Use it or lose it: the hidden cost of diabetes technologies

Stephen W. Ponder MD, FAAP, CDCES

2018 ADCES Diabetes Educator of the Year

Since the creation of insulin itself, there has been a growing dependency on technology in the day to day life of persons with diabetes. Diabetes technologies aim to make self-care tasks easier to perform, more accurate, and often faster to complete. Hopefully, the mental burden of diabetes decision making is lightened. But can things be lightened too much? Are persons with diabetes at risk for becoming so tech-dependent that their core competencies start to wither? Might a point be reached where the person will contribute almost no decision-making roles in their own insulin delivery process, aside from maintaining the hardware and infusion apparatus of a CGM enabled insulin pump?

Blood glucose and ketone monitoring were originally cumbersome and time consuming processes. These now require mere seconds to perform. Insulin dosing is largely automated in partial closed loop delivery systems. Documentation of self-care data has long ago been replaced by meter memory cards and/or wireless apps which track every aspect of patient care. We have handed over much of our daily lives to technology. After all, when was the last time anyone had to memorize a telephone number or use a paper map to navigate?

As technologies continue to marginalize the role of the person with diabetes, does this create an increasingly high level of dependency on these devices and systems? In the absence of a complete cure, how far can we safely separate ourselves (with technology) from the cognitive principles of diabetes self-management? Are persons who use high-tech diabetes management tools at risk for fragmentation of their foundational self-care skills and problem-solving abilities when their technologies are disabled or not accessible? Lastly, how can diabetes care and education specialists act to mitigate patient “de-skilling”? The term “de-skilling” has arisen to characterize the phenomenon of loss of core self-care skills through prolonged use or dependency on diabetes technologies.