What Diabetes Care Could Learn From Air Traffic Controllers

View Transcript

Air traffic controllers make sure that planes take off and land safely, even at the most remote airports. Flying without them would be not only scary, but virtually impossible. Yet, that’s how children with Type 1 diabetes and their families sometimes feel when trying to manage the disease, according to Dr. Deneen Vojta, executive vice president of Enterprise Research and Development at UnitedHealth Group, UnitedHealthcare’s parent company.

Kids with diabetes have to test their blood sugar several times a day and adjust their insulin dosage based on the results. Every three months, patients meet with an endocrinologist who checks for signs of serious complications and tries to figure out what triggered previous spikes or dips in their sugar levels. On a daily basis, however, families fly solo.

“The clinic visits are not well-timed in terms of what families’ needs are,” said Dr. Laura Gandrud, a pediatric endocrinologist at McNeely Pediatric Diabetes Center at Children’s Hospital in Minneapolis. “Diabetes is a disease that requires multiple decisions a day based on what a child is eating, how active they are, how they’re feeling, and their blood sugar levels in the morning and afternoon.”

Dr. Vojta thought diabetes care management could take a cue from air traffic controllers. Working with Gandrud at Children’s Hospital, UnitedHealth Group set up a research study that outfitted a group of 114 children with diabetes between the ages of eight and 17 with fitness trackers. Why trackers? Because physical activity plays a major role in blood sugar levels—work out harder than usual or start a new sport, and sugar drops. Sit around more than usual, and sugar levels will rise.

Just as planes equipped with sensors feed information about conditions to air traffic controllers, the patients uploaded the data from their insulin pumps and trackers every week for doctors and nurses to review as part of a research study. Based on the data, the medical staff at Children’s Hospital would email recommendations for medication changes every week, rather than every three months, and if they saw a particularly troubling development, would call the family to intervene.

The researchers wanted to see whether more frequent and intensive monitoring could significantly reduce patients’ A1C levels, a measure of average blood sugar levels over the past two to three months. Lowering A1C levels even for a short time is associated with better long-term health outcomes, according to Gandrud.

Research study results will be presented at the American Diabetes Association conference in June 2017. What Vojta and Gandrud will say now, however, is that patients and doctors alike found the program to be incredibly helpful in day-to-day disease management.

More timely interventions helped 17-year-old Brian Meads and his parents navigate the kind of everyday events that can seriously shake up a child’s life. When the beginning of soccer season caused his sugar levels to drop, doctors noticed the change and corrected his insulin dosage much more quickly and precisely than his family could have on their own.

“Before the study, sometimes he and my parents would wake up two or three times a night to adjust his medication,” said Megan Meads, Brian’s sister.* “During the study, his numbers were so good that he only had to wake up once a night. My parents were also on his case a lot less because they had more confidence that everything was being managed well.”

Gandrud said the opportunity to keep a closer eye on patients was invaluable, and she hopes the technology-inspired methods pioneered in the study will soon become mainstream. But there are some hurdles to overcome first. While a large pediatric diabetes center such as Children’s can assign enough staff to review the flood of data streaming in from trackers and pumps, doctors at smaller, independent practices in rural areas don’t have that luxury.

Still, Dr. Vojta says family doctors might one day outsource the data analysis involved in more frequent monitoring to an outside firm, which could alert the doctor when computer software detected a troubling change in the patient’s vital signs.

“We can do better for someone with Type 1 diabetes living in rural Utah and being managed by a family doctor,” Vojta said. “We could help his family doctor by offering some support that functions much like air traffic control.”

After all, if one must fly through a dark sky, it’s reassuring to have a voice from the tower guiding the way.

*Megan Meads is an employee of UnitedHealth Group; her employment was not a factor in her brother’s participation in the study.