The Science of Diabetes Self-Management and Care2023, Vol. 49(4) 326 –327© The Author(s) 2023Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/26350106231169696journals.sagepub.com/home/tde
The impact of technology on the lives of people with diabetes, the clinical practice of diabetes care and education, and our Association over the past 50 years is wide and deep, leading to fundamental changes in each of these areas.
In preparing to write this commentary, I reviewed articles published in The Diabetes Educator in the 1970s and 1980s. I was reminded of things I’d forgotten. For example, the accompanying article I’ve chosen references prices of $340 to $675 for the three blood glucose monitors available in the United States at that time!1 [click this link to access article: https://journals.sagepub.com/doi/abs/10.1177/014572178000600301]
I smiled wryly at the broad range of accuracy issues, remembering requirements for meter warm-up, a huge drop of blood, careful washing and wiping of the strip, and the oh-so-long minute until results. There were so many ways in which accurate results could be compromised by the user. I winced at references to “compliance” with “outcome measures” of a regimented testing schedule and accurate recording of results. I noted no or minimal discussion of teaching people with diabetes how to use blood glucose results.
The archival article I chose to highlight, however, makes some interesting and still-instructive points. One of my favorites appears in the summary:
Prior to the new approach, most of our approaches in management have been based on theoretically, how insulin works, and theoretically, what urine sugars mean, and theoretically, what the textbooks tell us should happen. The daily values of blood glucose, which patients can now easily obtain, give us a better idea of how each individual in reality, responds to a specific regiment of insulin, diet and exercise.1
Because I’m an educator, I’m going to share a story. In 1979, when I had been a “diabetes teaching nurse” for just 3 years, I traveled to Scotland on vacation. I stayed in a bed and breakfast on the shores of Loch Ness. After the hostess and I chatted a bit, she asked about my work. Upon learning that I was a diabetes educator, she sat me down at her kitchen table to talk about her diabetes. I can still hear her telling me (emotion thickening her Scottish brogue), “Mah doctor tellt me aboot a new blood test that wid tell him whit a’ve bin up tae fur th’ lest 3 months . . . and ah tellt him that if ah wanted him tae ken whit a’d bin up tae fur th’ lest 3 months, a’d tell him”! I remember thinking, “Oh no! This is NOT a good road these two are heading down!” So, I tried to explain what I thought she would find useful about knowing her A1C.
Back home, the lessons my hostess taught me that day about technology stayed with me. Those lessons? First, to be respectful when presenting advances. We can use technology to promote trust and deepen our relationships with people with diabetes . . . or not. It’s up to us.
And second, to put first things first. Talk first about how technological advances might affect people with diabetes and their management. Address what it might make easier AND what it might make harder.
A dear friend and colleague remarked to me that diabetes care and education specialists have always appreciated technology as a bridge. In the early days, we’d get referrals to teach people with diabetes how to check their blood glucose, and in doing so, we’d learn so much more about them. We would discover issues that had to be dealt with such as that they weren’t really sure they had diabetes; or that their family thought if they had done (or not done) x or y, they wouldn’t have gotten diabetes; or that they were only checking because they wanted to please their doctor and didn’t have a clue as to how to respond to the results. So blood glucose monitoring was a bridge to deepening the understanding and partnership between people with diabetes and diabetes care and education specialists.
The authors of our archival article pointed out so beautifully how blood glucose monitoring is a bridge between theory and reality. We learned that things we had confidently proclaimed as true either weren’t or were true some of the time for some people with diabetes. This is an important understanding that has continued to evolve with the use of continuous glucose monitoring and closed-loop insulin delivery systems.
Fast-forward 50 years to reflect on how technology makes our services both better and more accessible. It bridges space and time. Virtual visits have connected diabetes care and education specialists and people with diabetes who are in rural areas, on lockdown, or can’t travel to visits for myriad reasons. People with diabetes can securely text a photograph of a lesion or injection/infusion site reaction to their provider rather than trying to describe it. People with diabetes regularly upload their personal data from devices for provider review and recommendations.
The fundamental ways that advances in technology have changed so much for both people with diabetes and diabetes care and education specialists are valuable and important. That diabetes care and education specialists continue to use technology to truly individualize the care they provide and to deepen the partnership between people with diabetes and themselves . . . these are truly priceless and the bedrock of our specialty.
Kathryn Godley retired last year after 46 rewarding years in the field of diabetes care and education. In 2022, the Association of Diabetes Care & Education Specialists honored her with the Donna Tomky Award for Excellence in Clinical Practice (awarded annually to a nurse practitioner).
None reported.
Kathryn Godley https://orcid.org/0009-0001-4414-7608
From Certified Diabetes Care and Education Specialist (Retired), Forestport, New York (Ms Godley).
Corresponding Author:Kathryn Godley, 4325 Lakeview Road, Forestport, NY 13338, USA.Email: kathryngodley@gmail.com
