examine associations between mindfulness, diabetes distress (DD), stress-related symptoms, and glycemic management (A1C) and show how incorporating a mindfulness intervention into DSMES can target both DD and A1C in at-risk populations.

    Also, check out Deb’s 2 research presentations, one oral and one poster:

    F03C – 12-Month Outcomes for a Behaviorally-Enriched Diabetes Prevention Program for State Employee Commercial Drivers

    Not all participants achieve DPP outcomes. Identifying opportunities to augment, enrich and enhance the traditional program are needed to meet individual needs.  This session will present data from a 12-month observational study that evaluated the effectiveness of an innovative, behaviorally enriched  Diabetes Prevention Program (DPP), on program outcomes of attendance, weight loss and physical activity.  This innovative, coach-led, behaviorally-enriched DPP was designed specifically to engage and motivate a “hard to reach”, mobile population at risk for developing type 2 diabetes using a behavior and social assessment and decision support tool set to facilitate a practical behavior change model (Information, Motivation, Skills) integrated into routine team care delivery and clinical software applications. Note: Sarah Downs and Alyssa Griswold contributed as co-authors on this submission.

    P409 – Diabetes Education Through Peer Support for Hispanic Spanish Speaking People with Type 2 Diabetes

    Diabetes is twice as likely to affect Hispanic people than their Caucasian counterparts. Our previous community-based participatory research demonstrated that technology in addition to social support is necessary to effect diabetes-related behaviour change in Hispanic individuals with type 2 diabetes (T2DM). In this feasibility study, we address gaps in diabetes care for Hispanic people with T2DM by combining technology with an online peer support intervention. The inclusion of Hispanic, Spanish-speaking peer facilitators with diabetes lived experience will enable culturally appropriate discussion, advice and strategies to enhance the use of CGM and improve diabetes outcomes in participants. This poster presentation will describe the study background, methodology and intervention protocol.

    Also, please consider attending the Dexcom Educational Theater on Thursday, August 13, 2020 at 2:45 pm CT, Lighting the Fire: Bringing DSMES to Life with CGM with Dr. Bill Polonsky and Dr. Diana Isaacs. During this session, Dr. Diana Isaacs incorporates solution-focused principles when discussing CGM data with her clients.* This program is open to anyone whether attending the conference or not. You can register here.

    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

    *Note: Deb is employed by Dexcom but anything posted on this blog is her personal opinion.

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