Unlocking the potential of remote monitoring for your diabetes patients is more than just accessing new data – it's about pairing it with thorough reviews and adjusted care plans based on this information.
That’s why at SweetSpot, our promise of empowering your team to access crucial CGM & Insulin data for your entire patient population is paired with support from our dedicated team of Certified Diabetes Care & Education Specialists. Our clinical team collaborates with our clinic partners to triage high-need patients, analyzes their CGM and/or Insulin data, and offers quality management recommendations for the doctor’s approval as well as counseling to the patients on how to implement those changes.
Continue reading to learn about the strategy and successes of the SweetSpot clinical team from our Director of Diabetes Education and Clinical Services, Jodi Hughes.
Approaching Patient Reviews: A Continuous Journey
At SweetSpot, our approach to patient reviews is centered around a continuous process. We don't just assess a patient's condition during a single visit and then wait months before reassessing. Instead, we take a holistic view of their progress, constantly evaluating what has changed, where they were, and where they are now.
Continuous Evaluation
We start on SweetSpot, which easily allows us to see how the patient’s glycemic health has changed since their last visit, and to view their up-to-date CGM and/or insulin report(s) remotely. We delve deep into their progress notes, lab values, and recent trends to gain a comprehensive understanding of their health journey. This allows us to make incremental adjustments that aim to effect change without overwhelming the patient.
For instance, if a patient is experiencing nocturnal hypoglycemia alongside spikes after meals, we prioritize addressing the most pressing issue first — ensuring their safety by stabilizing their nocturnal lows. Once achieved, we pivot our focus to managing postprandial spikes, gradually tackling each concern in a prioritized manner.
"We'll address both concerns with the patient, but we take a marathon – not a sprint – approach. My priority is ensuring immediate safety. Once we've stabilized the situation, we can then focus on achieving that long-term stability."
The AIM Methodology: Assess, Implement, Monitor
I personally operate with what is often referred to as the ‘AIM’ methodology — which is to Assess, Implement, and then Monitor. This structured approach truly guides our decision-making process when it comes to patient care.
Assessment
We begin by thoroughly assessing various aspects of the patient's condition, from their medication adherence to their blood sugar trends. This initial step lays the groundwork for informed decision-making.
We ask ourselves:
Does it look like the patient is bolusing for their meals?
Are their fasting numbers in range? Are their 2-hour postprandial numbers in range? (SweetSpot also provides this information automatically!)
Looking at their previous notes, are they compliant with their medications? Are they adhering to their medication regimen? Have they had new changes to their medication regimen?
Implementation
Based on our assessment, we now want to implement targeted changes tailored to the patient's needs. Whether it's adjusting medication regimens or recommending lifestyle modifications, each action is carefully considered.
Monitoring
Continuous monitoring is key to tracking progress and fine-tuning our approach. We closely observe how the patient responds to the implemented changes, making necessary adjustments along the way. With SweetSpot’s comprehensive data dashboard, I can very easily check in on patients for whom I’ve recently made treatment changes.
Effective Communication with Healthcare Professionals and Patients
Effective communication is pivotal in ensuring seamless coordination between healthcare professionals and patients.
Communicating with Healthcare Professionals
We communicate our recommendations to healthcare professionals through their own Electronic Health Records (EHR), facilitating swift review and feedback. This streamlined process enables efficient and collaborative decision-making, ultimately benefiting the patient.
Engaging with Patients
When conveying changes to patients, we prioritize clarity and support. We utilize phone calls, text messages, and portal messages to ensure patients understand and can implement the recommended adjustments. By providing guidance on utilizing medical devices or interpreting data, we empower patients to take control of their health.
Plus, patients truly appreciate the extra communication about their care.
What I've discovered is that when I reach out to patients on behalf of their doctor, they express genuine happiness that someone has taken the time to proactively consider their well-being.
"In our conversations about their care, it's not uncommon for patients to express sentiments like 'my healthcare team truly cares about my health!' This sense of being seen and valued enhances their trust and affinity towards their healthcare provider."
In fact, we once called a patient after noticing that his time spent in the low range increased from 2% to 7% in one month. He told us, “I’ve had diabetes for over 13 years, and no one has ever proactively reached out to me to check on me and my lows.”
But here’s the best part: After adjustments agreed to by the patient’s HCP, some basal rates were adjusted as well as one correction factor setting. Since these setting changes, patient has had no lows (0% < 70 mg/dL) and an increased time in range to 88%.
Enabling Better Patient Care through Technology
At SweetSpot, technology plays a vital role in enhancing patient care and monitoring.
Comprehensive Dashboard
Our comprehensive dashboard provides quick access to essential patient data, allowing for efficient monitoring and timely interventions. With features like real-time tracking of metrics such as time spent in low ranges, we can proactively address emerging issues before they escalate.
SweetSpot has significantly streamlined the process of triaging patients, allowing practices and our SweetSpot team to efficiently and proactively manage a larger patient load. This means that care teams can dedicate more time to thoroughly reviewing reports and discussing pertinent changes with patients, rather than getting bogged down by administrative tasks like logging in and downloading reports.
"Even if I wanted to check on a patient every single day to assess their progress, it would only take me 60 seconds or less to do that with SweetSpot.”
Filtering Tools
Utilizing advanced filtering tools, we identify patients in need of immediate attention based on specific criteria such as changes in health status since the last review or time spent within certain parameters. This enables us to prioritize interventions and allocate resources effectively.
I usually start by filtering for low time spent, focusing on those experiencing frequent hypoglycemia. If I notice a significant increase from previous reviews, like someone going from 2% to 10% in a month, it's a red flag. It could indicate medication errors or other issues needing attention, such as mixing up long-acting and short-acting medications. Being able to filter by GRI (glycemia risk index) too, I can also triage patients who need support because this newer metric considers hypoglycemia and hyperglycemia components.
That all would’ve been very difficult – if not impossible - to identify without SweetSpot and the filtering capability.
Empowering Patients, Ensuring Safety
At SweetSpot, our commitment to going above and beyond for our patients is unwavering. Through continuous evaluation, strategic interventions, and effective communication, we strive to empower patients to lead healthier lives while ensuring their safety and well-being remain our top priorities.
Want to learn more about SweetSpot and how we are revolutionizing diabetes management? Check out our website or shoot us a message at info@sweetspot.health.
SweetSpot is a remote diabetes management platform that integrates with multiple CGM and insulin delivery devices, like Dexcom, FreeStyle Libre, Tandem, Medtronic, and more, to provide physicians with a single view of their patients’ data. SweetSpot's intelligent algorithm identifies the most optimal CPT codes for both remote and in-person diabetes management, and a dedicated team of Certified Diabetes Care & Education Specialists are available to provide ongoing support.
As a company founded and powered by physicians and diabetes care providers, we place a strong emphasis on ensuring that there are no obstacles to getting started with SweetSpot. That’s why SweetSpot is easy to set up and designed to seamlessly integrate into your existing workflows and comes with no setup costs or subscription fees.
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