The use of digital diabetes coaching systems continues to expand, and a debate during the Scientific Sessions will examine the value of these systems.

Debate—Digital Coaching Systems for Type 2 Diabetes—Are They Worth the Cost? will take place from 1:45 p.m. – 2:45 p.m. ET on Saturday, June 26. Anne L. Peters, MD, Professor of Clinical Medicine, Keck School of Medicine of the University of Southern California, and Kasia J. Lipska, MD, MHS, Associate Professor of Medicine, Yale School of Medicine, are the featured debaters and offered ADAMeetingNews.org a preview of their discussion.

What will you cover during your presentation?

Dr. Peters: I will discuss the history of the systems and digital coaching before they became “a thing,” and then talk about how they’ve evolved from just being about blood sugar or weight to incorporating a variety of elements. These are more integrated and entail overall chronic disease management, so that increases their value right there. It’s all about how you integrate these systems effectively into care. It’s a piece of a puzzle rather than the solution.

Dr. Lipska: There is no question that digital technologies have the potential to help people with diabetes manage their chronic condition better. But we should pause and ask whether the rapid adoption of—and huge investment in—digital coaching for diabetes systems is really good value. I will be discussing gaps in the evidence base and challenges with digital coaching for diabetes.

What are the key messages from your presentation?

Dr. Peters: Digital coaching has been shown to work in terms of glucose management, weight reduction, blood pressure management, and in the psychosocial domain in terms of those with depression and anxiety.

There are now a variety of programs to choose from. People can choose which system they like the best, although that is limited to some degree by what is reimbursed by their insurance. And these systems must be individualized. People who want them should have access, but it shouldn’t be forced upon people for whom this is not the best way.

Diabetes management is so integrated into somebody’s life. You don’t just generally take one pill and it’s gone. You have to take medication. You have to change your lifestyle. You have to be mindful.

Dr. Lipska: The digital diabetes care market will be worth upward of $700 million in 2022. However, very few randomized clinical trials have evaluated the effectiveness of digital diabetes coaching. The existing studies lack robust designs and long-term follow-up. So I think we are getting a bit ahead of the evidence with widespread adoption of these systems.

My second point is that motivational coaching can be valuable for many people with diabetes. However, motivational coaching—particularly when it is scripted and algorithmic—does not solve the issues many patients face with self-care. Self-care has to fit for each patient in the particular context of their own life. And problems of “fit” are not problems of motivation but rather of solving practical issues.

Finally, while digital coaching may benefit those with the technical literacy and numeracy skills to interact with them, many people with diabetes still lack access to basic health care and insulin, which are life-saving and may represent more pressing problems to address.