Embracing Diabetes Technology
By Hope Warshaw, MMSc, RD, CDCES, BC-ADM,
FADCES
Today’s Dietitian
Vol. 26 No. 2 P. 24
Dietitians delivering diabetes care share their varied roles, go-to resources, pearls of wisdom, and more.
Over the last couple of decades, the delivery and management of diabetes care have dramatically shifted due to the continuous evolution of various technologies. Among them are Bluetooth-connected blood glucose monitors, professional and personal continuous glucose monitors (CGMs), as well as connected insulin delivery devices, from smart insulin pens and caps to automated insulin delivery (AID) pump systems.
Add to these innovations, technology-enabled systems that assist with glycemic management in the inpatient setting are being used to ensure patient safety.
“This growing list of connected devices offers the person with diabetes and their clinicians meaningful and actionable data that enables clinicians to pivot from time-bound, reactive care to continuous proactive, data-informed care,” says Janice MacLeod, MA, RD, CDCES, owner of Janice MacLeod Consulting in Glen Burnie, Maryland, and a member of the Association of Diabetes Care and Education Specialists (ADCES) Board of Directors, 2024–2027.
Other technologies allow for the delivery of diabetes care via telehealth, remote patient monitoring, virtual device training, and more.
“We see new models of care emerging that support a person’s daily self-care decisions, timely care plan adjustments aided by clinical decision support capabilities, and potentially artificial intelligence (AI),” MacLeod says.
Ever-evolving and advancing technologies will continue to transform the roles and responsibilities of the RD in diabetes care and education. These responsibilities include technology training, data analysis with ongoing management and support, collaborating with prescribing providers, serving as the technology advocate and champion, sharing expertise with technology start-ups, and other roles.
In this article, Today’s Dietitian (TD) interviews nine RDs who have, collectively, 170 years of dietetics expertise and 140 years experience as certified diabetes care and education specialists (CDCESs). In varied settings, these RDs use diabetes-related technologies to optimize clinical outcomes, reduce disease burdens, enhance quality of life, and ensure patient safety. Read about their roles, go-to resources, and pearls of wisdom, and why they believe it’s critical that RDs in diabetes care get and stay technology proficient.
Shannon Bailey, MS, RDN/LD, CDCES
Manager, Healthy Lifestyles
Ascension St. John Health System
Bartlesville and Tulsa, Oklahoma
RD for 25 years, CDCES for 20 years
TD: Describe your work setting, roles, and responsibilities.
Bailey: I currently manage the healthy lifestyle programs in a large health care system, including our American Diabetes Association–recognized Diabetes Self-Management and Education and Support (DSMES) outpatient program. Before transitioning to this management position, I worked in this system as an inpatient CDCES—a position often held by a nurse but I believe can be filled easily by a competent RD well versed in medication management and care coordination. In this role, I implemented diabetes device policies and protocols and educated health care providers about glycemic management technologies.
TD: How do you collaborate on technology with prescribing providers?
Bailey: I serve as a technology expert and resource, and this motivates me to stay up to date with this rapidly changing landscape. In my role, I work with our acute care providers—including those in emergency departments, operating rooms, and medical/surgical units—as well as nursing staff to answer questions that patients and others may have about safe insulin pump use during hospitalization and device safety during medical tests, such as CT scans, MRIs, and X-rays. This involves research on best practices and developing resources for all staff.
TD: Why is it critical for RDs in diabetes care to be proficient with technologies?
Bailey: To maintain our value, we must be on the front lines of change. By being proficient with diabetes technologies, RDs can learn to adjust insulin dosing to assist in the care of a patient on steroids with escalating insulin needs or help hospitalized patients optimize their glycemic management using their AID pump system while also updating providers on this relatively new technology.
TD: Do you have any pearls of wisdom to share with other RDs who work in diabetes care and education?
Bailey: Wear and use the various technologies. Hands-on practice offers further insight into real-world scenarios and decisions people with diabetes may make in varied situations. For example, understanding how the algorithm in each AID pump system operates and how it adjusts insulin is critical to how you educate a person about the system.
Charlotte Hayes, MMSc, MS, RDN, CSSD, CDCES, ACSM CEP
Head of Diabetes, Wellness & Education
Team Novo Nordisk, Pro Cycling
Atlanta
RD for 40 years, CDCES for 35 years
TD: Describe your work setting, roles, and responsibilities.
Hayes: I am head of diabetes, wellness, and education at Team Novo Nordisk, an all-diabetes professional cycling team. Our athletes compete in cycling road and track races around the globe. During the racing season, I travel with our athletes who participate in competitive events and training camps. I support riders’ glucose management as well as nutrition and fueling. My small office is mobile, equipped with well-organized supplies and a Wi-Fi connection for remote monitoring of diabetes and performance data.
TD: How do you collaborate on technology with prescribing providers?
Hayes: Most Team Novo Nordisk athletes, all with type 1 diabetes, receive their care within their country’s unique health care system. Their diabetes management is highly individualized. Their choice of CGM, insulin, and insulin delivery device depends on coverage offered by their health care system as well as the preferences of the cycler.
TD: Why is it critical for RDs in diabetes care to be proficient with technologies?
Hayes: If we don’t embrace and adopt new technologies, we’ll fall behind. I began my diabetes career in the technological dark ages but realize in today’s world we must embrace technology to continue to carve out and reinforce the important role of the RD. My early mentors instilled an appreciation for innovation and the commitment to a continual learning mindset.
TD: Do you have any pearls of wisdom to share with other RDs who work in diabetes care and education?
Hayes: Firstly, get to know the amazing people in the diabetes technology community who continuously push the bounds of technology, from researchers, clinicians, people with diabetes and their caregivers, and tech developers. RDs can do this by subscribing to the weekly e-newsletter from diaTribe.org (https://diatribe.org), follow the hashtag #wearenotwaiting, and subscribe to and follow news from Advanced Technologies & Treatments for Diabetes (https://attd2022.kenes.com). Dietitians can attend the annual DiabetesMine Innovation Summit and biannual DiabetesMine D-Data ExChange organized by diabetes technology evangelist Amy Tenderich (https://www.linkedin.com/in/amytenderich). Secondly, appreciate that these technologies have been developed to reduce the burdens of diabetes care and serve as a platform to inform, empower, and activate patients to achieve optimal self-management. Thirdly, think about how technologies can streamline your workflow. And lastly, give yourself grace, patience, and plenty of practice to develop proficiency.
Sarah Hormachea, MS, RD, CDCES, BC-ADM
Owner, Sarah Hormachea Diabetes Care & Education Consulting
Media Spokesperson, ADCES
Denver
RD for nine years, CDCES for six years
TD: Describe your work setting, roles, and responsibilities.
Hormachea: One year ago, I left my job at an endocrinology office to set up a consulting practice so I could have more flexibility and freedom with my young child. My schedule was booked within a few months. I provide a mix of virtual nutrition counseling, insulin pump training, consultations for technology start-ups, and clinical supervision for RDs developing competencies in diabetes care and education. I consider myself a diabetes technology entrepreneur in progress.
TD: How do you collaborate on technology with prescribing providers?
Hormachea: Embracing diabetes technology as a core expertise has opened doors for new partnerships, empowered me to take a comprehensive approach to diabetes patient care, and work at the top of my scope of practice as an RD and CDCES. As a contracted trainer with Insulet (manufacturer of the Omnipod pumps) and Beta Bionics (manufacturer of the iLet pump), I coach providers in calculating their patient’s initial settings. I also work with RenewRx, a remote patient monitoring platform for gestational diabetes, to train health coaches how to interpret CGM data during pregnancy.
TD: Why is it critical for RDs in diabetes care to be proficient with technologies?
Hormachea: Use of diabetes technologies is now standard of care. If you don’t keep up, you will get left behind.
TD: Do you have any pearls of wisdom to share with other RDs who work in diabetes care and education?
Hormachea: You can’t be a tech champion without having mastery of diabetes devices. Also, think of diabetes technology more broadly by including smartphone apps like ChatGPT for meal planning, GoodRx for discount codes on medications, or Glooko for activity and glucose logging. These are low-cost, high-value tech solutions.
Jennifer Okemah, MS, RDN, BC-ADM, CDCES, CSSD
Clinical Director/Owner, Salute Nutrition, PLLC
Seattle
RD for 16 years, CDCES for 16 years
TD: Describe your work setting, roles, and responsibilities.
Okemah: I’m an entrepreneur with a private practice in three locations around Seattle with the ability to offer virtual/telehealth services. I provide direct care, manage our clinical team, and oversee all aspects of my company.
TD: How do you collaborate on technology with prescribing providers?
Okemah: I’ve positioned our team to be the experts in nutrition counseling and diabetes education for the providers who refer, and I work as a contractor with device companies for trainings. Our clinicians provide diabetes management recommendations to providers for initiating and titrating insulin, adding or changing other medications, and incorporating technology with diabetes care. This approach has created a trusting professional relationship with referring providers.
TD: Why is it critical for RDs in diabetes care to be proficient with technologies?
Okemah: The new technologies directly relate to food intake and physical activity—the areas of expertise for RDs. We must possess the ability and knowledge to use and decipher tech-enabled data.
TD: Do you have any pearls of wisdom to share with other RDs who work in diabetes care and education?
Okemah: Don’t feel like you have to know it all. Start with what is easiest to learn and, like the character Dory in the movie Finding Nemo, keep swimming. Test the products yourself to experience what your patients experience. Learn about the devices, but always learn about the devices’ limitations, too.
Kristi Peterson, RDN, CDCES
Assistant Director, Nutrition and Diabetes Education Programs
University of Washington Primary Care Clinics, UW Medicine
Seattle
RD for 10 years, CDCES for two years
TD: Describe your work setting, roles, and responsibilities.
Peterson: I’m the assistant director of nutrition and diabetes education programs at the University of Washington Primary Care Clinics. I support a team of dietitians and provide MNT, DSMES, and remote CGM monitoring. I also serve as the quality coordinator for our DSMES programs and collaborate with our population health team to decrease health care gaps.
TD: How do you collaborate on technology with prescribing providers?
Peterson: We work alongside our providers on all aspects of personal and professional CGM, providing them with firsthand experience in wearing the device, helping them and patients connect to and correctly interpret their data, and understanding the challenges and opportunities with insurance coverage and billing. Soon, we will support providers with the integration of CGM data into our EHR system, which is a big deal.
TD: Do you have any pearls of wisdom to share with other RDs who work in diabetes care and education?
Peterson: Wear and use the technologies yourself to obtain first-hand knowledge and experience. By doing this, you’ll provide better patient care and expertise to providers.
Jennifer Scarsi, RD, CDCES
Clinical Solutions Specialist, Welldoc, Inc
Greater Indianapolis Area
RD for 25 years, CDCES for 25 years
TD: Describe your work setting, roles, and responsibilities.
Scarsi: I support health care systems and providers that are implementing Welldoc’s digital health solution into their clinical workflow. This platform supports multiple cardiometabolic conditions and comorbidities and includes an app for individuals along with a care team portal. My role is essential to successful product implementation.
TD: How do you collaborate on technology with prescribing providers?
Scarsi: I work directly with providers to determine the most effective onboarding process. I also show providers how to use personal health data generated in the app as well as AI that looks at patterns and trends to inform clinical decisions, create an effective treatment plan, and increase efficiencies.
TD: Why is it critical for RDs in diabetes care to be proficient with technologies?
Scarsi: Technologies can enable RDs, along with other providers, to view and use patient-generated health information (PGHI), including biometric and lifestyle data. Today, summarized, PGHI is allowing for more efficient utilization of provider time. With PGHI, providers can have more patient-centric conversations and develop treatment plans. With AI, RDs can move away from doing mundane tasks, such as creating sample meal plans and menus, and practice at the top of their license.
TD: Do you have any pearls of wisdom to share with other RDs who work in diabetes care and education?
Scarsi: Use the technologies yourself. First-hand experience matters. Then, share a technology with an array of patients. Observe how they use and engage with it. This will help you determine which technologies you want to use and with whom.
Rachel Stahl-Salzman, MS, RD, CDN, CDCES
Diabetes Care and Education Specialist, Lecturer in Medicine
New York-Presbyterian Hospital/Weill Cornell Medicine Division of Endocrinology, Diabetes & Metabolism
New York, New York
RD for 10 years, CDCES for six years
TD: Describe your work setting, roles, and responsibilities.
Stahl-Salzman: I provide MNT and DSMES to adults and train people to use a range of diabetes technologies. I conduct much of this work virtually. I’m also involved in interdisciplinary education and community outreach, and I’m a dietetic internship preceptor.
TD: How do you collaborate on technology with prescribing providers?
Stahl-Salzman: With provider collaboration and my knowledge of diabetes technologies, I discuss each person’s needs and goals, recommend appropriate devices, and provide training and ongoing support for effective implementation and management.
TD: Why is it critical for RDs in diabetes care to be proficient with technologies?
Stahl-Salzman: RDs are an essential part of the care team and are increasingly relied on to support their patients’ use of technology. Our unique expertise in nutrition and other components of care helps us consider their roles in data interpretation and optimal use of technologies.
TD: Do you have any pearls of wisdom to share with other RDs who work in diabetes care and education?
Stahl-Salzman: Start small. You don’t need to learn everything about technology at once. Become a CDCES. Enjoy the process of learning and exploring new technologies.
Becky Sulik, RDN, LD, CDCES
Director of Education, Rocky Mountain Diabetes Center
Idaho Falls, Idaho
RD for 27 years, CDCES for 25 years
TD: Describe your work setting, roles, and responsibilities.
Sulik: I work in an endocrinology clinic where I lead a team of eight DCESs who assist our prescribing providers, including adult endocrinologists, a pediatric endocrinologist, nurse practitioners, and a physician assistant. I help patients select technology, and then I conduct the training. In addition, I coordinate our American Diabetes Association–recognized DSMES program and head up our quality measures/outcome projects. I also assist with technology-focused clinical trials.
TD: How do you collaborate on technology with prescribing providers?
Sulik: I collaborate with our prescribing providers on device training and follow up, device downloading and preparation of reports, device troubleshooting, interpreting diagnostic or clinical CGM data, and helping patients learn about and choose technologies to fit their needs. I also provide updates at provider meetings on technology, including case studies, and product features.
TD: Why is it critical for RDs in diabetes care to be proficient with technologies?
Sulik: This is where diabetes care is headed. If RDs don’t embrace it, they will be left behind. For example, the newer AID pump systems improve users’ time in range without the burden of precise carbohydrate counting. RDs can turn their focus to helping people improve their overall short- and long-term health by focusing on healthful behavior changes and more healthful food choices. This is right in the RD’s wheelhouse.
TD: Do you have any pearls of wisdom to share with other RDs who work in diabetes care and education?
Sulik: Integration of diabetes technology into today’s care paradigm should be at the very center of helping people with diabetes improve their lives. Rethink your assumptions about the “ideal” person for diabetes technology. With proper support and training, most people can successfully use technology. You can be the provider to make this happen.
Madalyn Vasquez, MS, RD, CDCES
Registered Dietitian/Diabetes Educator
Summit Health
Clifton, New Jersey
RD for five years, CDCES for four years
TD: Describe your work setting, roles, and responsibilities.
Vasquez: I currently work as a CDCES and certified pump trainer at a busy endocrinology office. In this role, I provide MNT, DSMES, and device training. Previously, I worked at a community health center. Before taking this diabetes-focused position, I provided MNT at Community Health Network, a nonprofit organization serving primarily Latino and underserved populations.
TD: How do you collaborate on technology with prescribing providers?
Vasquez: The prescribing provider refers patients to me to show them device options. Once the device is prescribed, I collaborate with the provider on the insulin pump orders and administer the pump training. Over time, I provide ongoing support.
TD: Why is it critical for RDs in diabetes care to be proficient with technologies?
Vasquez: Diabetes technology is the future of diabetes management. Patients are asking more questions about the technologies. We need to have answers or know how to find them. It’s exciting to see patients use devices, observe their results, and make management changes. Interestingly, use of technologies encourages greater patient involvement, sparks curiosity, and helps alleviate the day-to-day care burdens.
TD: Do you have any pearls of wisdom to share with other RDs who work in diabetes care and education?
Vasquez: Don’t be intimidated by technology. Tap the expertise of product sales representatives. Download the device apps and simulators. Try them out.
Final Thoughts
Diabetes care will increasingly involve technologies that ease management burdens for people with diabetes and their clinicians, reduce day-to-day decision making, and improve short- and long-term outcomes. The roles of RDs in diabetes care, regardless of practice setting, have the potential to expand as myriad technologies evolve. MacLeod advises dietitians to “Lean in, embrace the change, and be part of the solution.”
— Hope Warshaw, MMSc, RD, CDCES, BC-ADM, FADCES, is owner of Hope Warshaw Associates, LLC, a diabetes- and nutrition-focused consultancy based in Asheville, North Carolina. She’s a freelance writer specializing in diabetes care and education and provider of diabetes device training. Warshaw served as the 2016 president of the Association of Diabetes Care and Education Specialists, was chair of the Academy of Nutrition and Dietetics Foundation during 2022–2023, and currently serves as the Foundation’s past chair through May 2024.
TECHNOLOGY-FOCUSED DIABETES ASSOCIATIONS
Two key diabetes-focused associations are aiming to meet the education and resource needs of care providers when it comes to technology.
The American Diabetes Association (ADA). “[The] American Diabetes Association is advancing technology-enabled care delivery and outcomes with offerings delivered through multiple channels,” says Barbara Eichorst, MS, RD, CDCES, vice president of health care programs at the ADA. “RDs need to be well versed on the devices along with data analysis skills to help people select the optimal device as well as meet their needs for training and ongoing education and management,” Eichorst says.
Association of Diabetes Care and Education Specialists (ADCES). “A key goal of our newly crafted 2024–2028 strategic plan (https://adces.org/plan) is to advance the expertise of the DCES [diabetes care and education specialist], which absolutely includes all aspects of technology,” says Jane K. Dickinson, RN, PhD, CDCES, program director/senior lecturer at Teachers College Columbia University and 2024 ADCES president. ADCES aims to achieve this goal through numerous educational programs and resources. “ADCES is, in addition, striving to provide the clinicians they serve with opportunities to connect with colleagues so all may share, compare, and collectively advance our expertise,” Dickinson adds.
— HW
12 STEPS TO KEEP ABREAST OF TECHNOLOGY
RDs interviewed for this article provide the following ways dietitians can remain up to date and stay ahead of the diabetes technology evolution.
“While it’s a challenge to keep up, the good news is lots of resources exist,” says Rachel Stahl-Salzman, MS, RD, CDN, CDCES, a diabetes care and education specialist and lecturer in medicine at New York-Presbyterian Hospital/Weill Cornell Medicine, in the division of endocrinology, diabetes, and metabolism, in New York City.
1. Join the Association of Diabetes Care and Education Specialists (ADCES). Engage with the organization’s Technology Community of Interest, and attend their annual technology conference in December, as well as the annual conference in August. Use ADCES’s resource for all things diabetes technology, danatech.org (www.adces.org/danatech), which gets high marks from RDs.
2. Become a member of the Academy of Nutrition and Dietetics’ Diabetes Dietetic Practice Group (www.dce.org/home). Access the group’s newsletters, e-blasts, CE programs, and discussion board.
3. Join the American Diabetes Association (ADA). Attend its annual Scientific Sessions. Review and reference ADA’s Standards of Care, which is updated annually in mid-December. It now includes a section on Diabetes Technology. Access the 2024 Standards of Care at https://diabetesjournals.org/care/issue/47/Supplement_1. Use ADA’s Institute of Learning, specifically Making Diabetes Technology Work (https://professional.diabetes.org/content-page/making-diabetes-technology-work). And access ADA’s Consumer Guide for details on available technologies (https://consumerguide.diabetes.org).
4. Visit DiabetesWise (https://diabeteswise.org), a website developed by diabetes experts at Stanford University that features information geared specifically to consumers and health care practitioners to gain assistance in choosing an insulin delivery device and continuous glucose monitor.
5. Access Panther-Diabetes Technology (www.pantherprogram.org). This website, developed by experts at the Barbara Davis Diabetes Center, at the University of Colorado, offers excellent resources that focus on insulin delivery devices, device placement, skin care, and data management.
6. Tap into knowledge from organizations founded by entrepreneurial and innovative leaders in the diabetes technology arena that include DiabetesMine, diaTribe, Tidepool, and Taking Control of Your Diabetes for Life. Subscribe to diaTribe to get its free weekly e-newsletter (https://diatribe.org).
7. Find an RD mentor with diabetes technology expertise. Dietitians can develop a network of tech-savvy practitioners by identifying diabetes care colleagues at their institutions, online, or at an in-person tech-focused meeting. Ask them if they’re willing to be your technology mentor. Communicate specifically what you want to accomplish along with achievable timelines. For example, you may want to become certified to train people on AID pump systems or become more proficient using a data-analysis system, like Glooko or Tidepool, in counseling sessions.
8. Follow diabetes technology experts on social media. On LinkedIn follow Amy Tenderich; Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES; Viral Shah, MD; Rachel Stahl-Salzman, MS, RD, CDN, CDCES; and Dana Lewis. Hashtags: #wearenotwaiting #diabetes
9. Read the technology research in the journals Diabetes Care, Diabetes Technology and Therapeutics, and Journal of Diabetes Science and Technology, as well as industry publications.
10. Visit the websites of technology developers and companies to learn about their products, or, if available, contact company clinical or territory sales representatives. Watch company-sponsored webinars and in-person programs.
11. Become familiar with and comfortable using data reports from analysis programs such as Glooko and Tidepool (device-agnostic), and continuous glucose monitors and pumps (proprietary devices) patients frequently use. Identify reports that most concisely help patients make sense of their data, such as glucose results, amount of carbohydrate consumed, and insulin doses, and observe changes to make in their management plan to address postprandial glucose rises or missed meal boluses.
12. Access the Coalition for Health AI (artificial intelligence) at https://coalitionforhealthai.org. Read its Blueprint for Trustworthy AI, which offers initial guidance on AI for health care providers. “RDs should access this document and remain aware of this coalition’s work because they’re health care focused and access the knowledge of health care experts versed in AI who aim to ensure high-quality care, increase credibility among AI users, and meet health care needs,” says Janice MacLeod, MA, RD, CDCES, owner of Janice MacLeod Consulting in Glen Burnie, Maryland, and member of ADCES Board of Directors, 2024–2027.
— HW