A Digital-First Model for Diabetes Care

Wondering what diabetes care might look like in the future? Dr. Aaron Neinstein and I wrote a prediction, inspired by changes that have happened during the COVID19 pandemic. In this perspective piece, we posit that diabetes is well suited for a digital-first approach.

Our health system’s – and the nation’s – rapid transition to telehealth, showed us that we are capable of quickly adopting video visit technology, affording our patients and providers the ability to receive ongoing care while remaining safe at home. While the telehealth functionality of 2020 is a step in the right direction, we argue that “a video visit changes only the location of a synchronous doctor-patient interaction” while in the future “new virtual care models will capitalize on automation and asynchronous technologies, enabling efficiencies freer from the boundaries of time, provider capacity, and geography.”

In diabetes care, we depend on data to make decisions. How did the recent medication change affect a patient’s blood sugars? What does a patient’s continuous glucose monitoring data reveal about overnight trends? In this field, patients and providers benefit from diabetes devices including continuous glucose monitors, insulin pumps, and glucometers. Today, many of the devices are enabled to wirelessly share data between patient and provider. Despite this, we have historically depended on inefficient, in-person workflows to access data – but the move to remotely delivered care has finally accelerated our use of cloud-based sharing of patient generated health data. As we continue to perfect our care models, seamless data flow will be critical.

Perhaps even more importantly, we need to focus on patients on the other side of the digital divide. Rapid adoption of video visits has worked for many, but those without reliable access to internet-based technologies, or the skillset required, experience disadvantages. We must leverage the efficiencies gained by a digital-first approach to diabetes care, to intentionally focus on improving care to patients who need it most. We believe using population health platforms will be essential going forward. Using a population view of patient care, we can then direct our attention to those most in need – whether that’s to assist patients who need more support in sharing data, or patients who are experiencing poor health and complications of diabetes.

Now a few months into delivering virtual visit-based care, we know that it is here to stay. Our current works centers around supporting patients who have had delays in routine diabetes care, in digitizing processes that still require in-person work, and transforming our clinical work flows to support virtual care. We are inspired by the innovation and growth of the healthcare community during the past few months, and are looking forward to the realities of digital-first diabetes care in the not-so-distant future.

By Tejaswi Kompala, MD, UCSF Clinical Fellow