Dr. Sherr’s story: How I use Tidepool in clinical practice

Jennifer Sherr, MD, PhD is a pediatric endocrinologist at Yale New Haven Health and anAssociate Professor at Yale University School of Medicine. Diagnosed with type 1diabetes in 1987, she is very passionate about the care she delivers, and aims to reducethe burden of living with type 1 diabetes for both her patients and herself. Dr. Sherr hasbeen devoted to clinical research over the past thirteen years, working on projects onnew diabetes technologies, like sensors and automated insulin delivery, as well astreatments, such as new glucagon formulations.

As a person with diabetes and healthcare provider, what have been some of your greatest challenges with diabetes technology?

I’m really interested in taking away the burden of uploading everything. I think device manufacturers need to send all diabetes data directly to the cloud and then share that data with users so they can access it in an understandable manner and feel more engaged with it. It’s critical because, in the end, it’s our data. We need to be able to see it. We need to be able to access it. We need to be able to use it and make adjustments from there. So automatic uploads would be huge.

Another area that I think is under-explored is understanding when an infusion set is not working as anticipated, and getting an automatic so it can alert for the person with diabetes so he/she can replace the site sooner. Sometimes I have bad sites, bad sites mean bad days, and bad days mean that my family does not like me. The same thing happens for my patients with diabetes who call in. For example, a child has missed a day of school — they’re on the couch, they’re not feeling well, and the parent feels helpless. There’s oftentimes this feeling of pressure and guilt on families for not figuring out about the infusion set sooner. So I would love to see if there’s a way we can use technology to alert us to change the site, how to make better sites in the future, and how to help patients avoid hypertrophy (scar tissue).

In the end, I want to forget I have diabetes. I’ve been trying for 32 years to do this! So I want technologies that will help me with that.

How important is access to patient data and how does this affect your ability to help your patients manage their diabetes in-clinic or remotely?

Very important! It gives me an opportunity to have a conversation with patients about their diabetes engagement and allows me to have a better concept of what’s going on in their lives. It’s taking a step back with people and helping them share their stories and, most importantly, not having any judgment with it. I have a frame up in my office that says, “Strive for progress, not perfection” and I think when you’re living with diabetes, that’s the ultimate goal.

I like to use the example of creating a roadmap for the journey. When I talk to families about why it’s so important to look at the data, I want to help families feel comfortable looking at the data, understanding it, and then looking ahead at how they can optimize doses or have different engagement behaviors that may help.

It’s about laying the groundwork to make the path smooth until we have automated insulin delivery (AID) systems that can make the road easier to travel.

Why did you choose Tidepool’s platform for your data management?

I remember hearing about Tidepool many years ago and really trying to pitch it to the folks here at Yale New Haven Health. It came up specifically when our pediatrics team was starting to think about telehealth. We were looking for ways to improve engagement with patients and making sure we could view all their data.

Tidepool already had a process for setting up business agreements and onboarding with clinics — it just facilitated everything. After four months of discussion, Tidepool’s Community and Clinic Success Manager, Christopher Snider, was doing webinars for our entire practice and showing us what to do. Then a month later in July of 2019, we went live. Looking back now, I just think how great is it that we did this in 2019 because who knew what 2020 would bring! It was perfect timing.

How important is it to be able to remotely monitor patient data, and how did you find the transition from in-clinic appointments to telemedicine visits?

We actually didn’t fully set up telemedicine until the pandemic, when we suddenly needed all our patients to onboard quickly. We developed some letters to send through MyChart to push out a week before telemedicine visits, with instructions on how patients could set up their Tidepool account or upload from home. It definitely provided more of an incentive for them to upload from home. Before, I think they were in a good spot and weren’t necessarily thinking about needing to upload again shortly after an in-clinic visit.

In regards to being able to remotely monitor patient data, it’s very important! If a patient is using an Omnipod and a Dexcom G6, I want to see it all in one spot. One of the things I love about being able to share data with patients is that it helps me figure out where I can hone in. I was chatting to a patient’s mom recently and she told me, “I remember the first time we met. You brought up the report and immediately said, ‘It looks like you don’t bolus for all the carbs your son is having.’” She couldn’t believe I could figure it out so quickly! And I told her by seeing the data, it becomes very evident what’s going on.

How has Tidepool eased the burden in your diabetes data management or helped you connect with your patients?

I actually think telehealth is such a better experience, and Tidepool helps to facilitate that. It gives me better insight into what’s happening at home and I also think, at least for pediatric patients, they’re at ease. The kids all want to show me their pet, or tell me what they’re working on, or show me their rooms. And it means if they’re having a low on-screen, I can see how they’re treating it and transition into care suggestions like, “I don’t think chocolate is the best way to treat that low. Why don’t we talk about different options?”

As a person with diabetes, how do you identify the right moments to insert your personal experiences into clinical conversations with patients?

I think it’s dependent on the climate and context. With new onset families, I start out by asking if they know anyone who lives with type 1 diabetes. And I can use that opportunity to tell them, “Well, you’ve met me today. I have type 1 diabetes and I’m doing fine.” If they’re tearing up, I’ll empathize with them. I wake up some mornings and wish I didn’t have this anymore, too. So I wait for the conversation and see how things go.

It’s very much reading the room — understanding the right moments, understanding where a family is at, and inserting those stories as appropriate. And it’s not about me, it’s about them. It’s about how I can relate back to what’s going on in their life at that time. Every person with diabetes experiences it absolutely differently.