Telemedicine Study
Doximity Study Finds Telemedicine Will Account for $29 Billion in Healthcare Services in 2020
Researchers Also Estimate that 20% of All Medical Office Visits Will Be Virtual this Year
SAN FRANCISCO, Calif. – September 16, 2020– Doximity, the professional medical network, today published its “2020 State of Telemedicine Report,” a comprehensive analysis of telehealth trends in the U.S. since the onset of the COVID-19 pandemic. The report includes a patient survey of over 2,000 U.S. respondents on their attitudes towards telehealth, an analysis of online physician CVs, as well as data from the company’s telemedicine feature set, which is used regularly by over 100,000 U.S. doctors. The study found that 20% of all medical visits will be conducted via telemedicine in 2020, which accounts for more than $29.3 billion of medical services this year alone.
“2020 has brought dramatic changes to the healthcare system, and the transition to telemedicine is one stark example. The pandemic served to spur adoption with doctors and patients alike. And faster than anyone thought possible, moved a significant percentage of medical care online,” explains Peter Alperin, MD and Vice President at Doximity. “We hope our research will help illuminate telemedicine’s evolving role in the medical landscape for national healthcare stakeholders.”
Other Key findings from the study include:
The Pandemic Has Driven Telemedicine Adoption
Since the COVID-19 outbreak, the number of U.S. respondents reporting having at least one telehealth visit has increased by 57%. For those with a chronic illness, this increase is even higher at 77%. Prior to the pandemic, engagement was relatively low, 86% or respondents reporting that they had never done a telehealth visit.
Physicians Reporting ‘Telemedicine’ as a Skill Has Nearly Doubled
Findings from last year’s study showed the number of physicians who self-reported telemedicine as a skill had been increasing by 20% year-over-year for three years. That number has nearly doubled, increasing by 38% between 2019 and 2020.
Female Doctors Are Adopting Telemedicine At Higher Rates
When analyzing physician interest in job opportunities by gender, the data shows that women were 24% more interested in telemedicine jobs relative to men, a significant increase over last year’s data that showed female physicians were engaging with telemedicine job ads at a 10% higher rate than their male colleagues.
"This year alone, over 20% of medical office visits will likely be conducted via telehealth. The combination of shelter-in-place orders, and the need to protect those patients most at-risk from C-19 infection, have created a real necessity to employ alternatives to the traditional in-person office visit,” said Christopher Whaley, Ph.D., lead author and assistant adjunct professor at the University of California, Berkeley School of Public Health. “Moreover, physicians have found telemedicine has served as a vital lifeline for practices negatively impacted financially by the pandemic. In our view, the rapid uptake of telemedicine has important structural implications for the U.S. Healthcare system.”
Click here to download the full 2020 State of Telemedicine report.
About Doximity
Doximity connects physicians and clinicians to make them more successful and productive. It is the largest professional medical network, with over 70 percent of all U.S. physicians as members. The network enables medical professionals to communicate with colleagues and patients and to share their perspectives on the latest health care trends and research. Doximity is based in San Francisco and was created by the founders of Epocrates and Rock Health. To learn more, visit www.doximity.com.
BOOK REVIEW: The Truth According to Blue
Juicebox Podcast Listener review #1
My son is 11 years old and entering 6th grade (also type one diabetic) had these comments. 10 out of 10 stars. Loved the mystery and he was very happy Blue got a CGM at the end. He loved reading about Otis the diabetic alert dog (and is pretty convinced we need one). He really enjoyed the mystery and he was jumping up and down at the end with suspense of what was going to happen.
As an adult reading with my child I thought the book was great, a fun adventure for sure! It put a spotlight on a character that has a chronic illness which you don’t see very often. I also liked how the main character had an everyday life similar to a lot of us. I think it hit all the marks about diabetes from feeling different to accepting your differences and being proud of them. I also liked that the main character, Blue knew how to dive, drive a boat and do all sorts of things that maybe kids with diabetes wouldn’t realize they could do. It had a great parallel with Jules in the book being a “normal” teen and without diabetes she also had challenges in her own life to overcome. I would say it also lent a great message about friendships and accepting people for who they are. I would recommend this book for any middle aged child and even parents too as I was really able to relate to Blue’s parents and how much they worry about her and the ground rules that they had especially around diabetes.
Thank you for the opportunity to review this book. Tracey Vargas
Juicebox Podcast Listener review #2
Reviewers: Jaime (Mom, an elementary school teacher, and T1D) and Natalie (daughter)
Jaime: As an elementary school teacher I know how important it is to have authentic text that children see themselves in. While we have some exceptional multicultural books, I've struggled to find books that include physical disabilities and chronic illnesses. As an avid listener to the Juicebox podcast, I was thrilled to find The Truth According to Blue and for Scott to be asking for reviewers. We jumped and was thrilled to receive the book in the mail a few days later. I let my daughter read the book first. She's a strong reader and will often finish books in one sitting. I wanted to see if this book held her interest, as well as other books, do. To be fair, she isn't a T1D and is going into high school so I knew she would not connect as well to the main character, Blue as others would. However, she still finished the book over the course of a week and seemed to be genuinely interested in it and enjoy the storyline. I'll let her share her thoughts later.
I too enjoyed the book and storyline. The author does a good job of describing the coastal town and the family dynamics that play into how Blue manages her T1D. As a T1D that was diagnosed later in life, I have no connection to the struggles of having parents participating in your diabetic management. I'm also fairly positive that this would be a different experience for every child who has T1D. Regardless, it's still a relatable and realistic portrayal of what one might experience. As a parent, I enjoyed seeing a good relationship presented between Blue and her parents.
Blue's frustration with have type 1 and being seen as the "girl who has diabetes" is extremely relatable to anyone who has T1D. It was nice to read a book that not only included the management but the frustrations as well especially coming from a writer who is not diabetic themselves. The only problem I had with diabetic care in the book was how often Blue went swimming with her pump. I'm sure this is really only noticeable to those of us who know the swimming struggles of wearing a pump. Otherwise, it seemed to be a pretty accurate depiction of a T1D.
The characters became better developed as you got into the book, with Jules becoming more likable and relatable as Blue learned more about her. Both girls are struggling with labels they have been given how they want others to see them. The growth in both characters and the friendship that they develop was enjoyable and realistic to read.
Otis, the diabetic alert dog, is a fun addition and thankfully does not die! I was concerned when Blue was worried about him getting older that he would not survive the book, but he did! As with many stories, the dogs always endear themselves to us and Otis is no different.
With many young adult books, the line between fiction and fantasy is often blurred. The adventures that Blue, Jules, and Otis encounter while searching for treasure is at times unrealistic and dangerous. However, I think without those, it would not be very exciting to read about a T1D with her head in a clear bottom bucket looking for treasure! Even with the problems that the three of them face trying to find treasure, it felt that the T1D information/management could overshadow the story especially if you are not a T1D yourself and know the true effect on one's day to day activities.
Overall, I think many young adult readers would enjoy reading this book regardless if they are a T1D or not. The struggle to find yourself and becoming more independent is universal. Who wouldn't enjoy an adventure story about treasure, two friends, and a really cool dog with a sweet ending?
Natalie:
Everyone enjoys a book with characters who we can relate to and grows throughout the story and this book definitely delivered. Everyone at some point has struggled with who they are and it's great to see those characters in a book; it helps us to see them as more human and not these great characters who we struggle to connect with and see them as distant. As my mother was recently diagnosed I found it really cool to be able to recognize what blue was doing to manage her blood sugar because I’ve seen my mother do what she does. Now as an individual who is not T1D, I did not connect with Blue as much as some with type 1 might, but I still enjoyed seeing her determination and spirit. The way the town was described was lovely, I felt as if I could walk down the street to the Island Bowl and have a good time. I enjoyed following all the characters' relationships improve and even grew to like Jules despite having a bad first impression of her. I do believe that Otis, Blue’s medical alert dog, was my favorite character. I believe that it's always enjoyable when an adorable pup who helps people is one of the main characters. I also liked the fact that once Blue, Jules, and Otis hit a wall they didn’t stop, they kept trying and I enjoy reading about characters who persevere when it seems like they should just stop. By the end despite having had an amazing adventure Jules and Blue found a different kind of treasure, friendship.
New test better predicts which babies will develop type 1 diabetes
from Science Daily, August 7, 2020 - University of Exeter
Scientists at seven international sites have followed 7,798 children at high risk of developing type 1 diabetes from birth, over nine years, in The Environmental Determinants of Diabetes in the Young (TEDDY) Study. The TEDDY Study is a large international study funded primarily by the US National Institutes of Health and U.S. Centers for Disease Control, as well as by the charity JDRF.
In research published in Nature Medicine, scientists at the University of Exeter and the Pacific Northwest Research Institute in Seattle used the TEDDY data to develop a method of combining multiple factors that could influence whether a child is likely to develop type 1 diabetes. The combined risk score approach incorporates genetics, clinical factors such as family history of diabetes, and their count of islet autoantibodies -- biomarkers known to be implicated in type 1 diabetes.
The research team found that the new combined approach dramatically improved prediction of which children would develop type 1 diabetes, potentially allowing better diabetes risk counselling of families. Most importantly, the new approach doubled the efficiency of programmes to screen newborns to prevent the potentially deadly condition of ketoacidosis, a consequence of type 1 diabetes in which insulin deficiency causes the blood to become too acidic. Identifying which children are at highest risk will also benefit clinical trials on drugs that are showing promise in preventing the condition.
Dr Lauric Ferrat at the University of Exeter Medical School, said: "At the moment, 40 per cent of children who are diagnosed with type 1 diabetes have the severe complication of ketoacidosis. For the very young this is life-threatening, resulting in long intensive hospitalizations and in some cases even paralysis or death. Using our new combined approach to identify which babies will develop diabetes can prevent these tragedies, and ensure children are on the right treatment pathway earlier in life, meaning better health."
Professor William Hagopian of the Pacific Northwest Research Institute, said: "We're really excited by these findings. They suggest that the routine heel prick testing of babies done at birth, could go a long way towards preventing early sickness as well as predicting which children will get type 1 diabetes years later. We're now putting this to the test in a trial in Washington State. We hope it will ultimately be used internationally to identify the condition as early as possible, and to power efforts to prevent the disease."
Researchers believe the combined approach can also be rolled out to predict the onset of other diseases with a strong genetic component that are identifiable in childhood, such as celiac disease.
Sanjoy Dutta, JDRF Vice President of Research, said:" We know that while genetics have a strong correlation as a risk factor for family members to develop T1D, most newly diagnosed individuals do not have a known family history. JDRF has been exploring the non-genetic, environmental risk factors that trigger T1D to help develop treatments to forestall or prevent disease onset."
Complete info is available at Science Daily
An Average Day with Type 1 Diabetes
Most days are perfectly imperfect…
If you already listen to the Juicebox Podcast this quick post will serve as a reminder that:
There is a way to eat normally and achieve the A1c that you want.
A great A1c doesn’t necessarily mean that your BG is 85 (4.7) all day and night long.
Just because you haven’t figured something out doesn't mean that an answer doesn’t exist.
If you haven’t yet listened, I hope that this post represents what is possible when you:
Have easy to understand tools for using insulin.
Listen to the Juicebox Podcast at JuiceboxPodcast.com, Apple Podcasts, Spotify or on your favorite podcast app..
Try these episode to start #11 Bold With insulin, #29 Fear of insulin, #37, Jenny Smith, #44 Diabetes Rollercoaster, #62 Unfounded Fear, #100 Revisiting Bold, #105 All About A1c, #121 Insulin, Insulin, Insulin
You can always listen to the Juicebox Podcast or your favorite podcast app but if you don’t have one try one of these. Apple Podcasts/iOS - Spotify - Amazon Alexa - google play/android - iheart radio - .
You Too Can Bolus for Chinese Take Out
A successful insulin bolus is all about the balance between amount and timing.
Arden recently had Chinese takeout that consisted of sesame chicken, white rice and edamame.
Take a look at her 24 hour Dexcom graph and see if you can guess what time Arden ate the Chinese food. The yellow block represents a restart of her Dexcom CGM.
Now lets talk about the insulin that we used for the meal. Try not to look at the next graph yet...
History tells me that Arden will need between 9 and 10 units of insulin for this food. I don't know how much she'll eat and I don't know how many carbs the food contains. Honestly, I don't care about the carb count for two reasons. 1. I know historically how much insulin this food requires, the trick is to time it correctly. 2. Even if I use the correct amount of insulin the bolus won't work if it's mis-timed.
Example of Correct Amount of Insulin not leading to desired result
Bolusing the entire amount too soon will cause a crash while eating because the carbs will get overpowered by the insulin. Correcting this low will lead to a crazy high later (unless you add insulin, which you'll likely be afraid to do because of the initial low. However, that would likely be the correct thing to do). Outcome: UNDESIRED
Bolusing the entire amount too late will cause a spike that won't come down because the carbs will overpower the insulin, rocketing the BG. This result now voids the "correct" amount of insulin. Yes you used the correct amount of insulin for the food initially but the unintended spike has not been compensated for by insulin. Mis-timing the insulin created another insulin requirement. This spike will last forever without more insulin. Outcome: UNDESIRED
Take away: The insulin, even in the correct proportion, will inevitably not be successful if it is mis-timed.
What does timing mean in simple terms?
The fight between carbs and insulin needs to be balanced. Imagine a tug of war. If one side pulls first, the flag in the middle of the rope becomes uncentered. Now the side that pulled first has a huge advantage that the other side probably can't overcome. When we bolus we want the insulin and the carbs to pull at the same time so that the flag stays right in the middle.
The first step to a balanced pre bolus is understanding the insulin. Man-made insulin does not work immediately and you need to figure out how long it takes to work for you. It may be five, ten, fifteen or more minutes, figure it out. None of this will work without pre bolusing. Trust that.
Once you know how long it takes for your insulin to begin to reduce your BG, consider the food. Something sugary will hit your BG quicker while a heavier less volatile carb like bread may take longer to start pulling up your BG but then last much longer in your system. Each food type will need different timing considerations and hence a different pre bolus.
None of this needs to be perfect because you can always readdress as you go (made easier with the Dexcom CGM and an insulin pump but not undoable with injections).
Understand the roll of basal insulin. Pumpers have a basal rate set that is trying to hold a steady BG during the day. When carbs are added and your insulin needs increase, you aren't just stuck with one weapon (bolus) you can also blanket the carb richer hours with more basal insulin. (Extra basal also does wonders bringing down a spike or stubborn high BG). So don't just use a targeted strike (bolus), carpet bomb too with an increased basal rate. Decreased basal rates are also effective in handling stubborn lows without carbs.
Okay lets take a breath because none of this is nearly as complicated as it seems. Lets go over some basic tenets and then look at the Chinese food graph.
You have to pre-bolus to create a balanced fight between carbs and insulin.
Temporary basal rate increases and decreases are a vital tool.
If your BG is too high. You didn't use enough insulin, you mis-timed it or a combination of both.
If your BG is too low. You used too much insulin, you mis-timed it or a combination of both.
When your BG gets high do not spend time trying to figure out why, just get it down. Figure it out later.
When something goes wrong, its not a mistake to beat yourself up over. It is actionable data, a learning experience that will help you make a better decision next time.
CGM users: Stop the arrow without causing another one. Bump and nudge the graph line. Small adjustments will keep you off the diabetes rollercoaster.
It is far easier to stop a low or falling BG then it is to effect a high and stubborn BG.
Often you get what you expect so expect BGs in the 70 - 110 range and make them your goal. CGM users: Set thresholds that allow you to react before it is too late.
Be bold with insulin.
It's time to look at the graph from the Chinese food. Do you remember when you thought Arden ate? Did you guess around 3 pm? Actually, the spike at 3 pm was one tiny snack with a mis-timed pre-bolus. The take-out was at 7 pm. Check it out.
Simply put. I cranked up Arden's basal about 20 minutes before the food arrived and bolused 3.00. Thats 4.00 units in, 6.00 more needed. The next 1.50 went in when the food began to create space between pre-bolus. I need to stretch the insulin impact because there are two different carbs at work in this example. The sugar on the chicken is going to act fast so the pre-bolus and temp basal needed a head start. The next issue is the white rice which brings a heavy impact that is also long-lasting so we need force and staying power. I held the balance of the insulin until the rice started to make its impact around 7:40 pm. I should have bolused the remaining 3.80 all at once but I played it a bit safe because I knew that we were about to lose the Dexcom data for two hours. Had I sent the entire 3.80 at 7:40 the BG wouldn't have made it to 140. Thats it. We tested half way through the Dexcom restart to be safe and to make sure that Arden didn't need more insulin.
You may be inclined to say that this is too much effort but I contend that the few moments that it took to make these adjustments is a far better world to live in then spending the next five hours bolusing a high number that just won't move. It will take you a few tries to make sense of everything but one day you'll have it and all of this will feel easy. Arden eats what she wants and her A1c has been between 5.6 and 6.2 for four years. Be bold with insulin!
You many also like:
Blog post: Anatomy of a High Carb Breakfast
Podcast: Bold With Insulin
If you want to continue to find out more about how we manage type 1 diabetes please check out my podcast. The Juicebox Podcast is free and available on all podcast apps and online. Subscribe and start listening today!
I am not a doctor and this is not advice. Disclaimer is here.