Diabetes monitoring gets a technology upgrade

Three rehabilitation centers on Long Island are piloting a program to help diabetic patients better monitor their glucose levels when they return home, in an effort to prevent future illnesses and hospitalizations.

Patients are sent home with a Bluetooth-enabled glucometer that reads their blood sugar level after they take a small sample with a finger stick and send the information to a licensed practical nurse monitoring it 24 hours a day. They also can choose to have their results sent to family members and doctors of their choice. 

“The whole goal is to keep them out of the hospital, keep them safe and keep them stable,” said Lisa Penziner, director of special projects at Lynbrook Restorative Therapy & Nursing, which is starting to send its first patients home with the kit. 

“People are here because of the result of what diabetes has done to their body,” Penziner said.

The COVID-19 pandemic made the situation worse for many diabetics, she said.

“A lot of diabetics did not go out of the house to see their doctor and get the care they needed,” Penziner said. “We’re getting them back on track.” 

Diabetes is a collection of disorders and illnesses that take place when a person has high blood sugar, said Dr. Stanislaw Klek, a diabetes specialist at NYU Langone Hospital-Long Island in Mineola. 

Specifically, a diabetic's body does not make enough or properly use insulin, a hormone that turns food into energy.

According to the Centers for Disease Control and Prevention, 37.3 million adults in the nation have diabetes, but one in five don’t know they have it. Diabetes is the seventh-leading cause of death in the U.S., the agency said. 

“When your body is exposed chronically to these elevations in your glucose values, it's actually directly damaging several different organs, including the eyes, the kidney, the nerves, the brain, the heart,” said Klek, who is not affiliated with the pilot project. “So it's really essential to be able to manage diabetes and get your glucose values down to the targets that are set between patients and physicians in order to prevent any of those long-term complications.” 

There are three types of diabetes, including Type 1, which is believed to be caused by an autoimmune reaction that stops the body from making insulin. The CDC says this accounts for 5% to 10% of the diabetic population and usually is diagnosed in children, teens and young adults. Type 2, the most common form, develops over the years and usually is found in adults.

People with Type 2 diabetes can't keep blood sugar at normal levels because their bodies do not use their natural insulin well. The CDC says it can be prevented or delayed with healthy lifestyle changes, such as losing weight, eating healthy food, and being active.

The third form, known as gestational diabetes, develops in pregnant woman.

Remote monitoring devices for diabetic patients that send information to health care teams are becoming more common, said Dr. Robert Gabbay, chief scientific and medical officer for the American Diabetes Association. It’s still unclear how much of an impact they will have in the long run, he said.

“This has all been facilitated by Bluetooth-enabled remote monitoring — blood glucose meters, continuous glucose monitors, smart pens with insulin dosing, and activity monitors,” Gabbay said. “This type of innovation is here to stay, but will require more validation to be able to document health care improvements and overall value.” 

The remote monitoring program is also open to diabetic patients at Excel at Woodbury for Rehabilitation & Nursing, and Momentum at South Bay Rehabilitation & Nursing in East Islip. 

Penziner said Medicare covers the cost of the device and monitoring. The program is facilitated by Progressive Care, which utilizes the technology through Livecare Health. 

Brian Cordts, director of the Diabetic Education and Management Program at Lynbrook, said the program is a key piece of a larger effort that includes classes about nutrition and support groups for patients. 

“That means monitoring what your number is and what those numbers mean, as well as knowing how everything you put into your body affects your blood sugar,” Cordts said. 

For example, sugar-free cookies can be packed with carbohydrates, which break down into sugar. Guzzling too much juice to boost low blood sugar could end up causing a spike in a diabetic’s glucose level. 

Cordts has spent the last few months working with patient Jullett Marshall, who had part of her right leg amputated last year due to complications from diabetes. 

“I drink a lot of water and eat a lot of vegetables and fruits,” said Marshall, 65, while also admitting that “sometimes I eat certain things I shouldn’t eat.” 

For months, she had pain, swelling and a sore in her right foot and leg. Doctors discovered a broken bone that had never healed properly. They tried healing the wound with hyperbaric oxygen therapy, but her foot and lower leg could not be saved. 

Cordts said it is likely that diabetic neuropathy, which is loss of sensation in the leg, prevented her from knowing the seriousness of her injury. 

“I tell my residents as soon as it hurts, it’s usually too late,” he said. “You have to monitor your feet and know what they look like on a daily basis. All of these routines are really important for a diabetic.” 

Marshall said she is comfortable using the finger sticks and setting up the Bluetooth-enabled glucometer on her own. She believes it will give her even more support as she starts the first part of her at-home recovery with relatives in Brooklyn.

“I think with a lot of institutions — hospital, outpatient facilities, nursing home facilities — we're going to see this type of remote patient monitoring continue to expand over the next couple of years,” Klek said. “I think the pandemic really forced our hand to mobilize a lot of the capabilities we already had in place in terms of telehealth and patients …. This is the wave of the future.”

By Lisa L. Colangelo

lisa.colangelo@newsday.com@lisalcolangelo

Lisa joined Newsday as a staff writer in 2019. She previously worked at amNewYork, the New York Daily News and the Asbury Park Press covering politics, government and general assignment.