“Diabetes uniquely requires patients be experts in their own care and demands 24/7/365 vigilance. Close communication with a health care team eases the burden and improves outcomes.

Glucose management revolves around numbers. Unfortunately, numbers are just noise unless translated into actions. Innovations, such as color for people with low numeracy, are essential for improving outcomes. Alarmingly, 80 million, fully one-fourth of our population, have low literacy and numeracy.

People want to better care for themselves; they just need to be shown how. With a diabetes self-management tool in the palms of their hands, people can use colors to engage and more effectively care for their diabetes.

Society also benefits if health care disparities lessen. When access to care is more equitable, people with diabetes should increasingly see those indicators move from red to green.”

Elizabeth Holt is an endocrinologist.

She shares her story and discusses her KevinMD article, “If we better manage diabetes, can we better manage COVID?”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show, we have Elizabeth Holt. She is an endocrinologist, and her KevinMD article is titled “If we better manage diabetes, can we better manage COVID?” Elizabeth, welcome to the show.

Elizabeth Holt: Thank you, Kevin. I’m happy to be here.

Kevin Pho: We’ll get to the article in a little bit, but first off, can you share your story and journey to where you are today?

Elizabeth Holt: Sure. So as you said, I’m an endocrinologist. I spent 28 years in private practice of endocrinology in North Carolina. During that time, I was active in medical societies locally, regionally, and nationally. I’ve even lobbied politicians locally, in my district, and in my state. I’ve been in the halls of Congress in Washington, D.C., lobbying for changes to improve the lives of patients. I’ve also partnered with for-profit and not-for-profit companies, again on causes to improve lives for people.

Then in December of 2019, I pivoted and joined industry, and I did that to reach even more people and have the capability to impact even more lives. I’ve been with LifeScan, maker of the OneTouch brand of products for people with diabetes and related conditions, since September of 2020 as their chief medical officer.

Kevin Pho: Now, for physicians who are connected or involved with industry, how does that make the lives of patients better? Because there are a lot of physicians I talk to who always wonder, “Why should I be involved with this company?” But from your perspective, how does working with industry, specifically as a physician, improve the lives of patients?

Elizabeth Holt: Well, for me, I came in with nearly three decades of experience in direct patient care, and I’m bringing that every day as we’re designing products. I’m always thinking, “Well, how will this impact patients, and how will it impact their health care providers? What can it do to make their lives better, to make it easier, to reduce the burden?” And so I always have that thought of the patient. With all the experience I have, I have a very good feel for what works, what doesn’t, what’s helpful, what isn’t, and what gets in the way.

Kevin Pho: Now, when making that transition from your decades-long experience with clinical practice into industry, has it been what you expected?

Elizabeth Holt: No, both. I’ve been able to do what I was hoping to do and to impact broadly on a lot of people, and yet there’s an awful lot of paperwork and standard operating procedures and policies that we have to follow, as there should be. But it’s been a new experience.

Kevin Pho: Now, for those other clinicians listening to this podcast who are interested in following your footsteps into industry, what’s one piece of advice that you could share with them?

Elizabeth Holt: I think the thing that I learned the most isn’t actually about industry, but my patients were my best teachers. I learned the most by paying attention to what they told me, being humble, and being open to new ideas and new concepts. And we do that at LifeScan, so I was able to take that experience and then transition it.

Kevin Pho: All right, let’s transition into your KevinMD article. It was written back in April. It’s titled “If we better manage diabetes, can we better manage COVID?” Now, for those who didn’t get a chance to read your article, just walk my audience through it and share the story of why you decided to write it.

Elizabeth Holt: Well, we published an article last year, in 2021, in Diabetes Spectrum, and it was results from a study we did that we called Tu Salud. It was a study that we did in people with diabetes, and it really struck me because what happened was that we leveled the playing field. We paired our OneTouch Verio Flex blood glucose meter, which has a color-range indicator that pairs a color with a glucose number, with our OneTouch Reveal app and then health care provider feedback. The study subjects who had lower numeracy skills were able to achieve the same glycemic benefits from measuring their glucose numbers as subjects who had higher numeracy skills.

That really struck me, especially as we think about underserved populations. And then in COVID, we really realized how very vulnerable those underserved populations are and how important it is to provide tools for everybody, all people with diabetes in particular, that decrease the burden of disease management and improve glycemic outcomes. That’s part of our mission at LifeScan. We want to deliver personalized health and wellness experiences to engage people with diabetes and related conditions to live their best lives. And so that’s what inspired me to write that article.

Kevin Pho: So tell me in particular how your product works for those people who have limited numeracy skills. How does that work in practice?

Elizabeth Holt: So we have blood glucose meters where, on the face of the meter, there are colors, and then there’s an indicator that will point at one of the colors depending on whether the glucose number shown on the meter is within that person’s target range or not. The indicator will point at the blue end of the range if the glucose is below their target range, green if it’s within the target range, or red if it is above the target range. So you can know at a glance just by looking at the meter and looking at the color, even if you don’t understand numbers. And even if you do understand numbers, it’s quick to just look at a color. So it makes it easy to understand even if numbers are not your thing.

Kevin Pho: Now, you’ve had decades-long experience as an endocrinologist. What proportion of your patient population, when you were still in practice, had problems with numeracy skills?

Elizabeth Holt: That’s a great question, and it’s not something I actually asked my patients, and I probably should have, because we take it for granted that people understand what their numbers are, especially in diabetes. We tell them, “We want you to be in a certain range,” assuming that they will know at a glance if the number they see is below that or within that or above it. And maybe they don’t know that a certain number is between two others.

Kevin Pho: And you make that connection between diabetes care and COVID. So talk more about that connection. If we could better manage diabetes, how does what you’re talking about relate to how we can better manage COVID?

Elizabeth Holt: Sure. Well, in COVID, 40 percent of the deaths that happened during COVID were in people with diabetes. People with diabetes are more likely to get COVID and to have worse outcomes. And then underserved populations are often the frontline workers who are more exposed to COVID. So if we can better manage their glucoses and get their diabetes in better control, maybe they won’t be as susceptible. Maybe they’ll weather it better if they do get COVID and come out on the other end healthier and surviving.

Kevin Pho: So how do you anticipate the findings of the study potentially changing practice going forward?

Elizabeth Holt: Well, I would hope that health care providers will pay more attention to the fact that people don’t necessarily have the literacy and numeracy skills that we assume they do. In the United States, I’ve seen that 80 million people, which is fully one-quarter of our population, have low literacy and low numeracy skills. So this is very relevant for very many of our patients, and we need to take that to heart and give our patients the tools so they can actually benefit from the things that we’re asking them to do.

I’ve seen so many times where people come in and they didn’t bring their logbook because they’re not keeping it, but they don’t tell me that. Or they have numbers and they’re not in range, but they haven’t taken any action because they don’t understand that. We have done research that shows that when we associate color with a number and show that to patients, they will say, “Oh, I’m more likely to take an action. I will do this, that, or another,” compared to when they see it on a black-and-white screen.

Kevin Pho: So let’s take a step back. Now, for those podcast listeners who are not clinicians and may not be familiar with diabetes care, why are numbers so important? And give us some of the challenges diabetics face when it comes to reading glucometers that you see from your experience.

Elizabeth Holt: Sure. So diabetes often revolves around the blood glucose numbers. We want to keep the blood glucose in a very tight and narrow range in the body, which is where it is normally. But in people with diabetes, oftentimes it can be much above that range, with high glucose, and sometimes, unfortunately, below that range, which can cause immediate problems. High glucoses cause problems more in the longer term. Years of having high glucoses can do damage to different organs in the body that can end up causing heart attacks or blindness or kidney failure or amputations.

So we want to keep the glucose in a very narrow window. That means that we need to measure it and then act if the glucose is not in range or is starting to move out of range, and people need to understand their numbers in order to do that.

Kevin Pho: And when it comes to glucometers, and you’re certainly more familiar with this than I am, being involved with the industry, what are some of the current trends, and what do we have to look forward to in terms of that technology?

Elizabeth Holt: We want to make not just glucometers but all devices that people use for diabetes easier to use, more intuitive, and more helpful. And so not only pairing colors with the numbers but giving advice and messages. One of our meters, the OneTouch Verio Reflect, gives messages. We call them Blood Sugar Mentor messaging, and they give the people using them guidance, insight, and encouragement regarding their blood glucose numbers, not only what their number is right now, but it will also look for patterns and patterns of patterns. When we pair that with our OneTouch Reveal app, which the patients can access at no charge on their smartphone or computer, it allows them to get even more insights into their glucose management.

And then we’ve taken that: We have an ecosystem, so health care providers can get the OneTouch Reveal health care professional app. When the patients give permission and connect to the health care provider’s clinic with a code, the health care providers have access to their numbers and can view the patient’s data. So if a patient is having a problem and calls the office between visits and says, “My numbers are running high,” or, “They’re running low,” the health care provider can then log in and see exactly what the patient’s talking about. Or if it’s a telehealth visit, the data is there.

So how do you get all your blood glucose numbers to your doctor if you’re not there to bring your logbook? Well, this is a way of doing it. It’s in the cloud and accessible. Or you go to the doctor’s visit and you forgot your logbook or your meter; it doesn’t matter. It’s in the cloud, and the data is accessible. So we’re really improving patient care by doing things like that. We’re always looking to innovate and make our meters and our apps even better.

Kevin Pho: We’re talking to Elizabeth Holt. She is an endocrinologist. Her KevinMD article is titled “If we better manage diabetes, can we better manage COVID?” Elizabeth, what are some of your take-home messages that you want to leave with the KevinMD audience?

Elizabeth Holt: I think the world and things are very tough right now, and sometimes we’re getting discouraged, but I want people to know that you’re not alone. While you might not think of industry as a partner, you actually do have allies in industry, and we’re thinking about you, whether you are a patient or a health care provider, or often you’re both. We want to innovate in areas that will impact your health and well-being and reduce the daily burden for you.

Kevin Pho: Elizabeth, thank you so much for sharing your time and insight. Thanks again for being on the show.

Elizabeth Holt: Thank you, Kevin. Happy to be here.