How to make the diabetes patient experience suck less

For each person with diabetes, the patient experience differs but it can be arduous, frustrating and depressing. A panel discussion at the MedCity ENGAGE conference this week on challenges patients and providers grapple with and what can be done to address them drew on the perspectives of health IT businesses Omada Health, MySugr and Health2047 as well as the Behavioral Diabetes Institute.

Dr. Jack Stockert of Health2047 noted that care models just don’t fit the problem, partly because the needs to address for patients who are on course to develop Type 2 diabetes differ from those already diagnosed with Type 2 diabetes and Type 1 diabetes patients. He observed that most technologies designed to help diabetics manage their condition fall short of the mark because they don’t address the nuances of behavior change and prevention that are critical for people with pre-diabetes or Type 2 diabetes to better manage their condition. Stockert also noted that digital health tools for diabetes tend to drown users in data or don’t provide enough.

“Where are the business models that reward on outcomes?” Stockert pondered. “We want … a model that focuses on the centrality of the doctor-patient relationship.”

One challenge with the way our healthcare system works is that it is better suited to handling acute conditions rather than chronic diseases, Stockert observed. So the news earlier this year that Medicare will cover participation in the Diabetes Prevention Program was a significant shift in that direction. Omada Health has focused its efforts on patients at the pre-diabetes stage and offers a digital version of the Diabetes Prevention Program.

Adam Brickman of Omada Health acknowledged the challenge of getting people to change their lifestyle and balancing that need with their state of mind.

“When a blood test comes back and people find they are pre-diabetic. There’s a feeling of shame, helplessness.”

One aspect of Omada’s approach is the use of peer support and in-person interventions. He also noted that having the right attitude is critical for the health coaches the company employs to work with program participants.

“When we interview health coaches, we look for people with empathy.”

Empathy is critical because as Susan Guzman of the Behavioral Diabetes Institute observed, it’s so often lacking where the Type 2 diabetes patient population needs it most. She pointed out that the kind of support people get at home can make all the difference between diabetics who can successfully manage their condition and those who can’t.

“The data is very clear — those with support at home do better than those who don’t [have it],” said Guzman.

But she added the caveat that when support becomes more like policing,  judging, and blaming people for their condition, it’s not productive.

“We walk a fine line between shame and treatment,” Guzman said.

Frank Westermann of mySugr, a digital health startup from Vienna, Austria that recently opened an office in San Diego, was able to use personal insights from his own battle with Type 1 diabetes in developing monitoring tools to aid patients and providers.

“We avoid negative messaging,” said Westermann. He noted that the need for constant vigilance for diabetics can wear people down. That’s why he tried to develop a platform with a gaming component to add some levity to the experience.

“We make diabetes suck less, which you probably don’t hear from anyone else,” Westermann quipped.

Panelists acknowledged that digital health tools aren’t a panacea for reducing Type 2 diabetes and helping people with pre-diabetes lessen the risk of developing the chronic condition. Brickman said that he would welcome feedback from payers and providers to improve collaboration. He also encouraged payers to hold companies like his accountable.

Photo: Neil Versel