Diabetes Data: A Roadmap to Better Management
At our September Musings event, experts in diabetes technology gathered to discuss what the explosion of data means for people with diabetes, healthcare providers, and systems, and how it will continue to improve management and care.
In just the last five years, 98% of the world’s data has been generated. This explosion of data has shown us that this is more than just numbers and graphs, and it can be used by more than just engineers and avid tech users. Data is changing every part of our lives, including how we treat diabetes and approach disease management. Undeniable benefits are coming from technology like continuous glucose monitors (CGM), coaching apps, and closed loop systems, which allow people with diabetes to recognize patterns in their own data and make more informed choices.
Healthcare teams are also benefiting from the increase in available diabetes data, especially with the expansion of electronic health records. Interpreting so much data can be a difficult task, but an integrative approach allows healthcare teams to personalize treatment plans, ultimately leading to the better care for all of us.
The diaTribe Musings panel, Diabetes Data: A Roadmap to Better Management, featured four experts in the field, who were joined in conversation by diaTribe founder Kelly Close:
Chris Boulton, Head of Diabetes, Sanofi US
Jeff Dachis, CEO and Founder, One Drop
Holly McGarraugh, Principal, McGarraugh Consulting
David Price, MD, Vice President of Medical Affairs, Dexcom
You can watch the entire discussion here.
On the expansion of data collection
The panelists highlighted how COVID-19 has helped us all understand the importance of care outside of the regular doctor’s office visits. Since the start of the pandemic, the number of people with diabetes using data capturing devices and apps has significantly increased. Dr. Price spoke about the trends he has seen with increased use of Dexcom’s CLARITYapp, which has increased as more people are able to use CGM. “With the onset of the pandemic, the use of CLARITY in the clinic has enabled healthcare providers to have discussions with patients about their data outside of a face-to-face office visit,” he said. “One of the things that Dexcom has realized is that the data is being used to inform treatment decisions as well, and the people who do best are those who look back at their data retrospectively.”
Data from devices and apps is being used to improve outcomes for people with diabetes as well. For example, One Drop has gathered over 30 billion health data points from popular apps used by millions of people worldwide to help them create predictive insights for individuals. “You can generate a lot of data but unless you’re willing to take action on it, it’s useless,” said Dachis. “The One Drop platform makes it easier for people to not only access their health data but feel empowered to act on it. That happens through telehealth appointments, coaching, forecasts, and glucose predictions.”
Having the ability to view and understand their own data allows people to make decisions to improve their health without needing to see a doctor in-person. “Health doesn’t live in a doctor’s office with notes you can’t read. It lives in the day-to-day, moment to moment, 8,760 hours a year, that we’re not at the doctor’s office,” said Dachis.
Having their data right at their fingertips can also provide people with a more tailored, simple approach to their diabetes management. Boulton provided insights into a study jointly conducted by the Association of Diabetes Care and Education Specialists and Sanofi, which found that around 80% of people with type 1 diabetes felt it would be good to have a more personalized understanding of their diabetes and wanted something that made their diabetes-tracking less time consuming. He explained that this is where the use of CGM, apps, and other technology can help with tasks like reminding people to take their insulin or, in the case of telemedicine, even prescribe it for them.
With the huge technology advancements made in recent years, so much is possible now that was not before. “Now we have the opportunity for data to be layered, to be shared, to provide insights that we didn’t have before,” said McGarraugh. “It’s not just glucose, but it’s also exercise, the medications you take, your blood pressure, and all these other bio-metrics that are seamlessly layered together that can provide people with genuine insights. We can now look at data as an enormous solution. It's the beginning of something really big.”
On the impacts on people with diabetes
The reality is, however, that data can sometimes feel impersonal – nothing but a collection of endless numbers, charts, and metrics. It’s easy to forget that data can have real impacts on people with diabetes.
For example, people are using the Dexcom CLARITY app “to inform their immediate treatment decisions” and “facilitate better informed decisions over time,” explained Dr. Price. And the benefits are apparent. Dr. Price shared that the more engaged people are with their app, the better their glucose control becomes over time.
Not only can data feel impersonal, but the sheer amount of data produced can also be overwhelming and complex. “We have a responsibility to generate the right data. We need to think carefully about what data we collect and how we put it together, so people feel empowered,” said Boulton.
Dr. Price agreed. “We need to make devices simpler; we need to make the process of getting them and using them simpler,” he said.
And while healthcare technology can sometimes make people feel like they are just one patient among many, Dachisreiterated the need to see the people behind the numbers. “We’re talking about people, not patients,” he said. “They are only patients for 15 minutes every six months. We have to empower these people and make sure that their healthcare can be pro-active.”
Although health outcomes can be improved by giving more people access to the best technologies, many people in the US simply do not have access to the devices that could best help them.
“The sad news is that we have fabulous devices and fabulous drugs, but we also know that right now diabetes [outcomes] in the US are getting worse,” said McGarraugh. “We have a small portion that has great access, who get wonderful care. But we have a lot of people that are getting sicker. We have big systemic problems. We need to figure out how we improve access, how we improve coverage. It can’t be more of the same. It’s going to come down to broad policy changes, but we have the ability to get there.”
Dachis agreed. “The existing healthcare system is not working for everyone. In fact, it’s not working at all for a huge portion of the population that needs it the most,” he said. “We have figured out how to unlock the power of all this real world data we’re talking about to empower everyone living with chronic conditions, to make critical changes for their health.”
Read here to learn more about how systemic issues are affecting diabetes prevalence and management.
Despite the great advancements in both diabetes technology and therapy, a study just published in the New England Journal of Medicine indicates that success with glycemic management has not improved at a population level in the last 20 years. And glucose management specifically has declined over the past decade. “When data comes out saying as a population, we’re doing worse, obviously it is really disconcerting and troubling,” said Close. “We should start to stratify that data to see where it’s getting better versus where it’s getting worse and what approaches could look like on that front.”
The panelists agreed that payers could make a difference by expanding coverage of therapies and technologies so that more people have access.
“Although overall diabetes control is worse, people with access to technology do better,” said Dr. Price. “We see it in real world evidence and clinical trials. So we need to grow this access. We need good reimbursement from payers. And thankfully, that’s improving significantly, especially with more Medicaid-expanded states.”
On what the future holds
There is still so much to unlock in terms of diabetes data. The panelists shared their hopes for what they would like to see in terms of care.
“There’s so much yet untapped. I think about the progress we’ve made since 5 years ago when my daughter was diagnosed with type 1,” said Boulton. “I’m optimistic and pragmatic. In that 5 years, she’s gone from being diagnosed as an eight-year-old with multiple daily injections of insulin to now having a pump and a CGM. There's so much happening so quickly and still so much to learn. We need to be patient and persistent.”
“I'd like people to think less about data,” said Dr. Price. “I’d like solutions for type 1 and 2 diabetes – treatments and drugs – so that people don’t have to think about the data. I’d like to see people with diabetes not have to think about glucose control.”
“I think healthcare has to be continuous, proactive, and personalized for the individual,” said Dachis. “By making it easier for us to access our own health and become empowered to take action on it. By doing that on simple things like mobile phones we can help millions of people realize their full potential and reimagine what is possible for them.”
“I don’t think I could add more than what’s already been said,” concluded McGarraugh. “It’s about access, it’s about prevention, pulling all of these components together, and making it work, so that we keep it simple and we ease the burden, not add to it. I think the time is now.”
Watch the entire panel discussion here.