Diabetes Forecast

What to Know Before You Sign Up With a Virtual Coach

By Matt McMillen ,

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Everyone can use a coach now and then, someone to educate, guide, and cheer from the sidelines. If you have diabetes, a coach can work with you to create a personalized plan to meet goals that will help you better manage your disease. A coach can also provide encouragement and support.

In traditional health care settings, people with diabetes are often told what they need to accomplish, such as losing weight and eating healthier, but aren’t given enough assistance along the way. “A coach can help them develop an effective plan and see it through,” says Gary Scheiner, MS, CDCES, owner and clinical director of Integrated Diabetes Services in Wynnewood, Pennsylvania.

There’s no official definition or certification for “coach” in diabetes care. Instead, the term is used because of what it connotes. A diabetes educator, registered nurse, registered dietitian, and other experts can all be coaches. “The ability to inspire and motivate is intrinsic to being a successful coach,” says Scheiner.

Virtual Reality

Technology allows you to access a virtual coach whenever you need it. This can be especially useful for people who live far from their health care providers or who have mobility issues that make in-person appointments difficult.

“We know that face-to-face education and coaching are effective, and digital tools enable you to connect to coaches and education without the logistical barriers of in-person, face-to-face meetings,” says endocrinologist Aaron Neinstein, MD, an assistant professor of medicine at the University of California–San Francisco and director of clinical informatics at the UCSF Center for Digital Health Innovation.

Given the enormous number of people with diabetes and the limited number of health care providers, availability is a key advantage of virtual coaching programs, says Neesha Ramchandani, PhD, PNP, CDCES, a certified diabetes care and education specialist at New York University’s Rory School of Nursing. “A larger number of people can access diabetes care and education,” she says. In the past few years, health companies have begun to offer virtual coaching apps to more easily meet the needs of people with diabetes by providing ready, often round-the-clock access. Because of the way they’re designed, virtual coaching apps don’t require approval by the Food and Drug Administration; as a result, they can’t make treatment decisions. Some are staffed by live people offering advice, while others use artificial intelligence (AI) software to make recommendations. Some apps offer both.

People Helping Out

Certain coaching apps connect you with a diabetes educator or other diabetes specialist for video or text chats on your phone or computer. If you struggle to reduce your carb intake, for example, your coach can work with you to determine your particular roadblocks in order to clear the way to healthier eating. These apps can help you address big-picture issues such as overcoming diabetes burnout, along with immediate concerns such as navigating an abnormally high or low blood glucose reading.

Machine Learning

For some virtual coaching apps, AI software uses data you enter (such as your blood glucose level and what you’ve eaten) to provide guidance for your daily diabetes management. When you eat a carb-heavy lunch, the app might text you a suggestion to take a walk to lower your blood glucose. It can also spot trends: If you’ve been dealing with overnight lows, your AI coach may suggest you discuss your eating and insulin dose with your doctor. Some AI coaching apps link with other diabetes management apps and devices, collecting health data they use to guide you.

As the technology advances, so will the power of artificial intelligence to learn how your body responds to different foods, activities, insulin doses, and other factors. The goal: to train the app to find patterns and predict when highs or lows may occur. It then tailors messages that offer guidance to keep you in the right range.

So Far, So Good

Is virtual coaching effective? The answer’s a tentative yes. In a paper published in 2019 in the journal Diabetes Technology and Therapeutics, Ramchandani reviewed and summarized the limited amount of research available. She found that virtual coaching appears to significantly benefit blood glucose management. It also may prove effective in aiding behavior change, as well as providing social and psychological support. Still, she says much more study is needed.

Based on the existing research, Neinstein is optimistic. “I’m willing to take a leap of faith that that research will translate to the digital world,” he says.

Choose Wisely

Ramchandani recommends that you pick technology that features coaches who are also diabetes educators. That way, you can be certain you’re in knowledgeable hands.

Your health care provider may be able to recommend diabetes services (such as the one owned and run by Scheiner) that provide coaching via phone and video chat. When it comes to coaching apps, your health care provider may not be familiar with such new technology, says Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDCES, a certified diabetes care and education specialist at the University of Chicago’s Kovler Diabetes Center. If that’s the case, ask friends with diabetes for recommendations.

Find diabetes educator–led coaching on smartphone apps such as MySugr (for which Scheiner is the head coach) and Blue Star, as well as on meters such as those by One Drop, Livongo, and DarioHealth. Other meters work with coaching apps; certain Accu-Chek meters connect to the MySugr app, for instance. Once you’ve chosen an app, sit down with your health care provider to make sure its recommendations are accurate and appropriate for you.

Consider Cost

Few insurance plans cover virtual coaching. (If you get insurance through work, check your benefits. Some large companies may offer coverage.) Out-of-pocket costs start at about $40 to $50 per month for access to diabetes educators. With some coaching programs, unlimited test strips are included in the subscription price, which can help offset overall cost.

Something else to keep in mind when considering cost: You won’t need a coach on a permanent basis. “Once your coach has helped you meet your core needs and goals, they can let you fly on your own and go back if you need a refresher,” says Hess-Fischl.



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