For the March 17, 2015 #DCDE Twitter chat we talked about the current design of today's healthcare systems and communications between patients and doctors. We also discussed how diabetes patients can become better experts on their disease and the technology available to manage it, and how they can converse with their doctors about diabetes in an informed manner.

We were honored to have Jewels Doskicz, RN, (@She_Sugar) returning as our host and welcomed special guest Joyce Lee, MD, MPH, (@joycelee). Dr. Lee is a pediatrician and diabetes specialist and an associate professor of pediatrics at the University of Michigan.

Joyce Lee special guest for #DCDE twitter chat

Question 1

We started off by talking about diabetes education, asking:
what gaps do you see in diabetes education?

Some talked about how it is difficult to continuously learn about diabetes after diagnosis, and that many are left in the shadows without the proper education:

one and done for diabetes education

no diabetes education after diagnosis

diabetes education largely skipped once diagnosed

Dr. Lee and Jewels mentioned the distance between ideal diabetes management and practical applications:

distance between real-life applications and recommendations from doctors

doctors who don't have diabetes may not understand fully the management behind it

Others said that diabetes education and support is often found online.

Question 2

We then moved on to technology and diabetes management, asking:
technology helps with diabetes management

Jewels said it allows for more time spent on life, especially for her young, type 1 diabetic daughter:
diabetes technology brings less life interruptions

Technology can also help us adhere better to our diabetes regimen:
fine tune diabetes treatment with the use of technology

Many lamented the lack of availability of diabetes technologies:
diabetes technology is not easily accessible

To these concerns, Dr. Lee said that vital technology should be more accessible and should be given right at diagnosis:
diabetes technology shouldn't have to be earned

Question 3

We segued into discussing possible technologies that would make diabetes easier to manage by asking
describe a tool that would make diabetes management easier and more effective

The artificial pancreas was mentioned:
artificial pancreas would make diabetes care easier

Others want more diabetes supplies and more accurate technologies like CGMs:
more meter strips and diabetes supplies

more accurate and universal CGMs

Dr. Lee responded to the comments about CGMs by talking about the Nightscout project, which is an open-source project "that allows real-time access to a Dexcom G4 CGM browser via smartphones, computers, tablets, and the Pebble smartwatch. The goal of the project is to allow remote monitoring of the T1D's glucose level using existing monitoring devices," according to the Nightscout website.

value of technology for diabetes patients and caregivers

Question 4

Next we asked our participants to
explain creative work-around when managing diabetes and dealing with lack of technology

Jewels reminds us that our workarounds are always changing:
diabetes work-arounds based on age and always changing

Many said they are creative with their temporary basal rates:
creative with temp basal

Throughout the chat, people talked about the Diabetes Unconference, an event held from March 13 to 15, 2015 that offered peer-to-peer support for adults with type 1 and type 2 diabetes. At this event, some diabetics said that Certified Diabetes Educators (CDEs) don't create very individualized diabetes plans. To this, Dr. Lee responded

need more personalization for diabetes plans

Others said that CDEs can be very helpful, but these helpful ones are often hard to find:

good CDEs hard to find

Question 5

We followed up by asking,
How could diabetes technology help you communicate better with your healthcare provider?

Some talked about how better continuous communication of data could make for more valuable appointments:
diabetes data should be reviewed by doctor before visit

upload blood sugar readings in between visits

Dr. Lee discussed the roadblocks that prevent better communication from the doctor with the patient:
patient portal doesn't work well

She also explained that though she would like to be able to email her patients directly, many hospital lawyers forbid doctors from emailing as the servers may not be HIPAA secure.

Question 6

Then we talked about sharing workarounds with your doctor, and asked,
response by doctor when sharing helpful diabetes management tools

Some responded with humor:
stop eating so many carbs

get diabetes colleagues out of the technology of the 90s

Others said how gracious and open their doctors are:
diabetes health providers listen to suggestions with an open ear

open to listening


in closing, describe one thing that would make diabetes management easier

Some responded by wishing they were more confident in their diabetes management:
more confidence in knowing about diabetes

Others said that technology needs to create less room for error in calculations:
more accurate technology

We ended with thank-you's and goodbyes:
thank you for #DCDE hose and special guest

To learn more about #DCDE Twitter chats:

How to Participate in a Twitter Chat
Diabetes and Healthy Weight: #DCDE Twitter Chat Summary
Family Communication and Diabetes: #DCDE Twitter Chat Summary