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Regardless of your role, title, or experience, if you work in diabetes care, I venture that you share in the broad goal of making people with diabetes’ lives “better.” Innovation allows enhancements in care delivery, improved experience with diabetes devices and products, and promotes a higher quality of life by diffusing medical breakthroughs and removing unnecessary burdens of living with chronic diseases.
Even as the world bore the persistent COVID-19 pandemic, numerous diabetes-related innovations occurred to support people with diabetes. (1)
Last week, I had the pleasure of attending the Fall 2022 DiabetesMine Innovation Days in San Francisco, CA. This two-day event consisted of an Innovation Summit and d-data exChange, and was attended by nearly 100 diabetes leaders, entrepreneurs, product developers, and people with diabetes (PWD).
The summit complimented patients lived experiences by featuring artists, including Ms. Weronika Burkot of Blue Sugar Cube, (2) who leads diabetes advocacy through their artistic talents. As a public health professional, quality improvement leader, product owner (and appreciator of all things creative), I was teeming with reflections on this experience.
Emerging diabetes products
Dr. Daniel Kraft, MD commenced the summit by describing the evolution of industrial revolutions. While society, in general, is currently in the fourth revolution, he argued that healthcare is still in the 2nd or 3rd age. (3) In well-landed jest, he reflected that aside from electronic replacing paper medical records, hospital centers and universities appear unchanged in the last few decades. He invited attendees beyond reactive and proactive “sick care” — but to support prevention and predictive healthcare by tapping into the wealth of data, supporting patients, and creatively leveraging lessons from other fields.
As the healthcare revolution progresses, emerging products are significant in diabetes innovation. I was inspired to learn of products, from episodic nighttime AID for smart pen users to temperature-controlling insulin boxes. Speakers across both days echoed a similar sentiment: diabetes-related products should not add to the burden of an already relentless chronic condition.
As Amy Tenderich was announcing the Patient Voices winners, she mentioned that people with T1D make an average of 180 diabetes-related decisions daily. Entrepreneurs and product developers are tasked with making products that truly make PWD’s lives easier. Sounds straightforward enough, until you consider that everyone’s experience living with diabetes is different, and considering those differences and unique challenges, would be transformative for the millions of people living with diabetes around the globe.
Products are tools — not solutions
Don’t get me wrong; innovating diabetes products would significantly impact PWD. But innovations are decidedly not limited to technology and product development. As PWD interact with dozens of providers and systems, innovations can support patient experience and care delivery.
Panelists on food and food culture, mental health, and health equity reminded attendees of the potential that arises when we frame diabetes as a failure of a “non-compliant system” rather than “non-compliant patients.” In doing so, we can consider, for example, how colonialism and slavery have manipulated food culture in such a way that dehumanizes foods eaten by people of color in the U.S. Speakers and patients referenced how a sense of “surveilling” or “grading” patients on their food choices reinforce stigma, and that if the foods you, your family, and culture eat every day are not deliberately included in healthcare conversations, it reinforces feelings of “not belonging.”
Innovation is not immune to social justice considerations; as Dr. Osagie Ebekozien, MD, MPH, reflected, implicit bias is undeniably a human condition that cannot be decoded from our cognitive hardware.
However, implicit bias can be identified so when it does make an appearance (for example, when a provider assesses whether a patient should be recommended a new diabetes technology), the effects of that bias are mitigated by the sound, thoughtful systems surrounding that provider (institutional policies, EMR-alerts, etc.). Similarly, Dr. Marisa E. Hilliard, Ph.D., encouraged a reframing of the mental health burden of diabetes to focus on resilience and patient strengths. Leaders in healthcare, policy, advocacy, and public health can support institution- and systems-level innovations that address the avoidable challenges beyond the medical diagnosis and living with a chronic health condition.
The opportunities for a systems-thinker
Healthcare innovation is overflowing with possibility as the field pursues the fourth industrial age. My excitement for the innovations shared at DiabetesMine lies in part with the potential impact it can have across all patients living with diabetes, and not just a privileged few. With this, I would (sweetly) provoke innovators with two additional considerations from my public health brain.
First, how can innovations support all PWD for significant public health impact? As we consider that diabetes is not the same for everyone, I would be thrilled to see diabetes innovators address, for example, the burdens of systemic racism or extreme poverty. Many entrepreneurs described how they initiated their company on a small scale, with the population conveniently accessible through neighboring geography.
Starting small is, after all, a similar concept in QI. Still, it doesn’t lead to systems-level impact until it meets two additional criteria: first, it incorporates diverse PWD’s voices and experiences, and second, scales up to become the status quo. The goal is that the small test becomes the standard of care for all within that hospital system. I hope for diabetes innovations to become business as usual for all PWD.
And second, how do we support patient-centered innovation by shortening the 17-year gap between published research results and implementation in patient lives?
Addressing this intensely long implementation delay is one of my favorite components of working with the T1D Exchange Quality Improvement Collaborative (T1DX-QI); by using quality improvement science to implement population health analyses and emerging best practices on a small-scale and local level, we can build up to impactful, systems-level change for PWD. (4) In addition to this methodology, I encourage innovators to influence cross-sector collaborations to engage diverse patients, learn quickly and effectively in various settings, and leverage relationships to diffuse innovations quickly.
These are questions that the T1DX-QI aims to ask as we continue to innovate. Since 2019, the T1DX-QI has quadrupled our reach to now over 82,000 patients living with type 1 diabetes. We have implemented strategies to diversify the patient population of our enrolled endocrinology centers by age, racial identity, population density, and the ratio of patients on public insurance.
We are expanding our efforts to serve patients with type 2 diabetes and offering an expanded portfolio of services, including quality improvement coaching and capacity building (5), our EMR-based data product (6), health equity strategies (7), population health analysis (8, 9), and diverse stakeholder engagement (through clinical leaders, PWD, and industry partners) to impact care delivery.
After attending the DiabetesMine Innovation Summit, I am enthusiastically looking forward to the innovations led by the T1DX-QI and other innovators in the next year, and ten years. After all, the opportunities are endless.
1. Mungmode AH, H.; Rioles, N.; Cases, J.; Koester, L.; Ebekozien, O. Diabetes Population Health Innovations in the Age of COVID-19: Insights From the T1D Exchange Quality Improvement Collaborative. J Clin Outcomes Manag. 2022;29(5):185-92.
2. Burkot K. About Blue Sugar Cube [Available from: https://bluesugarcube.com/about.
3. Schwab K. The Fourth Industrial Revolutions: what it means, how to respond Foreign Affairs: World Economic Forum; 2016 [Available from: https://www.weforum.org/agenda/2016/01/the-fourth-industrial-revolution-what-it-means-and-how-to-respond/.
4. Weinstock RS, Prahalad P, Rioles N, Ebekozien O. T1D Exchange Quality Improvement Collaborative: A Learning Health System to Improve Outcomes for All People With Type 1 Diabetes. Clinical Diabetes. 2021;39(3):251-5.
5. Marks BE, Mungmode A, Neyman A, Levin L, Rioles N, Eng D, et al. Baseline Quality Improvement Capacity of 33 Endocrinology Centers Participating in the T1D Exchange Quality Improvement Collaborative. Clinical Diabetes. 2022.
6. Mungmode A, Noor N, Weinstock RS, Izquierdo R, Indyk JA, DeSalvo DJ, et al. Making Diabetes Electronic Medical Record Data Actionable: Promoting Benchmarking and Population Health Improvement Using the T1D Exchange Quality Improvement Portal. Clinical Diabetes. 2022.
7. Ebekozien O, Mungmode A, Odugbesan O, Majidi S, Prahalad P, Noor N, et al. Addressing type 1 diabetes health inequities in the United States: Approaches from the T1D Exchange QI Collaborative. Journal of Diabetes. 2022;14(1):79-82.
8. Noor N, Ebekozien O, Levin L, Stone S, Sparling DP, Rapaport R, et al. Diabetes Technology Use for Management of Type 1 Diabetes Is Associated With Fewer Adverse COVID-19 Outcomes: Findings From the T1D Exchange COVID-19 Surveillance Registry. Diabetes Care. 2021;44(8):e160-e2.
9. DeSalvo DJ, Noor N, Xie C, Corathers SD, Majidi S, McDonough RJ, et al. Patient Demographics and Clinical Outcomes Among Type 1 Diabetes Patients Using Continuous Glucose Monitors: Data From T1D Exchange Real-World Observational Study. Journal of Diabetes Science and Technology.0(0):19322968211049783.
Ann Mungmode, MPH
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