ADSADEA2017

Curse of the One Touch Verio IQ

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I first received a One Touch Verio IQ glucose meter when I started on my insulin pump in May 2016. As most diabetes sales reps do, I received a rave review about how it was one of the most accurate blood glucose meters on the market.

I was using the FreeStyle Insulinx at the time, which I absolutely loved for it’s ‘Lite’ test strips that only required a tiny sample of blood and weren’t wrapped in that annoying foil. Although I had no intention of switching from the Insulinx, I decided to place this meter in my travel case and use it as my spare.

To give it credit, the Verio is actually quite an attractive meter. It has a colour screen and a backlight that automatically comes on when inserting a test strip. The meter is a refreshing white colour, rather than the dull greys and blacks that I’m accustomed to. By far, my favourite thing about this meter was the plastic shell that holds the meter, test strips and lancing device, which makes it super easy to carry.

Unlike any other meter I’ve used, its also rechargeable. This is good in the sense that you don’t need to keep on buying batteries (which are expensive, mind you!), but also not so good in the sense that you need to remember to keep your meter charged up before leaving the house. As a travel meter, the battery life held up well and would typically last me a month.

Testing with this meter was tricky to get my head around. Unlike FreeStyle and AccuChek meters, the test strip port was situated at the top of the meter. Additionally, blood had to be placed on the side of the strip, rather than at the bottom.

My pet hate was getting strip fill errors if I didn’t get sufficient blood on the strip in one go. I had a lot of these in the beginning as I was getting used to placing blood on the side of the strip. This was extremely wasteful compared to FreeStyle meters, which would give me ample time to apply additional blood.

I also didn’t like the fact that the capped test strip vials only stored 25 strips rather than 50, and that boxes came with 50 strips instead of the usual 100. This was an unnecessary waste of packaging materials, and meant that I needed to buy double the number of boxes to get the same amount of test strips. Although the price was comparable to other brands, Pharmacies didn’t necessarily stock more boxes of Verio strips on their shelves.

However, the biggest dealbreaker for me was the accuracy of this meter. I have consistently found that the Verio reads 0.5 to 1mmol higher than each of my other blood glucose meters.

Of course when I raised this issue with Aussie distributor AMSL diabetes at the ADS-ADEA conference last year, I was basically told that it was the other meters that were wrong. The accuracy of this meter fell within the acceptable Mean Average Relative Distance (MARD) from laboratory glucose readings. It had also been recommended for calibrating readings with Dexcom, which is the golden child of Continuous Glucose Monitoring.

I’ve done a little experiment with some of my leftover test strips, comparing the Verio with my FreeStyle Insulinx, Accu Chek Guide and FreeStyle Libre. I washed and dried my hands prior to each test, as I’m well aware that any moisture or dirt on my hands can impact glucose readings.

To be fair, all meter readings are only accurate to the nearest 1mmol of a laboratory result. Two simultaneous blood glucose readings will likely produce different results. So how do I know which of these readings I can trust?

I’ve found myself feeling hypo on several occasions, only to test with the Verio and receive a reading in the 4s. Patterns as exhibited above are a regular occurrence.

I’m exercising my own judgement here, in saying that I simply cannot trust this meter.

Putting Patient Centred Care Into Practice at #ADSADEA2017

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There are still a few more sessions from this year’s ADS-ADEA conference that I hope to cover over the next couple of weeks, as time and brain capacity allows.

One of the buzz words at this year’s conference was the concept of ‘patient centred care.’ As a consumer, it felt extremely frustrating to sit in on several sessions hearing all the talk about it, while knowing that in reality it’s not always being delivered. 

On the first afternoon of the conference, I ducked into a workshop chaired by Diabetes WA about putting person centred care into practice. In attendance were mostly diabetes educators and other healthcare professionals. Melinda of Twice Diabetes was also sitting in on the session with me, and she has shared some of her thoughts on patient centred care here.

Professor Timothy Skinner took to the stage to tell us that there was no ‘one’ or ‘right’ definition of patient centred care. He gave us four statements for attendees in the room to consider.

“All the decisions that affect the progression and outcomes of diabetes care are made by the person with diabetes.”

“All the barriers to effective diabetes self-management are in the individual with diabetes interpersonal (social) and intrapersonal (psychosocial) world.”

“All consequences of diabetes are experienced by the person with diabetes.”

“Every individual is always making the best decision they can to optimise the quality of their life.”

Professor Skinner noted that person centred care occurs when healthcare professionals act in congruence with these four statements. I still don’t quite know how I feel about these. In one way, I agree that the person with diabetes should be the ultimate driver of their diabetes decision making. Or, that this should be the ultimate goal. Yet if these are assumptions that healthcare professionals are making in light of an undesirable outcome, then they certainly seem to imply blame on the patient.

Our table then had to discuss this prompt.

I really thought that this statement reinforced one of the sentiments that I continually echoed throughout my time at the conference. I don’t represent all people with diabetes out there. Melinda and I were likely among the more ‘switched on’ and ‘connected’ consumers. While I might head into a clinic appointment with a list of notes and knowing exactly what I want to ask, this may not be the case for every other person out there.

I had a very frustrating economics teacher in High School who used to answer questions with questions. But in this instance, this is exactly the approach I would be giving to patients expecting to be told what to do. Healthcare professionals need to start empowering consumers to make their own decisions. Healthcare professionals should be arming consumers with information and resources that will assist them in making their own, informed decisions.

My attention waned towards the end of the session, and I think it was simply because I don’t believe the answer to providing patient centred care should be so complex.

Patient centred care is simply delivering what the consumer wants, rather than what the healthcare professional wants. If the consumer doesn’t know the answer to this question, then healthcare professionals need to be supporting the consumer to find out what it is that they want.

Disclosures: Diabetes Australia provided me with a media pass to attend the ADS-ADEA 2017 conference, with the view that I was interested in attending and delivering my own honest insights to the wider diabetes community.

Technology Changing Diabetes Outcomes at #ADSADEA2017

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Another standout session from my time at the ADS-ADEA conference was a symposium on technologies changing digital health outcomes.

Professor Brian Oldenburg introduced us to the ‘new’ health communications landscape in a digital era, which was nothing new to many of the consumers in the room! The promise of technology is great, but how do we ensure that it has sufficient reach and sustainability? With technology ever evolving and enhancing, keeping up with it is a real issue.

The buzz word of the conference popped up once again, with talk of the need for ‘person centred’ design in these digital technologies. I felt that this would be a great opportunity to engage with digitally savvy consumers, such as the DA People’s Voice team who were all there frantically tweeting in the room! I would hope that the healthcare professionals in the room were reassured by the promise of digital technologies complementing, rather than replacing their fundamental role.

Digital health programs were challenged by their usability, engagement and outcomes. As we were introduced to a digital diabetes coach, I was really struggling to see how such a program would be engaging or motivating. While it’s true there is no judgement in a robot’s voice, there are also no expressions of empathy or other human elements that help us to foster trust. I was also skeptical that older people would have the computer literacy or appreciation for these programs. Many still prefer to be served by a teller at the bank, or by a person at the checkout. I’m a big advocate for providing options and not forcing technology on those who don’t want it. However, I was surprised to hear that these programs were being taken up by both older and younger people.

You can see the digital health coach for yourself and decide:

Bec Johnson of the Telethon Type 1 Diabetes Family Centre was next to take to the stage, talking to us about how digital technologies have played a fundamental role in helping the family centre to reach across the whole of WA. Can I just say how nice it was to sit there as a West Australian, having something that the East Coasters around me envied? You can check out my sneak peek inside the Family Centre right here.

Bec began talking about how isolating type 1 was for her, and her sentiments just echoed among many of the consumers in the room. She shared that it took 10 years until she first began connecting to other people with diabetes through the Reality Check forums here in Australia. Those forums were her saviour, and she knew that online communities would be a pivotal part of building a type 1 community here in WA.

The Family Centre’s closed community Facebook group is about connections, rather than information sharing. I was rather impressed as Bec told us that the group had ‘conditioned’ this culture among the group, with many participants quick to politely call out posts seeking clinical advice. New entrants to the group are screened with a series of questions, in order to maintain a safe space for parents to share some of their deepest darkest thoughts. The Facebook group also allows consultation with the community on events or programs, in order to deliver the needs of the community.

Bec highlighted the Diabetes Detective program, which would not be possible without shared CGM data and remote contact with Diabetes Educator Amy Rush to smooth out any blood sugar issues. Other examples of online education from the Family Centre include the ‘Cyber Carbs’ online carb counting course and Type 1 Babysitters training. Bec also touched on online crowdfunding, raising an impressive $10,000 for the Family Centre for her swim to Rottnest Island earlier this year.

I was only saying last night how it often feels that the contribution of an actual person with diabetes doesn’t feel valued by healthcare professionals, conference organisers, organisations and companies in the diabetes space.

What I loved most about Bec’s talk was how much it proved the value of having a person who has hands on experience in diabetes, working in diabetes.

Also, I’d really love to see the foundation of the Telethon Type 1 Community translate into something for young adults one day.

Disclosures: Diabetes Australia provided me with a media pass to attend the ADS-ADEA 2017 conference, with the view that I was interested in attending and delivering my own, honest insights to the wider diabetes community.

Championing Peer Support at #ADSADEA2017

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One of my favourite sessions at this year’s ADS-ADEA conference was the peer support symposium. Not only did it cover one of my favourite topics, but it also provided me with valuable insights into the work carried out by the Australian Centre for Behavioural Research in Diabetes (ACBRD) and Diabetes Victoria.

Renza took to the stage with her personal story, which I’m sure many consumers in the room could identify with. People with diabetes only receive a few hours of clinical support each year. They turn to peer support because it’s easily accessible, and in the case of the Diabetes Online Community, it’s available 24 hours a day.

The point that most resonated for me was the importance of timing. I know that I wouldn’t have been ready or willing to meet other people with diabetes at the age of 17, nor would I have seen any value in doing so. But today, having connection to people who simply ‘get’ it is so very valuable.

It brought me to this idea of the strong bond that diabetes creates among peers. As Renza touched on peers helping peers with diabetes, it really reminded me of how much more trusting we are of each other because of our condition. I’ve certainly gone out of my way to help other people with diabetes, some of whom I barely know. If only more of our healthcare professionals could foster this much trust, imagine how much better they would be able to support their patients?

Later in the session, Dr Jessica Browne of the ACBRD took to the stage to highlight some recommendations for peer support in Australia. Only 11% of survey respondents were taking part in peer support, suggesting that many programs did not have enough reach.

When I look at some of the communications from diabetes organisations, I would have to agree. I don’t often see weekly OzDOC chats promoted. People’s insightful blogs aren’t often shared. I don’t see cross promotion of events here in Perth from some of the leading diabetes centres. Technology companies are too focussed on marketing their products, and could definitely employ a bit more of a community focus. We are not enemies, nor should we be viewing each other as competition. We really should be supporting each other in order to better serve our communities and promote choice.

Unsurprisingly, 1 in 3 survey participants had not discussed their involvement in peer support with their healthcare professional, and 1 in 10 believed that it would not be endorsed. Dr Browne touched on the need for more heathcare professionals to link their patients up to peer support, which I wholeheartedly agreed with. It took me five years before I began to uncover some of the many forms of peer support out there. Online alone there are closed Facebook groups, Twitter chats, diabetes Instagrammers, people’s blogs and forums such as Reality Check and TuDiabetes. The possibilities are endless, and without peer support I would not be in such a good place today both physically and emotionally.

The elephant in the room was addressed, with Dr Browne and many consumers in the room expressing that peer support complements, rather than replaces the advice of a healthcare professional. Yet I felt that a conference targeted at diabetes healthcare professionals and promoting patient centred care really missed a golden opportunity to give them a taste of something that we were telling them was so valuable. There were no Tweet stands or promotional material in the conference bags to encourage healthcare professionals to get online. There was not one tweet throughout the whole conference from the @ADSADEA twitter account. The #ADSADEA2017 hashtag was largely flooded by the consumers in attendance.

Carolyn Jones was the final person to take to the stage, and she provided an impressive insight into how Diabetes Victoria engage with their peer support groups to more effectively deliver programs and events that consumers want. She touched on the need for choice so that the consumer could pick the option that suited them best, as well as the need for any peer support to empower the consumer. There are 80 peer support groups running across Victoria consisting of type 1, type 2, mixed groups and online groups. I feel that other states pale in comparison. There were more in rural than metro areas. More of the in person support groups were type 2 specific, which was reassuring to hear given that type 2s aren’t very active in online support.

A massive thank you to everyone involved in putting together such an insightful session. I felt that our consumer perspective on peer support was both championed, and nicely complemented with the research and evidence.

Disclosures: Diabetes Australia provided me with a media pass to attend the ADS-ADEA 2017 conference, with the view that I was interested in attending and delivering my own honest insights to the wider diabetes community. 

People With Diabetes Panel Discussion at Roche Educators Day

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Last Tuesday, I was a part of the ‘People With Diabetes Panel Discussion’ at the Roche Educators Day. This is the first time that consumers have formed a part of the day’s proceedings, and I do thank Roche for having us there frantically tweeting away! It was also extremely humbling to see consumers being championed throughout the day by some of the presenters and attendees asking questions.

In a refreshing change of pace, West Australians on the panel outnumbered Eastern Australians. I was introduced to fellow type 1 Samantha, who is also Mum to two type 1 children, and Stephanie who lives with type 2 diabetes. The Eastern Australian contingent was represented by Ashley of Bittersweet Diagnosis and Renza of Diabetogenic.

Having two people on the panel who weren’t as immersed in the online world as myself, Ashley and Renza made the discussion richer. It was very insightful to hear Stephanie’s experience as a type 2, and not feeling very enlightened with her diabetes management until completing a DESMOND workshop. Samm’s perspective of “don’t wish for your problems to go away, wish for better skills to deal with them,” has also stuck with me for a number of days.

The highlight of my day was being able to tell a room full of healthcare professionals the importance of building a good support system. A short three years ago, I didn’t know a single person living with diabetes. I was feeling relatively isolated and alone with my condition before I began writing my blog and connecting to others through social media and eventually offline.

Our discussion shifted towards the illusive concept of ‘control,’ and this really challenged a belief that I had held for a long time. I was told I would live a normal life on my diagnosis, more so from my parents than from my healthcare professionals. I long imagined reaching a point where I would feel in control of my diabetes. As much as I wanted to believe that diabetes doesn’t make me any different, it does. Diabetes is not normal. We can only do our best to minimise the disruption of a very lousy condition.

I got the crowd laughing when I began talking about how my healthcare professionals continually bang on about not having more than two hypos a week. Despite their well meaning intentions, it’s simply not a realistic goal. I’ve certainly found that it’s an unfortunate trade off with spending more time in range. Then at the other end of the spectrum, I was ecstatic to see numbers in the single digits after my diagnosis while my diabetes educator told me that I needed to be correcting a blood sugar of 9 mmol. Ah, such a fine art…

So, what is the best thing that’s come from being diagnosed with diabetes?

Confidence.

Diabetes has made me a more confident person. I have learned to speak up for what I want from my diabetes healthcare professionals, and to make sure that they are working for me and meeting my needs. Three years ago I’d hardly have imagined myself being so open about my diabetes, let alone being an advocate for others. I really do think that this confidence has spread beyond my diabetes alone.

We weren’t supposed to talk about our peers as a positive of diabetes, because we talk about them all the time. However, I said it anyway. Diabetes has made the great big world around me a lot smaller through the people I’ve been lucky enough to meet, both online and off. 

When I think about how hard it was for me to say goodbye to each of these amazing individuals on Friday after four days together, I think that peers are definitely the best thing that have come from diabetes.

Disclosures: Roche Diabetes Care Australia covered my registration and travel costs to attend Roche Educator’s Day. I am also being paid an Honoraria for my giving up my time to speak in the People With Diabetes panel discussion. There was no expectation that my participation would bind me to a particular view of Roche, nor was there any expectation that I would blog or Tweet about the event.