Dr. Richa Patel explains why data is important for managing diabetes and what technology is available for patients with diabetes.
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Diabetes in the Technology Age
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Learn more about Richa Patel, MD
Richa Patel, MD
Dr. Richa Patel is board certified in internal medicine, with a specialty in endocrinology, diabetes and metabolism. Dr. Patel is also board certified in obesity medicine. She earned her medical degree from Pramukhswami Medical College at Sardar Patel University in Karamsad, India. Dr. Patel continued her medical education by completing an internal medicine residency at New York Medical College/Wyckoff Heights Medical Center in Brooklyn, New York. She solidified her passion for endocrinology during her three years of practice as a primary care physician in South Florida; which led her to the University of Missouri - Columbia, where she completed her fellowship in endocrinology, diabetes, and metabolism. An accomplished author, Dr. Patel has contributed numerous articles to peer-reviewed publications such as the International Journal of Clinical Practice and the National Journal of Medicine. She can diagnose and treat hormone-related diseases and the complications that can arise from them. Her special interest in the field of endocrinology lies in obesity medicine and the management of its metabolic complications. Dr. Patel is a member of the Obesity Medical Association, the American Association of Clinical Endocrinologists, the Endocrine Society, the American College of Physicians, and the American Medical Association. She is affiliated with St. Joseph’s Hospital-South.Learn more about Richa Patel, MD
Transcription:
Diabetes in the Technology Age
Melanie Cole (Host): Welcome to BayCare HealthChat. I'm Melanie Cole, and I invite you to listen as we discuss diabetes in the technology age. Joining me is Dr. Richa Patel. She's Board Certified in Obesity and Internal Medicine with a specialty in Endocrinology, Diabetes and Metabolism at BayCare. Dr. Patel, it's a pleasure to have you join us today.
These are unprecedented times for medical care across the board, really, but for people with diabetes, this can be a difficult time to navigate. Tell us how your team has evolved to provide care for your patients while keeping them safe. What have you been doing during this pandemic for your patients with diabetes?
Richa Patel, MD (Guest): The current pandemic has definitely taught us some innovative ways I would say, to keep connected to our patients. And we do offer Televisits that I don't think we did before this pandemic happened. And we encourage actually for the routine follow-up visits to be virtual, unless there is a pressing reason that the patient must be seen in person. Also, we have a website on BayCare, regarding COVID-19 screening. There's the triage nurse service where patients can call in case, they have questions and it offers resources about how and where to get tested. Also patients who come to our clinic, they are screened by a standard COVID-19 questionnaire about their travel and exposure.
Host: Well, thank you for that. So, even before COVID, technology, maybe not Tele-Health quite as much, but technology was moving into the world of people with diabetes. So, how much does health care providers, how much do you rely on patient provided data when it comes to managing someone's diabetes?
Dr. Patel: The honest answer is a lot when it comes to management of uncontrolled diabetes, especially. We're a specialty clinic. So, most patients who are referred to us, they have uncontrolled diabetes, whether it's Type 1 or Type 2. So, patient's meal patterns, their snacking habits, their activity levels, their sleep habits, all these parameters; they have significant impact on their blood sugars. And that's why we're always interested in learning more about that.
For example, let's say, we see a patient whose blood sugars are always running high, particularly at bedtime. Then we want to know if they're snacking. What sort of snacks they prefer? If there's a particular pattern of low blood sugars on the other hand, then we want to know what goes on during that time of the day, in terms of their food intake, their level of activity, medication doses, et cetera. And we always try to take all these things into consideration before making any treatment related changes. So, we therefore advise our patients to bring us as much data as they can. You know, their blood glucose logs, blood pressure, logs, glucometers, if they wear any activity trackers, then we were interested in knowing more about that as well, you know. When it comes to information, we tend to get greedy.
Host: Well, that makes sense. I mean, the more information, the more informed choices that the healthcare provider and patient can make together. So, the technology has changed so much over the years, even since I was in graduate school and studying this. What technology do you find most helpful now? I mean, for people with diabetes, the phone apps and glucose monitors and tracking devices, tell us what's going on in the field that you're seeing that you like that works really well.
Dr. Patel: The technology, we can divide that into a few different categories when it comes to patients with diabetes using this technology. One that focuses on patient behaviors. So, there are apps that can help them keep a food diary or food logs, their carbohydrate count, activity logs, et cetera. There are apps for objective data like finger stick blood glucose data, or data from continuous glucose monitoring devices. We have insulin pump. We have smart insulin delivery devices that we call smart pens that not only records their insulin doses, but also can have, can connect with continuous glucose monitoring and can give us some very meaningful data. And lastly, there is, there are devices that can track your medication data. So, like insulin doses, time of these doses that were given and all that.
Host: Well then as a provider, Dr. Patel, how do you try to find the most reasonable solutions for patients? You know, there's a lot going on when you suffer from diabetes, you've got insurance information and
Dr. Patel: out-of-pocket costs and
Host: copays for these visits and costs for your medications. How can you help patients with that?
Dr. Patel: Right. So, a lot of things go into consideration before we recommend or prescribe any of these technologies, you know. Free technology is great, you know, free phone apps where you can track your food logs and activity. Like MyFitnessPal, there’s a Fat Checker, nutrition facts. There are all free apps and we encourage our patients to use them as much as they can. But when it comes to technology that needs prescription or needs recommendation from a physician, then one, we definitely want to know if the patient will actually benefit from it.
If you have someone with stable well-controlled diabetes, that requires oral medications only, and if all we need is maybe one or two blood glucose readings a day, then a simple glucometer, which is affordable, which is covered by their insurance, that's the way to go. You bring us the glucometer or you bring us your blood glucose data and it's smooth sailing. So, these patients, they would not really require these advanced technologies, like a continuous glucose monitor or an insulin pump. But on the other hand, if you have Type 1 diabetes, or you have Type 2 diabetes and you're on multiple insulin injections, or you tend to get frequent low blood sugars; then we do prefer you have a continuous glucose monitor. If you're a truck driver, let's say, you need frequent blood sugar monitoring, but you don't have the ability to stop and check your blood sugars safely. Then yes, we do prefer that you will have a continuous glucose monitor.
The second thing is if the patient will be able to use the technology comfortably because, this varies from individual to individual. It depends on the level of exposure to smartphones and apps. And it depends on their dexterity, their visual acuity and whatnot. Patient profession is also something that we always take into consideration when we're prescribing these devices. And finally, if we check all these boxes, we still need to make sure that this is something the patient can afford in terms of insurance coverage and copays.
I mean, Space X can send humans to outer space, but that doesn't really mean that all of us should or can or would go to the outer space, right? So, little things like that, before we make decisions.
Host: It's so important, really, the help that you're giving people. So, do you have the ability to download and share a lot of this data electronically, if maybe they're seeing you as an endocrinologist and then they've got their primary care provider, maybe they're seeing an obesity medicine specialist or they're seeing a personal trainer, anybody else, a nutritionist, a dietician, people that can help them in this journey; are you able to share this and keeping the pandemic in mind, how can sharing this data make a Tele-Health visit more meaningful.
Dr. Patel: So, we do have the ability to share a lot of this data. When you have phone apps, a lot of them can generate reports for you and patients can create either a PDF or a document that they share with us. The commercially available glucometers, most endocrinology practices, we have software that's compatible with a lot of these glucometers. So, what we need to do is we need to plug in the glucometer to download. There are more sophisticated versions out there, where the glucometer would automatically and virtually share the data with the doctor's office. When it comes to insulin pumps and continuous glucose monitors, they do allow us to share the data remotely. So, the patient doesn't necessarily have to come in. As long as they have an active account and we're connected, we can share data with each other remotely and that makes it very helpful when it comes to conducting a virtual visit. And if none of these workouts, let's say the patient has a simple, old-fashioned glucometer; we just ask them to write down their blood glucose, on a piece of paper, like make a glucose log, share that with us before the visit and they can email it to us, mail it to us. And, we go over that over the virtual visit. So, we still get, try to gather a lot of information. The goal is to keep the patient comfortable and not overwhelm them since it's honestly quite a task to tackle a chronic medical problem like diabetes, and we strive to keep it simple and still achieve the best outcome.
Host: Well, I'm quite sure you do. And I can hear in your voice how much you love, what you do. Wrap it up for us, Dr. Patel, if you would, in how you help patients with diabetes and the exciting technology that's available today that was not available 15, even 10 years ago, how you're utilizing Tele-Health. And even if Tele-Health is going to be something that you're going to use, after the pandemic. Kind of wrap it all up with this technology and diabetes.
Dr. Patel: It's definitely an exciting time to be practicing endocrinology because we have access to such good technology. And I would really hope that we can continue to use this Telemedicine. And again, it comes to not overwhelming our patients because they are overwhelmed with their care already, checking your blood sugars so many times a day, taking so many injections during the day, keeping up with your insulin pump, or your glucometers and glucose monitors. So, this is something that I would really hope we would carry forward, even in future and encourage our patients to use the technology to the best of their ability, so we can help improve not only their future, but future of our healthcare in general, because diabetes honestly such a burden to our healthcare when it comes to other comorbidities as well.
Host: Well, it certainly is. And thank you so much, Dr. Patel for joining us today and sharing your incredible expertise. This was a really great episode, so thank you very much. And to learn more about BayCare's Diabetes Services, please visit our website@baycarediabetes.org for more information, and to get connected with one of our providers.
And that concludes this episode of BayCare HealthChat. Please remember to subscribe, rate and review this podcast and all the other BayCare podcasts. Also remember to share this show with your friends and family, if you are someone who has diabetes, and you're learning about this technology, share this with others because we are learning from the experts at BayCare together. This is Melanie Cole.
Diabetes in the Technology Age
Melanie Cole (Host): Welcome to BayCare HealthChat. I'm Melanie Cole, and I invite you to listen as we discuss diabetes in the technology age. Joining me is Dr. Richa Patel. She's Board Certified in Obesity and Internal Medicine with a specialty in Endocrinology, Diabetes and Metabolism at BayCare. Dr. Patel, it's a pleasure to have you join us today.
These are unprecedented times for medical care across the board, really, but for people with diabetes, this can be a difficult time to navigate. Tell us how your team has evolved to provide care for your patients while keeping them safe. What have you been doing during this pandemic for your patients with diabetes?
Richa Patel, MD (Guest): The current pandemic has definitely taught us some innovative ways I would say, to keep connected to our patients. And we do offer Televisits that I don't think we did before this pandemic happened. And we encourage actually for the routine follow-up visits to be virtual, unless there is a pressing reason that the patient must be seen in person. Also, we have a website on BayCare, regarding COVID-19 screening. There's the triage nurse service where patients can call in case, they have questions and it offers resources about how and where to get tested. Also patients who come to our clinic, they are screened by a standard COVID-19 questionnaire about their travel and exposure.
Host: Well, thank you for that. So, even before COVID, technology, maybe not Tele-Health quite as much, but technology was moving into the world of people with diabetes. So, how much does health care providers, how much do you rely on patient provided data when it comes to managing someone's diabetes?
Dr. Patel: The honest answer is a lot when it comes to management of uncontrolled diabetes, especially. We're a specialty clinic. So, most patients who are referred to us, they have uncontrolled diabetes, whether it's Type 1 or Type 2. So, patient's meal patterns, their snacking habits, their activity levels, their sleep habits, all these parameters; they have significant impact on their blood sugars. And that's why we're always interested in learning more about that.
For example, let's say, we see a patient whose blood sugars are always running high, particularly at bedtime. Then we want to know if they're snacking. What sort of snacks they prefer? If there's a particular pattern of low blood sugars on the other hand, then we want to know what goes on during that time of the day, in terms of their food intake, their level of activity, medication doses, et cetera. And we always try to take all these things into consideration before making any treatment related changes. So, we therefore advise our patients to bring us as much data as they can. You know, their blood glucose logs, blood pressure, logs, glucometers, if they wear any activity trackers, then we were interested in knowing more about that as well, you know. When it comes to information, we tend to get greedy.
Host: Well, that makes sense. I mean, the more information, the more informed choices that the healthcare provider and patient can make together. So, the technology has changed so much over the years, even since I was in graduate school and studying this. What technology do you find most helpful now? I mean, for people with diabetes, the phone apps and glucose monitors and tracking devices, tell us what's going on in the field that you're seeing that you like that works really well.
Dr. Patel: The technology, we can divide that into a few different categories when it comes to patients with diabetes using this technology. One that focuses on patient behaviors. So, there are apps that can help them keep a food diary or food logs, their carbohydrate count, activity logs, et cetera. There are apps for objective data like finger stick blood glucose data, or data from continuous glucose monitoring devices. We have insulin pump. We have smart insulin delivery devices that we call smart pens that not only records their insulin doses, but also can have, can connect with continuous glucose monitoring and can give us some very meaningful data. And lastly, there is, there are devices that can track your medication data. So, like insulin doses, time of these doses that were given and all that.
Host: Well then as a provider, Dr. Patel, how do you try to find the most reasonable solutions for patients? You know, there's a lot going on when you suffer from diabetes, you've got insurance information and
Dr. Patel: out-of-pocket costs and
Host: copays for these visits and costs for your medications. How can you help patients with that?
Dr. Patel: Right. So, a lot of things go into consideration before we recommend or prescribe any of these technologies, you know. Free technology is great, you know, free phone apps where you can track your food logs and activity. Like MyFitnessPal, there’s a Fat Checker, nutrition facts. There are all free apps and we encourage our patients to use them as much as they can. But when it comes to technology that needs prescription or needs recommendation from a physician, then one, we definitely want to know if the patient will actually benefit from it.
If you have someone with stable well-controlled diabetes, that requires oral medications only, and if all we need is maybe one or two blood glucose readings a day, then a simple glucometer, which is affordable, which is covered by their insurance, that's the way to go. You bring us the glucometer or you bring us your blood glucose data and it's smooth sailing. So, these patients, they would not really require these advanced technologies, like a continuous glucose monitor or an insulin pump. But on the other hand, if you have Type 1 diabetes, or you have Type 2 diabetes and you're on multiple insulin injections, or you tend to get frequent low blood sugars; then we do prefer you have a continuous glucose monitor. If you're a truck driver, let's say, you need frequent blood sugar monitoring, but you don't have the ability to stop and check your blood sugars safely. Then yes, we do prefer that you will have a continuous glucose monitor.
The second thing is if the patient will be able to use the technology comfortably because, this varies from individual to individual. It depends on the level of exposure to smartphones and apps. And it depends on their dexterity, their visual acuity and whatnot. Patient profession is also something that we always take into consideration when we're prescribing these devices. And finally, if we check all these boxes, we still need to make sure that this is something the patient can afford in terms of insurance coverage and copays.
I mean, Space X can send humans to outer space, but that doesn't really mean that all of us should or can or would go to the outer space, right? So, little things like that, before we make decisions.
Host: It's so important, really, the help that you're giving people. So, do you have the ability to download and share a lot of this data electronically, if maybe they're seeing you as an endocrinologist and then they've got their primary care provider, maybe they're seeing an obesity medicine specialist or they're seeing a personal trainer, anybody else, a nutritionist, a dietician, people that can help them in this journey; are you able to share this and keeping the pandemic in mind, how can sharing this data make a Tele-Health visit more meaningful.
Dr. Patel: So, we do have the ability to share a lot of this data. When you have phone apps, a lot of them can generate reports for you and patients can create either a PDF or a document that they share with us. The commercially available glucometers, most endocrinology practices, we have software that's compatible with a lot of these glucometers. So, what we need to do is we need to plug in the glucometer to download. There are more sophisticated versions out there, where the glucometer would automatically and virtually share the data with the doctor's office. When it comes to insulin pumps and continuous glucose monitors, they do allow us to share the data remotely. So, the patient doesn't necessarily have to come in. As long as they have an active account and we're connected, we can share data with each other remotely and that makes it very helpful when it comes to conducting a virtual visit. And if none of these workouts, let's say the patient has a simple, old-fashioned glucometer; we just ask them to write down their blood glucose, on a piece of paper, like make a glucose log, share that with us before the visit and they can email it to us, mail it to us. And, we go over that over the virtual visit. So, we still get, try to gather a lot of information. The goal is to keep the patient comfortable and not overwhelm them since it's honestly quite a task to tackle a chronic medical problem like diabetes, and we strive to keep it simple and still achieve the best outcome.
Host: Well, I'm quite sure you do. And I can hear in your voice how much you love, what you do. Wrap it up for us, Dr. Patel, if you would, in how you help patients with diabetes and the exciting technology that's available today that was not available 15, even 10 years ago, how you're utilizing Tele-Health. And even if Tele-Health is going to be something that you're going to use, after the pandemic. Kind of wrap it all up with this technology and diabetes.
Dr. Patel: It's definitely an exciting time to be practicing endocrinology because we have access to such good technology. And I would really hope that we can continue to use this Telemedicine. And again, it comes to not overwhelming our patients because they are overwhelmed with their care already, checking your blood sugars so many times a day, taking so many injections during the day, keeping up with your insulin pump, or your glucometers and glucose monitors. So, this is something that I would really hope we would carry forward, even in future and encourage our patients to use the technology to the best of their ability, so we can help improve not only their future, but future of our healthcare in general, because diabetes honestly such a burden to our healthcare when it comes to other comorbidities as well.
Host: Well, it certainly is. And thank you so much, Dr. Patel for joining us today and sharing your incredible expertise. This was a really great episode, so thank you very much. And to learn more about BayCare's Diabetes Services, please visit our website@baycarediabetes.org for more information, and to get connected with one of our providers.
And that concludes this episode of BayCare HealthChat. Please remember to subscribe, rate and review this podcast and all the other BayCare podcasts. Also remember to share this show with your friends and family, if you are someone who has diabetes, and you're learning about this technology, share this with others because we are learning from the experts at BayCare together. This is Melanie Cole.