By Melinda Young

Diabetes care is better informed than ever before, yet overall glucose control has not improved as expected. Research suggests the problem is related to engagement — convincing patients to improve their health actions between their quarterly doctor visits.1

Investigators recently studied technological solutions to improve diabetes patients’ engagement. They found multiple digital diabetes management systems that could help. These solutions include smartphone apps, devices with built-in connectivity, and coaching and support provided remotely through human or automated connections.1

“One of the biggest gaps, despite all of these new medications and treatments over the past decade, is that blood sugar control of people with diabetes has not really improved very much,” says Robert A. Gabbay, MD, PhD, chief medical officer at Joslin Diabetes Center in Boston.

The gap is in the time between appointments. The doctor might educate the patient about how to manage diet, exercise, and medication, but with no follow-up for several months, the patient might not maintain optimal adherence. “We need to do something different,” he says. “The biggest promise of these solutions is to help patients between visits.”

Case management can provide patient engagement between visits. There also are technological ways to remind patients to stay on the right path and to keep them engaged in their own progress. Most providers and patients are unaware of technology solutions to diabetes care, and they do not know how to find the best option, Gabbay notes.

The study on digital diabetes management systems was designed to give providers some idea of what solutions exist and how they compare in design and outcomes. A chief feature among the solutions involves coaching on healthy behaviors, Gabbay says.

“The different approaches out there vary from ones that are completely automated and don’t require humans at all, providing text messaging and other things, to some combination of texting with personal conversations that help people problem-solve,” he explains.

Coaching technology helps patients track their food intake, exercise, medication use, sleep, and stress levels.

“It provides reminders to people and makes a series of healthy suggestions to keep people on track,” Gabbay says. “Typically, someone will set a goal — ‘I’m going to cut down on hamburgers’ — and the technology reminds the patient of that goal.”

The technology can reinforce positive behavior by sending messages, such as “You didn’t eat any hamburgers today. Great! And let’s work on that tomorrow,” he adds.

Many of the technological solutions are part of an overall case management plan, he notes. “They differ in how much they use that and how advanced those skill sets for those people are,” Gabbay says. “They could have health coaches, diabetes educators, physicians, or endocrinologists.”

While the technology solutions vary, many patients realize that having some personal piece is helpful, he adds.

The study outlines a variety of attributes diabetes technology solutions provide, including:

• Managing health conditions;

• Providing peer support interactions;

• Prescribing providers on the care team;

• Connecting through medical devices and continuous glucose monitors;

• Treatment personalization;

• Demonstrating clinical and real-world evidence.

Increasingly, healthcare payers are aware of digital diabetes management systems, but patients and providers are less informed, Gabbay says. “The number of patients involved with the technology still is very small when compared with the overall burden of diabetes,” he says.

“Payers are slowly covering these kinds of things. As that happens, it will make these solutions more available,” Gabbay adds. “From the payers’ perspective, they want data to show it’s effective before they pay for it.”

Many technological solutions to diabetes control are in the early stages of development. It is a quickly evolving field, Gabbay says. “But there clearly are data showing these are effective,” he adds.


  1. Levine BJ, Close KL, Gabbay RA. Reviewing U.S. connected diabetes care: The newest member of the team. Diabetes Technol Ther 2019; Oct 3. doi: 10.1089/dia.2019.0273. [Epub ahead of print].