David Winmill may not live with diabetes himself, but he certainly understands real-life with this disease as well as any non-diabetic ever could. With 20 years under his belt so far as a Certified Diabetes Educator and Nurse Practitioner, David entered the field of diabetes care right from the start after becoming a Nurse Practitioner. He’s known well for his ability to naturally blend education with compassion while caring for his patients, and has also taken many budding CDEs under his wing as well.
Today, David works with patients at Intermountain Healthcare in Ogden, Utah.
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You’ve been working in diabetes as a Nurse Practitioner for practically 20 years—most of your nursing career—so you’ve seen some incredible changes in the treatments, insulin, and technology available for patients over the years. Which technology development do you think has had the greatest impact on the daily lives of people with diabetes?
David: Probably the technology that has had the greatest impact in the lives of patients with diabetes has been and continues to be the advances in insulin pump technology and its integration with continuous glucose monitoring.
What aspects of diabetes technology and treatment in general do you feel is still falling short? What do patients need the most next?
David: While there has been a move to greater integration of the insulin pump and CGMS, I believe it is important for the technology to provide feedback to patients and provide tools for greater decision making on the part of the patient. So much focus is made on the blood glucose monitoring and CGMS as a tool for the provider. That paradigm needs to shift so the monitor/CGMS data is as much a tool for the patient, if not more so.
A great deal of this relates to patient education, and that involves teaching patients to engage with the information they get from their glucose meter/CGMS. The meter should have prompts to assist the patient in identifying patterns and trends and perhaps suggestions for change. For instance, a notification that fasting blood sugars for the past week have tended to be a bit low could prompt a suggestion to reduce the morning basal rate or basal dose of insulin. Most patients have the skills to make these kind of decisions and often do so anyway.
Ahh, yes! We definitely understand that need at Dario! The Dario app was designed not only to help patients analyze their own blood sugars more easily, but also to communicate with their healthcare team more often and easily as well!
In what ways do current technologies improve your ability to support your patients as their healthcare provider and what’s still missing?
David: The amount of information available to providers can be overwhelming. Our health care network is in the midst of launching a new electronic medical record system. One of the areas that I have encouraged focus is integrating blood sugar reports into the actual record. It is so important to have the actual blood sugar reports and trends in the record and takes so much time to dictate into the record. The problem is that there are so many different glucose meters, each reporting the blood sugars in their own specific format. It would be nice if the blood sugar data could be reported in the same format and once downloaded actually become part of the clinical notes.
Lastly, you work with a variety of patients, of course, but I would guess that you have one cluster you could categorize as people who actually “thrive” in their life with diabetes, what’s different about these patients that has helped them develop that positive perspective and approach towards this disease?
David: I have often thought about this. Two patients who come from similar backgrounds, similar degree of support from family and friends, diagnosed at similar ages, one flourishes and the other barely gets by if at all. There are so many variables that play a factor in how patients deal with their diabetes. Much relates to the degree of motivation and ownership of the challenge that is diabetes. Cognitive ability in mastering the skills and judgment to manage diabetes can play a role. I don’t mean necessarily a matter of intelligence, just that we all have different aptitudes as relates to dealing with levels of information. This requires an ongoing assessment of the manner in which patients process and use information and adapting the diabetes care plan accordingly.
THANK YOU, DAVID!