Is Digital Diabetes Coaching Worth the Cost?

Does digital diabetes coaching really work? And is it worth the money?

While these programs were basically unknown only a few years ago, there is now a dizzying number of businesses claiming to offer personalized mobile diabetes coaching programs. A diaTribe guide to the services lists fifteen different options, a number which may only grow in coming years. (In a related phenomenon, there are also many new coaching services that utilize continuous glucose monitoring for people without diabetes).

What is digital coaching?

Digital coaching is not telemedicine or telehealth. A digital diabetes coaching service can only supplement, but not replace,  your doctor, endocrinologist, or diabetes educator. Digital diabetes coaching services cannot order prescriptions and cannot address more complicated health issues.

Digital diabetes coaching services aim to help “fill in the gaps” between regular visits with an existing care team, as a representative of MySugr, one of the better-known services, puts it:

I really see the benefits of having those touch points in between physician appointments because the day-to-day is what really matters with diabetes. If you’re just going in every several months it’s hard to make changes that stick. If you’re able to check in with a coach every so often without having to make an appointment, not only does it help the management, but it helps ease anxiety which is a huge part of diabetes too.

While the details will vary from one business to another, the basic idea is that the patient will share his or her data (blood sugar, insulin use, weight, etc) through a mobile app. The app provides feedback and advice, whether it’s delivered by an algorithm or a trained professional. Even if the mobile coach doesn’t deliver any revelations, the hope is that little check-ins and notifications will help keep patients more mindful of their condition and in a better frame of mind to apply themselves to their diabetes management, leading to improved results.

Some coaching platforms are paid for by insurers or employers. Others require patients to pay for them directly – a common price is about $50 per month.

The case against digital coaching

Digital coaching services have studies that show that their coaching programs deliver big results – improving HbA1c, weight loss, and reductions in insulin and other glucose-lowering medications. But in a recent debate at the American Diabetes Association’s Scientific Sessions conference, Dr. Kasia Lipska of the Yale School of Medicine expressed doubt about the quality of the evidence in favor of these programs.

After reviewing the clinical literature, Dr. Lipska noted that most studies of the services tend to be sponsored by the companies themselves. They are typically of very short duration, and some are barely up to good standards for clinical science.

She referred particularly to a study run by Omada Health of its own program. Among the problems with this study: no control group, no randomization (perhaps meaning that participants were highly motivated), and missing data, in addition to the obvious conflict of interest.

Omada has also run a randomized controlled trial, considered a far more thorough approach. Those results, which have only been made public in a press release thus far, were “relatively modest,” showing some weight loss but less than a 0.1% improvement in HbA1c. A similar trial, of the Noom coaching platform, had similar results, showing no difference in A1c and a relatively minor improvement in weight loss.

The best-designed study of digital coaching platforms that Dr. Lipska was able to find “did not demonstrate clinical effectiveness.”

“I think we have to squint a little bit to see a lot of evidence for clinically important significant outcomes,” she stated.

Dr. Lipska also expressed some personal skepticism about the programs.

“The thing that really bothers me is that they’re really not aligned with the healthcare team. Me as a clinician, I have no input into the feedback that my patient gets.”

The case in favor of digital coaching

Arguing the opposite case was Dr. Anne Peters, the director of the University of Southern California’s Clinical Diabetes Programs, and a much-honored diabetes advocate.

Dr. Peters took a broader view of the problems that digital coaching is meant to solve, noting that the healthcare costs of diabetes continue to spiral and that many people with diabetes still struggle to achieve the targets set by their doctors.

Even if patients enrolled in digital coaching services do not experience better outcomes, the programs may be worth the cost to insurers and employers if it helps reduce the frequency of in-person visits to the medical center. Some studies have found that digital coaching systems reduce patient medical spending and office visits, big benefits for patients, insurers, and medical practitioners alike.

Moreover, in Dr. Peters’ telling, patients can use all the help we can get them. Technology and medication have improved significantly in recent years, but they are not effective without training and professional assistance. For decades we have known that diabetes education improves outcomes – is there a good reason to doubt that education delivered through a smartphone would fail to do the same?

Both debaters agreed that digital coaching platforms were only likely to help a certain percentage of diabetes patients, those with a modicum of technical acumen and a willingness to commit to a more intensive management style. It’s possible that such patients are already highly motivated to pursue management success and are therefore less in need of help than others less likely to use such a service. While Dr. Lipska argued that this means that digital coaching services may exacerbate healthcare inequities, Dr. Peters took a more optimistic view of the matter, counting any new treatment options as a positive even if they do not serve all patients equally well.


Digital diabetes coaching hopes to supplement standard medical care for diabetes by filling in the gaps between visits to the doctor’s office. By offering advice and reminders, they hope to keep your mind on your condition, setting you up for diabetes management success.

The evidence in favor of digital diabetes coaching is mixed. The proof that these platforms actually lead to improved outcomes is meager, but there is better evidence that they may save money for insurers and employers that offer the programs by reducing the frequency of in-person visits.

Would a digital diabetes coaching service be worth the cost to you? For a certain type of person, especially a patient ready to take his or her glucose management to the next level and willing to keep up with frequent online check-ins, these programs may well be highly effective.



Remember, Your Time in Range Isn’t a Grade Either

This content originally appeared on diaTribe. Republished with permission.

By Eliza Skoler

Time in Range (TIR) is another number for people with diabetes to pay attention to and use to improve their daily diabetes management. We talked with three women in the diabetes community about how they use TIR as a helpful number to keep them on track and inform their care.

Time in Range (TIR) is a helpful tool that captures the highs, lows, and in-range glucose values that characterize life with diabetes. TIR can help people understand how their daily habits and behaviors affect glucose levels, so they can use this information to feel better and reduce glucose swings. But it’s also another measurement to keep track of – and the goal is to look at it as a number and not have it loaded with emotion or negativity if it falls short of your goal.

For many people, it can be challenging to get past seeing glucose levels as “tests” and A1C checks as “grades.” But as Adam Brown explains, blood sugars are just numbers – they are neither good nor bad, but rather they are information that will help you make a decision about your diabetes. Click here to read about how Adam transformed how he views diabetes data. Seeing your A1C level as a grade can actually cause harm – some people are demotivated to take care of their diabetes when they feel they are frequently failing. Renza Scibilia and Chris Aldred write more about this in “What’s Your Grade?

Enter Time in Range (TIR), the percentage of time that a person spends with their glucose levels in their target range. TIR is a powerful tool to assess patterns in glucose levels throughout the day and over time, and this can help inform lifestyle changes and treatment decisions in a way that A1C cannot. People with diabetes should aim to spend as much time in their target range as possible.

With the TIR number comes the risk that people may see it as yet another test of their diabetes management. It might be another mark that tells them they are not measuring up.

“When I read about Time in Range, it was a bit scary at first, simply because it seemed like it was a ‘grade,’ like you would get in school, so I didn’t want to think of it too much because my own fear of failure is high,” said Sarah Knotts who has lived with type 1 diabetes for 32 years. She has two young children and works with mySugr as the US Head of Customer Support.


Image source: diaTribe

Stacey Simms agreed. Simms is the host of Diabetes Connections and author of The World’s Worst Diabetes Mom: Real Life Stories of Parenting a Child with Type 1 Diabetes. Her son Benny was diagnosed with type 1 diabetes in 2006, right before he turned two.

“It’s easy to look at TIR and other diabetes markers as a judgment on your value as a person. I think there’s a bit of a danger in looking at these markers as anything but math and management tools” she told us. “Less TIR doesn’t mean you’re a bad person or worth less than a person with more TIR. I don’t know how we can keep these tools from weighing on the mental burden of diabetes, but I do think being aware they can have this effect is a good first step.”


Image source: diaTribe

Knotts now uses TIR regularly. “My biggest hurdle to get past was that I equated TIR to being a grade – as if I was turning in a term paper or project and those percentages related to a letter grade,” she said. “Just as your A1C is not an accurate picture of your control, a TIR is also not a complete picture either. Yes, I have a range that I want my TIR to be, but I’m not focusing on one average number, or one A1C target. I’ve been able to learn that if I can keep my numbers close to the target range, everything else (A1C, standard deviation) tends to also be better, and I feel better overall.”

Christel Oerum, who was diagnosed with type 1 diabetes at the age of 19 and created Diabetes Strong with her husband in 2015, thinks about TIR both every day and in a long-term sense.


Image source: diaTribe

“I use TIR daily in the sense that I aim for glucose levels in my target range (70-160 mg/dL, but I don’t focus on always meeting a daily TIR goal, as I think that’s too stressful and not realistic,” she said. “There are going to be days where I’m in range most of the day and days where I’m not, and for me, that’s okay. I do have a monthly TIR goal that I’d like to see myself hit, but that’s more of a retrospective analysis.”

Oerum acknowledged how easy it is to get obsessed with making TIR goals. “For me, that’s not healthy, which is why I try to not use TIR as a daily goal but rather as an overall indicator of whether I should make changes to my care,” she said. “TIR is not a grade or score. It’s a tool to help you manage your diabetes to the best of your ability.”

Simms’ family focuses less on the actual numbers (like TIR and A1C) and more on helping Benny thrive with diabetes: “I spend a lot less time working on TIR than on things like fostering independence, teaching Benny to trouble shoot and helping him advocate for himself. TIR is a great tool to check on for trends and adjustments, but we don’t use it very often. I wouldn’t want Benny checking TIR every day or even more than once a week unless he was really tweaking settings or trying something new.”

We don’t want TIR to be scary or intimidating. At diaTribe, our hope is that more and more people will be able to use TIR in a non-judgmental and informative way, helping themselves and their families lead healthier lives. Oerum summed it up well. “TIR for me means more details on how my management is going and can help me hone in on what to change and what to leave alone. Diabetes can’t be about perfection, and just as my A1C isn’t a grade of my effort, neither is my TIR.”

This article is part of a series on time in range.

The diaTribe Foundation, in concert with the Time in Range Coalition, is committed to helping people with diabetes and their caregivers understand time in range to maximize patients’ health. Learn more about the Time in Range Coalition here.


“Freedom would be not to worry about my blood sugar level while eating birthday cake.”

Maria Model mySugr

Meet Maria, one of mySugr’s models living with diabetes. Maria was diagnosed with type 2 in an annual routine checkup. Living a healthy lifestyle and never being overweight, Maria was really surprised by her type 2 diagnosis.

mySugr loves to show the many different faces and stories of people with diabetes in the real world. So they do their own photoshoots and feature real people living with diabetes instead of using stock photos.

1. What were your biggest fears/concerns when you were diagnosed with diabetes?

I was wondering how much I will have to change my habits. I’ve always thought that my lifestyle was healthy, but now I have to give up even more. And of course, I am still afraid of how diabetes will affect my life at an old age.

2. What’s the hardest part/biggest struggle for you in living with diabetes day-to-day?

To say no to candies. I used to have a huge sweet tooth.

maria checking blood sugar

3. What piece of advice would you give to a person who is newly diagnosed with diabetes?

Each organism is unique. Each organism has different needs and wants. Besides the physical changes after a diagnose, we also have to think about our psyche. We should try to listen to our bodies and be conscious. We should observe how our blood sugar level reacts to different methods of treatment. Not only pills and injections, but also natural methods like fasting helps, meditation and sports.

4. Is there a phrase/statement about diabetes that drives you crazy?

Almost everybody thinks that only older and overweight people can get type 2 diabetes. Until I was diagnosed I thought the same.

5. When you think of the word “freedom” in terms of diabetes, what does that mean to you?  What would make you feel more free?

Freedom would be not to worry about my blood sugar level while eating birthday cake.

paper is for origami


What Causes Prediabetes and Type 2 Diabetes on Coaches Corner

What Causes Prediabetes and Type 2 Diabetes on Coaches Corner

mySugr Coaches Kristen and Maggie fill us in on what causes prediabetes and type 2 diabetes. Learn what you can do about the risk factors you can control and how to shed the guilt around the risk factors you can’t control.

Let’s learn about the factors that can help prevent, delay, and better manage prediabetes and type 2 diabetes, as well as factors that are non-modifiable.

Note: We cannot provide medical advice. Please contact your doctor directly for specific questions about your care.


  • Modifiable risk factors vs. non-modifiable risk factors
  • Weight as a risk factor
  • Working on small changes that make big impacts


Scott K. Johnson – Hey, thanks for tuning in to another episode of Coaches Corner, it is great to see you again. Let me know where you’re watching from today. One small way that mySugr is giving back, is by hosting these short conversations with our diabetes coaches to talk about staying healthy in body and mind. We really appreciate you sharing some time with us. Now I do have to give the standard disclaimer, we cannot provide medical advice. Please contact your doctor directly for specific questions about your care. And another quick housekeeping note, we are shifting to two broadcasts per week through the end of May. On Mondays and Wednesdays at 3 p.m. Pacific time with the exception of next Monday which is Memorial Day. We’re going to take that holiday off. We’ve got some great topics lined up for the rest of the month, so I do hope that you’ll join us. Today, mySugr Coaches, Kristen and Maggie fill us in on what causes pre-diabetes and type 2 diabetes. Learn what you can do about the risk factors you can control and how to shed the guilt around the risk factors you can’t control, let’s take a look. Alright, Kristen and Maggie, always great to have you back again. Today we’re talking about what causes diabetes and pre-diabetes and if I ever heard a loaded question, this is one of them but we’re going to try and break down some of the common topics and dig into this a little bit. So, but maybe before we go into what causes pre-diabetes and type 2 diabetes, how would you define type 2 diabetes?

Maggie Evans – Great question, Scott, so I would think, you know, one of our main pillars that we kind of talk about when it comes to type 2 diabetes is the concept of insulin resistance. So when you think of insulin resistance, we know insulin is a hormone that our pancreas, which is a little organ next to stomach, our pancreas makes insulin which technically acts kind of like a key to a lock on the cell site that allows glucose to go into ourselves to make energy. So for us to live and be active and do the things that we want to do, so we need that mechanism to happen in order to live, essentially. In diabetes and in insulin resistance specifically, we tend to see that, that key mechanism just isn’t working as well, so that insulin just isn’t as effective at getting that glucose into the cell, that sugar into the cell, for it to make energy. So what ends up happening is we tend to see this larger amount of sugar building up in the bloodstream and then the pancreas kind of goes into a little bit more overdrive and tries to produce more insulin in a way to try and get that glucose into the cell. So we see kind of a rise in insulin and it’s just still not as effective. We also see this rise in blood sugar. So that kind of starting point where we see these rises in blood sugar but not necessarily numbers that would merit type 2 diabetes, we call that pre-diabetes. So it could be referred to as like, “impaired fasting glucose,” just “impaired glucose levels.” That might be something that your doctor refers to as that. And then once that gets to a point where the blood sugar numbers are high enough to be classified as diabetes, then we can kind of consider that, to be more so that full-blown insulin resistance.

Scott K. Johnson – And these are, when we talk about doctors checking our glucose levels and things like that, these are typically part of like, an annual physical lab exam, things like that, right? Something that the doctors would look at, on a pretty periodic regular basis.

Maggie Evans – Of course, yeah so these, especially the A1C might be on something more like, a yearly lab panel. There’s something called a complete blood count or a CBC for short and typically our glucose levels will be on there, so no matter what, if you’re fasting for those, you know, monthly or you know, quarterly labs, you can still see your fasting glucose on there and sometimes that can be that indicator that tells your provider, “Hey, these glucose levels are rising,” so there might be potential for that to develop into type 2 diabetes.

Scott K. Johnson – And I know that, understanding where diabetes comes from, what causes diabetes, it’s an incredibly complicated topic. There’s a lot that’s not yet understood and a lot that’s misunderstood. One of the things that many people newly diagnosed with diabetes think about or feel, is that they’ve done this to themselves. They’ve eaten themselves into having diabetes. We’re going to touch on some of the factors but just right off the top I want to put it out there that it’s not quite that simple, alright, that’s not quite the case, but we’re going to look at what these factors are and I like the way that you two are breaking these down into modifiable risks or things that we can actually do something about and then there’s also a handful of non-modifiable risks or things that are very much out of our control. So let’s jump into the factors.

Kristen Bourque – Yeah so, kind of as Maggie put it so well about, you know, we talk about pre-diabetes and type 2 diabetes, so when I kind of go over this a little bit, this is where it’s very important to work on those modifiable factors, like you mentioned, Scott so, if I were to put two separate columns, essentially, non-modifiable risk factors are things that maybe, again are, of course including like, age, ethnicity, a family history of type 2 diabetes, so things that of course we can’t change or modify which is why it’s called a non-modifiable factor. But there is this whole other category of modifiable risk factors, things that we can work on and of course modify to help either prevent or delay the development of type 2 diabetes but also if we do have type 2 diabetes, to help manage it better. So of course when we look at a couple things that right off the bat of course, is our intake of our, you know, nutrition, right, so our diet as well as our activity. So those are two things that can really have a substantial impact on our blood sugar values, depending on where our numbers are in terms of our weight, and we do want to preface this by saying, of course, this is something you want to talk with your doctor about, but weight loss might be a recommendation that is beneficial for you to either again, delay type 2 diabetes or again manage it better. Also there’s another piece of it too is medication so depending on the type of medications and we know that can actually encourage things like, weight gain, excuse me, as well as like, steroids which can impact blood sugar values too. So it’s hard to put that category of medications ’cause it may be something that you need to have in your life as well, so potentially could be a non-modifiable risk, but in general, it might be something where it’s a short period of time that you’re on that medication and that might be causing those values to be a little bit higher. So again we always like to encourage people to kind of look at what are the things that we can work on and change, to help improve those blood sugar values, over time as well.

Scott K. Johnson – You mentioned around the topic of weight, that often times some weight loss can actually help matters quite a bit, but what are we looking at in terms of numbers or you know, if someone is overweight, dealing with diabetes or pre-diabetes, I think they can often have this misconception that they need to go from where they are today to this super fit athlete, you know, lose a bunch of weight, but that’s not really true, is it?

Kristen Bourque – No and that’s such a great point too and this is why I kind of say, you know, make sure and talk with your doctor about kind of, where your numbers are at. Something that we do use is our body mass index, it’s a measurement of our height versus our weight, but the problem is, it doesn’t account for a lot of important factors so, you know, age, of course, muscle mass, so there’s a lot of pieces of that puzzle missing. One thing that we really like to recommend is, and you could do this at home, it’s actually just to measure your waist circumference. We found that people that have a larger waist circumference or more, we call visceral fat, so, fat in that midsection area do also have an increased risk of developing type 2 diabetes and that insulin resistance that Maggie was mentioning, so I actually prefer that, over the BMI because we can simply measure it at home, and we also know even if we don’t have a tape measure, we know, if those pants are fitting a little tighter, that maybe we are struggling a little bit. But that could be a good marker of, you know, again, even if we were to lose a couple inches, we’re also going to help improve those numbers and those other risk factors, you know, again in turn as well too, you know, again, just overall, the big picture there.

Maggie Evans – Another measure that we can use too, is just simply about 5% of your weight as well so a reduction in about 5%. So it doesn’t have to be a large number. For most people that ends up being just about 5 or 10 pounds and of course when, you know, we’re working with people and we make these recommendations, this isn’t 5 pounds in a week, it’s 5 pounds over a period of time. It’s making these slower, more sustainable changes over that period of time to really help make us more insulin-sensitive versus insulin-resistant.

Scott K. Johnson – Yeah that helps put it into perspective quite a bit. So when I look at the, and hear the list of things that are modifiable risks or things that are in my control, I’m actually quite encouraged that there’s a lot that I can do to help myself if I’m worried about or dealing with pre-diabetes or type 2 diabetes, so I really appreciate breaking it down in that way.

Kristen Bourque – Yeah and I think, Scott you bring up a great point that, I know it can seem overwhelming, especially if your doctor, you know, tells you that you have a diagnosis of pre-diabetes or type 2 diabetes but even working on one of these risk factors will help improve those values so I know it can seem a little bit overwhelming to digest all that information, but even small, small changes make a big impact over time.

Scott K. Johnson – It’s a great point, alright well, thank you, this was a quick session on pre-diabetes and type 2 diabetes but I think that we covered quite a bit. Is there anything else that either if you want to go into on this topic?

Kristen Bourque – I think we covered it pretty well yes and definitely, message your coach if you, you know want to, again work on some of these modifiable risk factors, we’re here to support you on that journey for sure.

Scott K. Johnson – Sounds good, thank you and we’ll see you again very soon for another session. Alright I hope that that was helpful and if you have additional questions or want us to dive deeper, go ahead and leave us those questions in the comments. We are happy to follow up and address them in an upcoming episode. And then I hope that you’ll come back on Wednesday, when I catch up again with Maggie and Kristen about the signs and symptoms of pre-diabetes and type 2 diabetes. Until then, stay well and we’ll see you next time, bye.


Diabetes Can Be Controlled But It Is a Constant Struggle!

Philipp was diagnosed with type 2 diabetes right after knee surgery in 2005 and his diagnosis was like a little odyssey. Before jumping into the interview with Philipp, here is what he shared about his diagnosis journey.

mySugr loves to show the many different faces and stories of people with diabetes in the real world. They do their own photoshoots and feature real people living with diabetes instead of using stock photos.

“I was diagnosed with diabetes in 2005, during the evaluation and testing to discover anything that would delay the total left knee replacement surgery.

Nobody mentioned anything about diabetes when I had blood work done the week before surgery.

But upon being admitted hours before my 8am surgery, I was told I was a borderline diabetic. I anxiously asked what does that mean? The technicians at the attending nurse stated that I had a predisposition to having diabetes.

As far as I was concerned, I either had diabetes or I didn’t. I couldn’t grasp the concept of borderline.

After surgery, and in the recovery room when I woke up, I didn’t think anymore about it.

However, once I was delivered to the ward and further tested that evening, I was told that I was now a full-blown person with diabetes. That was a shock, and I began gathering information from the staff. How could I go from borderline diabetes to having diabetes overnight? I wasn’t told what kind of diabetes I had until hours into the second day of my hospital stay. That is when I was diagnosed as type 2.

Upon my third day prior to my release, I was told that I was being prescribed oral diabetes meds and not insulin.

Several weeks later, I was dehydrated and became extremely thirsty and began drinking 32 oz. “slushy” drinks from the 7-11. One every hour.

It became so intense the next day. While my wife was at work, I became so concerned that I drove myself to the VA emergency room. After waiting more than 1 hour I was seen in the ER and after testing my blood sugar level, it was well over 300.

I was blessed for driving to the ER because my vision was super blurry and traffic was almost non-existent. What guided me mostly were the lane dividers that I could hear to guide me, muscle memory for guiding the vehicle and knowing how far away the VA was from our home.

The experiences that are key here are extreme thirst, extreme body temp rise, the extreme need to urinate multiple times in an hour, visual impairment, and potential for bad decision making that can wind up in a very serious situation.


1. What was your biggest fears/concerns when you were diagnosed with diabetes?

That it was a mistake. I wasn’t overweight, I exercised regularly and watched what I was eating.

2. What’s the hardest part/biggest struggle for you in living with diabetes day-to-day?

First was the prescription for diabetes medication that the result was not managing my sugar level. Second, not believing this disease couldn’t be eliminated. Third, monitoring my sugar regularly and the levels did not fall below 200.

3. What piece of advice would you give to a person who is newly diagnosed with diabetes?

My advice would be to research as much as possible to get accurate and reliable information regarding diabetes. Do not believe that diabetes can be eliminated. Diabetes can be controlled but it is a constant struggle.

4. Is there a phrase/statement about diabetes that drives you crazy?

Yes! The statement that diabetes can be eliminated by a regulated diet of certain meds drives me crazy.

5. When you think of the word “freedom” in terms of diabetes, what does that mean to you? What would make you feel more free?

Freedom for me would mean that diabetes can be cured in a certain amount of time.


How Telemedicine Improves Diabetes Care

How Telemedicine Improves Diabetes Care

By Heather Nelson

Rapid advances in telehealth have provided doctors a level of convenience (1) that lends itself to well-rounded patient care. In this article, we will highlight some benefits of telemedicine relating to diabetes management.

Rise of Diabetes Distance Care

Telemedicine is the use of technology in delivering medical care to patients from a distance (2). Once considered necessary for rural or underserved communities, telemedicine has transformed over the past 50 years into a vibrant, integrated service utilized by hospitals and physicians around the globe (3).

Diabetes telemedicine has combined the wonders of technology and the necessity of recurring specialty care to enable providers to be more proactive. One effect of telemedicine on the management of diabetes is that providers are able to help their patients see improved HbA1c levels (4).

As always, in the grand scheme of diabetes therapy solutions, the measuring stick has always been the almighty HbA1c. As technology improves, doctors are seeing the added benefits of reading telehealth data from sensors to measure Time-In-Range as well (TIR) (5).With both of these in mind, a new treatment option can succeed or fail based on the ability to improve HbA1c ranges consistently or provide greater time in optimal blood glucose range. This seems to be no struggle for telemedicine.

The benefits of telemedicine in diabetes distance care are so promising that the CDC (Centers for Disease Control and Prevention) ran a 2-year study in rural Alabama and Georgia (6). The outcome showed decreased hemoglobin A1c as well as average reduced travel time of over 78 minutes per visit. Based on their findings, the CDC declared that “diabetes care delivered via telemedicine was safe and was associated with time savings, cost savings, high appointment adherence rates, and high patient satisfaction.”

Additionally, another study found lower HbA1c levels as well as improved blood pressure and cholesterol levels after just one year of telemedicine (7).

These studies might seem great on paper, but you might be asking yourself…

“How can telemedicine help me manage my diabetes?”

Well, I’m so glad you asked. Welcome to “Telediabetes”!

We all know that diabetes is a chronic disease that requires regular and constant monitoring. Some providers wish to see their patients bi-annually, while others request quarterly or even monthly check-ups. The practical challenges of regular office visits can sometimes prove challenging, and in the gap of in-office care and at-home management, the person with diabetes flounders. This gap is precisely where telemedicine shines.

4 Reasons Why Real-time Feedback No Longer Requires Face-Time Appointments

  • Is the driving distance to your endocrinologist office making those quarterly visits hard to squeeze into your lunch hour? Transmit your health records and let telemedicine connect you for guidance in basal rates adjustments or dosing tweaks with less time off work.
  • Is prohibitive weather keeping you from talking with your mental health practitioner about diabetes challenges? Log into a portal and send a message detailing your snow-day concerns straight away. They can respond via email or video conference to provide real-time support and encouragement.
  • Are school absences piling-up making it hard for your child to miss another half-day for their monthly appointment? Simply log-in, upload the latest chart data you’ve been keeping, and let their doctor analyze the trends and suggest small changes. These tweaks can make a big impact in keeping them at optimal health while keeping them in school and learning (8).
  • Have travel challenges made your food dosing questionable? Send a message to your certified diabetic educator (CDE) and let them guide you to healthier solutions and safer swagging.

Whatever reason you have to miss out on those essential office visits, telemedicine doesn’t judge. Telemedicine understands.

With Great Tech, Comes Great Responsibility

The rapid advances of tracking devices and sensors mean we can readily gather reliable glucose data in a fairly simple manner. But that’s not the full picture your healthcare team will need. We all know that taming the diabetes monster requires a multi-faceted approach. The rise of newer and better diabetes management technology has perfectly poised the diabetic community to benefit from telemedicine and all it has to offer including lifestyle modifications, mental health checks, and more. But we must have solid data to reap those benefits.

The best way to take advantage of all the rewards of telemedicine is to provide good and useful data. The more data you can afford, in a succinct and readable format, the better distance care your provider can give. Utilizing technology means you should be able to provide food records, insulin doses, basal and bolus rates (for our pump-loving friends) as well as activity, health events, and other biometrics like Ketones, HbA1c readings, weight and body measurements.

Beyond the tracking of data itself, presentation also matters. Clearly you can’t courier-pigeon over a stack of origami-worthy paper logs and in this day and age, you shouldn’t have to. Organize your logs into a format that is easily accessible for your healthcare provider. If they need CSV, Excel sheets, or PDFs, provide what they can read.

How mySugr PDF Reports Makes Data Sharing Easy

If you are reading this and genuinely shocked to learn that you need to log things like insulin dosing and food intake, allow us to usher you out from under your rock and into the age of technology by introducing the reporting feature in the mySugr app! Indeed we believe you are the captain of your pancreas. As such, the ability to harness all your well-tracked data into usable information for you and your doctor is a key focus of our app. Using the reports feature you can quickly:

  • View your own data at a glance, anytime, to see trends.
  • Select your own time period to see only the data you wish to discuss. No more information overload or sifting through months of records needlessly.
  • Send preferred data to your doctor via email for quick communication about necessary formula changes. Even select from one of our three output formats for optimal communication.
  • Stay in constant communication and more!

Using the data in these reports, you can truly be the master of your own fate. The reports are meant to empower you as you discuss your treatment decisions with your provider, making the conversation more constructive and putting you back in the driver’s seat of your care.

And for our US friends in the diabetic online community (DOC), we still have our fabulous bundle! mySugr has over 2 million registered users to-date and a 4.6+ rating on the App Store and Google Play. The mySugr Coaching service is second-to-none and utilizing our monthly subscription gets you:

  • Blood glucose meter
  • Lancing device (with a box of refills…so that’ll last you basically forever, amiright)
  • Unlimited test strips (new shipments arrive before you even run out!)
  • The mySugr Pro App (that includes the ability to estimate the HbA1c!)
  • Diabetes coaching (with a pretty top-notch team)
  • Free shipping

And all the tech-support a person could need!

Indeed, we believe telemedicine is here to stay (9) and with good reason!

People living with diabetes can find more freedom and a better quality of life with the rising accessibility of a healthcare team armed and ready to interpret and predetermine the many responses to all the data we track.

As always, mySugr stands on the edge of change ready to help usher in this new age with open arms and glucometers for all Rise up mighty warriors and embrace the freedom of “telediabetes”!

(1) Wicklund E. Leveraging Primary Care Telehealth for Convenience and Quality. White LA, Krousel-Wood MA, Mather F. Technology meets healthcare: distance learning and telehealth. Jan. 2001.

(3) eVisit: The Ultimate Telemedicine Guide | What Is Telemedicine? 2018.

(4) Hompesch M, Kalcher K, Debong F, Morrow L. Significant improvement of blood sugar control in a high risk population of type 1 diabetes using a mobile health app – A retrospective observational study. Poster presentation at ATTD 2017, Paris, France.

(5) Beck R, Bergenstal R, Riddlesworth T, Kollman C, Li Z, Brown A, Close K. Validation of Time in Range as an Outcome Measure for Diabetes Clinical Trials. March 2019.

(6) Xu T, Pujara S, Sutton S, Rhee M. Telemedicine in the Management of Type 1 Diabetes. 2018.

(7) Steven Shea, MD, Ruth S. Weinstock, MD, PhD, Justin Starren, MD, PhD, Jeanne Teresi, EdD, PhD, Walter Palmas, MD, Lesley Field, RN, MSN, Philip Morin, MS, Robin Goland, MD, Roberto E. Izquierdo, MD, L. Thomas Wolff, MD, Mohammed Ashraf, BA, Charlyn Hilliman, MPA, Stephanie Silver, MPH, Suzanne Meyer, RN, Douglas Holmes, PhD, Eva Petkova, PhD, Linnea Capps, MD, Rafael A. Lantigua, MD, PhD, for the IDEATel Consortium. A Randomized Trial Comparing Telemedicine Case Management with Usual Care in Older, Ethnically Diverse, Medically Underserved Patients with Diabetes Mellitus. Jan-Feb. 2006.

(8) Please note that all mySugr products have a minimum age limit of 16 years for the mySugr Logbook and 18 years for the mySugr Bolus Calculator (for more details please read mySugr’s General Terms & Conditions).

(9) Klonoff David C., M.D. Using Telemedicine to Improve Outcomes in Diabetes—An Emerging Technology. July 2009.


Should You Be Afraid of Insulin?

It’s an all-too-common fear for people with diabetes. There is the completely natural fear of needles, but depending on the messages they’ve received from their care providers along with the experiences with insulin from other people in their family or circle, they can feel like insulin is the last resort or that they’ve failed on everything else. We’ll dive into all of that.


  • What is insulin
  • Why is it prescribed
  • Common messages and fears
  • Should you be afraid of insulin?


Scott K. Johnson – Hey, thanks for tuning in to another episode of Coaches Corner. It is great to see you again. Let me know where you’re watching from today. I’d love to hear that. Post it in the comments. One small way that mySugr is giving back is by hosting the short conversations with our diabetes coaches, to talk about staying healthy in body and mind. We really appreciate you sharing some time with us. Now I do have to give the standard disclaimer. We cannot provide medical advice. Please contact your doctor directly for specific questions about your care. Today my sugar coaches Kristen and Maggie, talk about if insulin is something to be afraid of. Let’s take a look. And hi Maggie. Today we are talking about being afraid of insulin which is something that is quite common, especially for those who are new to diabetes, don’t really understand some of how it all works. But maybe we should start with some of the basics. So what is insulin?

Maggie Evans – Yeah, great, great start. So it is always useful to break down the basics. So we hear in the word insulin quite a bit. So I agree kind of, you know, understanding what that is. Insulin is a hormone that’s created by our pancreas or pancreas, it’s kind of right next to our stomach, and insulin is released in response to a meal. So when we eat a meal that’s broken down, and it tends to raise our blood sugar. So when that blood sugar response increases, that’s when insulin is released into the bloodstream. Now, when we explain the mechanism, mechanism of insulin, it’s helpful to use a term of just like a lock in a key. So imagine there’s a bunch of little locked doors on the outside of a cell, and insulin is that key to unlock the door to allow glucose into the cell. So when glucose is allowed in, that helps us create energy and helps us live our lives and do our thing. So thinking of insulin in that way, that it’s just simply a hormone that our bodies already make, I think can kind of help break down that barrier a little bit more too in terms of if it is something that ends up being prescribed.

Scott K. Johnson – Yeah, great point. So let’s from there, ask the question, why is insulin prescribed? If our body is already making it, what leads us to then need it as far as a prescription?

Kristen Bourque – Yeah, so Scott, I think, when we talk a little bit about first the differences between type one and type two, and we’ll talk more about this in our conversation. But essentially, insulin is provided as a treatment for diabetes. So with type one, our pancreas is no longer producing insulin. So there are multiple types of insulin that are provided to help essentially regulate the blood sugar right? With type two, generally what happens over time is the pancreas produces less insulin. So maybe additional insulin might be needed along with the use of oral medications to help regulate blood sugar.

Scott K. Johnson – And it’s, there’s actually quite a few misconceptions about insulin right? Can we dive into some of those? So especially, and I think this is one that’s, that I hear most common is the feeling of, of being a failure, right? Or the doctor saying, all right, let’s try with type two diabetes, as you mentioned, let’s try this this and this, and there’s always this phrase that if that doesn’t work, then we’ll start on insulin right, so it can be a hard step for people to take.

Kristen Bourque – And I think that you bring up such a great point Scott ’cause unfortunately sometimes we hear this kind of being almost used as a maybe a scare tactics sometimes for patients as well. If you don’t follow this and that insulin will be put on your regimen. And so I think there is a lot of unfortunately, negative kind of connotation around insulin. But the important thing to remember is with type two diabetes especially is over time. Again, as I mentioned, the pancreas produces less insulin, it can be up to 75%. So even if we’re doing, you know, diet, exercise, oral medications, we still might not get those numbers that we’re striving for. So yes, it’s very important to kind of wash away those ideas of feeling inadequate or like a failure because what we’re doing and those behavior changes may only sometimes bring us so far. So this is important to remember, is to rely on your healthcare team to find a way of providing you with various options for medications and whatnot to kind of find the best thing for you and ultimately, our goal is right to manage our blood sugar. So insulin may be put on the table, as just another option for you and it does nothing to mean that you did anything wrong in your management of your diabetes at all.

Maggie Evans – I think also emphasizing the fact that just like everybody’s body is different, everybody’s diabetes is different. And that your management of diabetes is going to look different than your neighbor with diabetes or someone else with diabetes. So recognizing that your body’s response to somethings just like what Kristen said, might be different than other people, and you just might well, need insulin. And yet again, breaking down the barrier to that and just recognizing that it is simply that hormone that we already produce, and sometimes we just need a little extra help along the way.

Scott K. Johnson – I love that. There’s a one of my good friends. His name is Bennet. And he has a catchphrase that he says that your diabetes may vary. And it really what it comes down to is right, whatever it takes to manage your blood sugars in a way that works for you. And so you’re able to meet your diabetes management goals, and also your quality of life goals. And it’s different for everybody. So I’m so glad that you mentioned that. What are some other misconceptions around insulin?

Maggie Evans – I think there can tend to be a fear of injections or a fear of needles, fairly common for a lot of people with diabetes. But recognizing that now there’s so many different options and the technology in the diabetes world is just advancing. I feel like every day I hear something new. But there’s other ways around giving yourself insulin injections either every day or with every meal. Now we have pumps that are available. So the pump system uses a little smaller needle that tends to just go right under the skin and barely noticeable. But that can be another way to reduce the amount of injections that you’re given throughout the day or throughout the week. And also knowing that the syringes now, the advancement in the needles is much better, they’re much smaller, they’re thinner, so you can barely feel them. So that makes it much less painful. I’ve even had people tell me that their actual insulin injections are much less painful than just their finger pricks for their, for their glucose checks, so, really interesting to hear that. But just knowing that there are other options and now they’re even coming out with an inhalable insulin, which is very effective as well. So if there is that fear of needles or fear of it being painful, reach out to your providers, reach out to your diabetes care team, let them know these concerns. And there’s always going to be options available. So just as long as you let people know what you’re feeling that can help us and your team kind of direct you in the right direction.

Scott K. Johnson – I’m glad you mentioned that, that open conversation. So if my provider has prescribed insulin, but I’m struggling to take that insulin because of the fear of needles, which, by the way, is completely normal, there is nothing normal about poking yourself with sharp objects, so but like you say, maybe talking with your, your team about the challenges that you are facing in doing what they ask of you, that makes a big difference. So what else are we dealing with?

Kristen Bourque – Oh, when I was going to just add to that kind of what you and Scott, Maggie you mentioned is kind of that fear of the unknown. I think too, with that, with the injection piece of it too. So, like you mentioned, Scott is talking to your healthcare team. But also a lot of times especially when initially prescribed that they’ll do a demonstration with you. So that kind of fear of the unknown, maybe having someone kind of walk it through with you, versus just kind of sending you home on your way, also will, I think help kind of minimize that fear over time too. So yeah, the next thing I would say, of course, is the fear of weight gain, we always kind of get this. And this would also be, the case of certain oral medications as well. But I think that insulin and weight gain are oftentimes associated together. But it’s important to remember that some patients will experience this overall, it helps the body to use food more efficiently. But again, this is going back to is everyone’s different, this isn’t going to be a for sure, side effect that happens. But it is again, going back to talking to your health care team about some of these fears or concerns that you have, in regards to I don’t want to gain weight once I go off, go on insulin. So just kind of let your doctor know, but important to still maintain, healthy diet and activity and all those things as well, to help kind of mitigate that as well, too.

Scott K. Johnson – Great, yeah, that makes a lot of sense. So if we, if we were to kind of wrap this question of should I be afraid of insulin? In a summary, few points, what would that look like?

Kristen Bourque – Of course, no. But just to kind of go off of some other reviews that we’ve mentioned, is that, I think, again, it’s very important to talk with your healthcare team about your concerns about your fears about this. They’re there to get, provide support and be there with you through this journey, but let them know kind of what your thoughts are around it, and see if they can kind of help you to feel more comfortable. But and then kind of just going off of what Maggie had mentioned is there’s so many different options for insulin nowadays, too. So this is another conversation to have with your provider is what you feel more comfortable with. Some people like to use a pump. Some people like to use insulin injections. So again, these are great options that we have that we did not have years ago. So you can ask someone that has had diabetes for quite some time, the differences in the technology and the needles and everything. So, you know, it’s great to know that there’s options available as well, so.

Scott K. Johnson – That’s great, that’s great. And I think that, it’s a very, very useful tool in the diabetes management toolbox. And if you’re struggling to meet your goals on the therapies that you’re using now, and the idea of insulin is there, it might be a way that you finally feel successful in doing what you need to do to get your blood sugars where they need to be. So I think it’s a very powerful tool, and not something to be afraid of. So thank you, thank you for breaking that down a bit.

Kristen Bourque – Yeah, and I think it’s like you said, Scott, it’s, and it’s an important thing to remember that it’s, it will get you closer to your goal. And that’s of course, what we want to focus on, is to manage our diabetes to manage it well. So insulin is just one of those other therapy options that’s available to us. And it’s a great option. So something to be again, a little bit less fearful and more open-minded if it comes up in conversation with your doctor.

Scott K. Johnson – Makes sense, great. Thank you. Well, with that, let’s wrap this session up and we’ll be back again soon. All right, I hope that was helpful. Carol, great to hear that this helps with your expectations, should insulin become a thing for you. Today was actually our last live episode of Coaches Corner. We have really enjoyed our time together. And for those of you who are using the mySugr bundle, I encourage you to continue asking great questions to your coach. They are there for you and happy to support you in your journey of living well with diabetes. If you would like to review any of the information in past episodes, we’ve pulled everything together into a single place, and we’ll put the link here for you. With that stay well, have a great weekend, and I hope to see you again sometime soon.


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