Educators must actively vet diabetes technology for safety, usability
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Digital health technology can improve diabetes diagnosis, management and education, and diabetes care and education specialists must take an active role to ensure devices are safe, usable and effective for patients, according to a speaker.
For people with diabetes, clinicians and diabetes care and education specialists to realize the benefits of technology, such devices must meet the needs of the intended users — and that need has only intensified during the COVID-19 pandemic, according to Raj Ratwani, PhD, vice president of scientific affairs at MedStar Health Research Institute, director of MedStar Health National Center for Human Factors in Healthcare and associate professor at Georgetown University School of Medicine.
“The title of this talk we came up with, before COVID-19, was ‘The Digital Health Revolution: Ready or Not, Here it Comes.’ We can get rid of the ‘ready or not.’ It has come,” Ratwani said during an online presentation at the virtual Association of Diabetes Care & Education Specialists annual meeting. “We are in a completely different world today, on several fronts, than we were just 3 or 4 months ago.”
The pandemic has served to speed up what was a slow, incremental shift to digital services, such as food and package delivery, grocery shopping and telehealth visits with health care providers, Ratwani said.
“When we think about new consumer technologies, also remember that it takes 7 to 15 years from the point that technology is first released until widespread usage,” Ratwani said. “Now, think about what is happening in the health care world. We see incredibly rapid adoption of certain technologies on timelines that are quite unrealistic given the circumstances that we are in.”
As key stakeholders, diabetes care and education specialists must take an active role to ensure technology is not only safe and usable, but is effective, Ratwani said.
Meeting expectations
People with diabetes encountering technology no longer make comparisons only within health care, Ratwani said. Instead, people are making “cross-domain comparisons,” so there is an expectation for effectiveness. Design, development, implementation, use and maintenance are all key pieces of technology effectiveness, he said.
“When I go and rent a car and use the app to preregister and walk to the rental car and drive away, or I order something in two clicks or less and receive it sometimes that same day, I am thinking about that as I walk into health care,” Ratwani said. “That is what people are expecting, and that is what we should be striving for: seamless technology in a safe and effective way.”
Wearable tracking devices allow diabetes care and education specialists to better monitor health data and provide incentives to work toward glucose and lifestyle goals. Technology can also improve diabetes screening and diagnosis, as well as access to care through telemedicine, either live or via messaging.
Unexpected tech users
Users of technology may not be so obvious; data suggest users who engage with technology the most are not young adults, Ratwani said.
“For example, in a recent analysis more than 1 million users of a chatbot used for COVID-19 screenings, we found that people aged 50 to 70 years used the technology more frequently than other ages,” Ratwani told Healio. “This is probably not what most people would predict and tells us that technology is being adopted and used in non-obvious ways.”
Survey data also revealed that women engaged with the chatbot more than men, and Black adults engaged with the technology more than people of other ethnicities.
“None of this is what we predict,” Ratwani said. “There can be some surprising results, and this is important when we think about how we can use technology to facilitate education and management of patients with diabetes. We must understand who uses this technology and what their preference are and integrate that with the lifestyles of our patients. That is not always as intuitive as we might think.”
Safety, privacy risks
Technology advances faster than federal policies to promote safe and usable technology, and stakeholders must be aware of the implications this can have.
“When you start talking about things like artificial intelligence and predictive algorithms, that is where there can be unintended consequences that do harm,” Ratwani said. “As you think about technology use, think about the function of that technology and how does that drive how we think about risk?”
Public-private partnerships established specifically to evaluate technology can help, Ratwani said. For example, ADCES offers the technology-based resource Diabetes Advanced Network Access, or DANA, which serves as a product clearing house for diabetes technology and mobile apps for members, evaluated for safety and other elements.
“We are not recommending or prescribing things to our patients that may be unsafe,” Ratwani said. “More of that will need to happen on a faster timeline, but we are not there yet.”
Assessing technology
Diabetes stakeholders must have the mindset of embracing technology, Ratwani said.
“Patients expect technology to be there given their experiences in other domains,” Ratwani said. “But how do we assess it?”
Ratwani said diabetes care and education specialists must ensure technology “SUITs” the provider, specialist and the patient's needs by meeting a simple checklist:
- Safety: Ensure the technology is safe to use;
- Usability: Ask questions and ensure the technology is usable for the intended population;
- Integrated: Ensure the technology can be integrated into other aspects of the care process;
- Traceable: Ensure there is a way to identify whether something goes wrong with the technology.
“The users have to be at the forefront of this,” Ratwani said. “As we are assessing technology and thinking about its use, think about whether it suits your needs.”
Perspective
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Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, FADCES
I completely agree with Raj Ratwani, PhD, that diabetes care and education specialists must take an active role in diabetes technology. Technology is changing rapidly and is being embraced by all types of people. Diabetes care and education specialists can serve as the technology champion at their respective practices by helping people with diabetes identify the right technology, configure that technology for the person’s unique needs and collaborate to ensure the technology is achieving the intended outcomes.
Managing expectations is also an important point as Dr. Ratwani discusses how we see the seamlessness of technology in areas such as shopping where two clicks brings a product to the door step. We are not quite there with diabetes technology. For example, continuous glucose monitors are great devices that can alert for high and low glucose levels and remove the burden of frequent fingersticks. Some even link with insulin pumps for automated insulin delivery. But we are not at the point where a person can just “set it and forget it.” The devices require education and action by the user. They can’t completely eliminate hypoglycemia, and there are times when technology fails. By utilizing the diabetes care and education specialist, people with diabetes can make the most of their technology and have a solid back-up plan when needed.
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Ratwani R. The digital health revolution: Ready or not, here it comes. Presented at: Association of Diabetes Care & Education Specialists Annual Meeting; Aug. 13 - 16, 2020; (virtual meeting).
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