Managing patient expectations for glucose management via a device
Diabetes devices are sometimes seen as ‘the answer’; however, it’s often useful to first ask ‘what is the question?’
The availability of devices in diabetes care has been controversial to say the least over recent years. In the UK National Health Service (NHS), self-monitoring of blood glucose meters, insulin pumps and latterly continuous glucose monitoring devices all seem to be associated to some extent with accusations of rationing, 'postcode lotteries' (ie, availability being dependent on area of residence) and resource constraints. It is true to say that the NHS has probably never been so resource-constrained. However, there are far broader factors that need to be taken into consideration when deciding whether a device is the right option for each individual patient.
It is crucial to understand what the expectations are in terms of the device, what it can or can’t do, what it does that might be annoying, or what it simply doesn’t cover...
There are always trade-offs to be considered. Take continuous glucose monitoring devices, for example. The ability to see blood glucose trends, the impact of food or behavior (eg, exercise), and warnings of impending hypoglycemia or hyperglycemia may well be offset by the unwelcome/unexpected intrusion of alarms at awkward or inconvenient moments. Similarly, whilst insulin pumps are associated with improved glycemic control and quality of life , they can also draw unwanted attention by increasing the visibility of disease state. Innovative ways to secrete an insulin pump within clothing can be required!
So, how do we help people to make informed choices about whether a diabetes device will actually meet their unmet need?
In inimitable psychologist style, I’m going to answer that question… with a question! What is the unmet need and how do you think the device will fill it? Below are a few more questions that will hopefully help you and your patient get to the bottom of the ‘informed’ bit, both from a glycemic control perspective and a psychosocial perspective:
Understanding the problem and potential solution
- What is the challenge that you are currently facing with your diabetes management?
- How do you think this specific diabetes device will help with that?
Understanding the technology
- Tell me what you understand about the device and how it can meet your needs.
- Do you see any downsides to using the device for your self-management?
Understanding the ‘I have to live with this every day’ aspects
- Are there times that you really need the device to not draw attention to your diabetes, eg, in work meetings or when out with friends?
- Are there times that you think the device will be good for your quality of life, in terms of flexibility, independence, reassurance, and reduced burden of diabetes?
Understanding the actions associated with the device
- Personalizing the device to meet individual needs (basic settings, alarms/alerts, tailoring targets)
- The short-term goal is to…
- The longer-term goal is to…
The take-home message…
Ultimately, the desired outcomes for our patients are optimal glycemic control with minimal diabetes burden. Diabetes devices undoubtedly help many people to achieve those outcomes. Matching the right patient to the right device at the right time is key. Managing expectations and clarifying understanding will help in this regard.
- Barnard KD, Lloyd CE, Skinner TC. Systematic literature review: Quality of life associated with insulin pump use in type 1 diabetes. Diabet Med 2007; 24: 607–617.