Common adherence challenges in diabetes and how I address them with digital health

1. The many responsibilities of diabetes self-management^1,2

Between the ongoing steps of monitoring blood glucose levels, taking medication, and tracking diet and exercise, burnout for people with diabetes is real and understandable. 

When I recognize that these tasks may cumulatively be contributing to nonadherence, I do a few things. First, I try to acknowledge the ways that the person is self-managing their diabetes and praise them for the work they have done. It could be something as simple as, “You’ve done a great job researching new options for your meal plan.” I also ask questions about how things are going and give them an opportunity to share what has been going well and what has not been going so well for them. That way, I’m able to share diabetes tech that matches their expressed needs. 

Then I walk them through what the tech is and how it could help them, such as automating some of the tasks they are finding cumbersome. 

2. Downplaying the consequences of unmanaged diabetes^3,4

I’ve seen many people with diabetes downplay the consequences of not sticking with their diabetes management plan. It can be easy to justify not checking their blood glucose regularly or missing an insulin dose here or there when they don’t fully understand the potential impact of half-hearted diabetes management. 

I’ve found that showing my patients real-time or aggregate glucose data from a continuous glucose monitor (CGM) can help spur some revelatory moments. It helps to take diabetes management out of the theoretical and into the practical. Instead of weighing each choice through the lens of how it could affect their A1C readout every three months, they can see how staying on top of their medications, diet, and exercise may affect their levels minute by minute.

Even if they’ve heard it from me 100 times before, actually seeing their glucose levels spike or dip in relation to something they’re doing or not doing can be the trick to helping them see how their actions may affect their diabetes.

3. Constant time pressures⁵

On top of the time required for daily self-management, it’s important to remember that people with diabetes have personal, family, and work obligations just like everyone else. Keeping appointments, staying in touch with their care team, and picking up prescription refills on time adds to their already long to-do list.

Since telehealth has become more mainstream, I always ask my patients how they prefer to meet and communicate. I’ve found that a virtual visit can help save them time since they won’t have to travel to my office, and less time away from work may mean that they don’t have to make that time up later.

I find that if I show a commitment to saving my patients time through things like virtual visits or text message reminders vs phone calls, they may be more open to other technologies that can also give me greater insight into their diabetes. And if we can find a way to make those technologies fit with their busy schedules, that’s a win for both of us.