Paper or Plastic? For Glucose Logs, That Is...

There have already been some snags and alarms raised in questioning just how successful this new batch of tech toys for diabetes will be in the end.

For quite some time I seemed to lag behind many of my colleagues in terms of technology savvy: I was the last among my friends to buy a Palm Pilot only to have it later freeze up on me and be discarded during residency, I bought my first-ever lap top just this year and only last week started downloading new applications onto my smart phone. Not too bad, I think, right? I am hoping those of you clinging to the age-of-paper will back me up on this one. I do still have a penchant for good old pen and paper when I need to get something down quickly. I like to have my journals in hand instead of PDFs on my computer screen even though I acknowledge that I am contributing to a few nice trees falling out there somewhere.

I am being pushed into the new age by some of my patients however, who are bringing in new ways of keeping their glucose records. During my fellowship the greatest joy was when our diabetes patient happened to be either an engineer or in some kind of accounting field. Why? You guessed it: no boring glucose logs with stretches of barely legible numbers. Instead we got graphs! In color! And bar charts! Oh my goodness, the elation during those visits. Much of the hard work was already done for us in terms of deciphering patterns, so the visit was quick and painless the vast majority of the time.

These days it goes even further. There are a number of online glucose tracking programs, as well as countless that can be downloaded or purchased in stores. It can be on your desktop, laptop, smart phone, regular cell phone and your insulin pump. How about the combined glucose meter AND phone?! Better yet is the rise of home tracking/telemedicine type monitors that communicate your glucoses straight to your doctor’s office. What more can you ask for? In addition to removing the step of writing things down, now you don’t even have to ask, “Doc did you get my records?”

But as great as this all sounds, there have already been some snags and alarms raised in questioning just how successful this new batch of tech toys for diabetes will be in the end. One of the major concerns has been the issue of monitoring and appropriate compensation for physicians and their offices. Let’s face it: as it is right now we do a lot in our offices for which we are not compensated. The phone calls we return, the e-mail questions and the endless paperwork all take a tremendous amount of time and energy from our staff and us. At this time there is no compensation built into billing for physicians for reviewing glucose data. So having all of this would be great and in fact is a necessary part of good diabetes care, but how would we be able to handle the additional data generated by all our diabetic patients sending numbers to us on a daily basis? Who out there can afford to devote someone in your office specifically to this task? If you can somehow, please share with the rest of us.

The second concern has been how widely accessible this will be to the majority of patients with diabetes. Some of this is a generalization, but hear me out: As a group, individuals with Type 1 diabetes tend to be younger and have a greater chance of being fairly tech savvy. But they only make up a small percentage of people with diabetes in this country. The vast majority of people has Type 2 diabetes, and is overall older and less likely to be as comfortable with more advanced tech devices. I know, I know, a sometimes-unfair generalization but I am just the messenger here. This is one of the ongoing arguments in the companies and agencies considering using these advanced glucose tracking devices, and it is an important question: is our target audience going to be able to use this device effectively?

With healthcare costs putting a significant burden on many families and the economy at subterranean levels right now, it is not the greatest time to ask people to pay, likely completely out of pocket by the way, for these devices, even though they truly may add a useful component to their care. Maybe when insurance companies ante up and help pay for this, everyone will be more ready to embrace these new health toys. But until that time I expect to see lots of paper with scribbled glucose numbers coming through my office. And let me tell you, compared to nothing, those sheets of paper are good as gold.

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