Digital therapeutics, such as insulin titration apps, are becoming more common as part of diabetes self-management, and consequently part of AADE7 Self-Care Behaviors®. Healthcare providers (HCPs) prescribe applicable digital tools to people with diabetes (PWD) who need help titrating their insulin. The AADE7® is a curriculum framework, used by diabetes educators, to assess and support the individualized needs of PWD. There are seven self-care behaviors: healthy eating, being active, monitoring, taking medication, problem solving, healthy coping, and reducing risks.
We can talk to PWD about digital therapeutics and insulin titration when addressing each of the seven self-care behaviors: (1) Insulin titration happens in response to (1) eating and (2) physical activity. We titrate in response to blood glucose (3) monitoring. Titration is part of taking insulin and (4) medication. The act of titration teaches (5) problem-solving skills. The use of digital therapeutics can help with (6) coping skills while taking away the burden of guessing what dose on insulin to take. Effective titration minimizes hypoglycemia and improves glycemic management, consequently (7) reducing risks.
Recently, Ellie Strock, ANP-BC, FAANP, CDE, Jeanne Jacoby, FNP-BC, CDE and I presented a poster at Advanced Technologies and Treatment for Diabetes (ATTD 2019) about integrating digital therapeutics and insulin titration into therapeutic self-management education and support (DSMES) for people with type 2 diabetes. We reminded our audience that insulin titration is an ongoing process that needs to be included as part of an institutional and multidisciplinary approach. Most of the conversations with our audience related to when and how do HCPs talk to PWD about using digital tools for insulin titration.
Not surprisingly, the topic of clinical inertia came up often, as the majority of insulin doses increase only slightly from the date of initiation to six months later. We heard again and again that traditional paper and pen insulin intensification strategies are not effective in bringing PWD to goal. Digital insulin titration tools may help with clinical inertia and treatment engagement.
To help assess the effectiveness of available technology and digital tools for insulin titration, HCPs can use DANA (Diabetes Advanced Network Access), an online resource from AADE for all-things-diabetes technology.
Find out the top three ways to incorporate digital therapeutics into AADE7 Self-Care Behaviors®. Hear a discussion among two Nurse Practitioners about practical approaches on how and when to talk to PWD about digital therapeutics:
Digital therapeutics are not simply for taking insulin, but also can help people with diabetes feel engaged in self-care and connected with responsive and caring HCPs. We encourage you to become familiar with digital therapeutics, as many PWD are interested in using these types of tools. We should know how to discuss the appropriate options when the need presents itself or when a PWD brings it to our attention.
I am excited about the concordance that a digital tool can offer between the HCP and PWD; there is a lot of potential to improve the relationship and the care. In my own practice, digital therapeutics strengthen the connection between me, my patients and my peers. In my own practice, I can already see that digital therapeutics strengthen the connection between me, my patients and my peers.
To read more about the critical role of diabetes educators in insulin initiation and titration, access this AADE Practice Paper.