SmartStart Bridges the Knowledge Gap for People with Type 1 Diabetes
Melissa Holloway built a mobile-first, interactive educational platform for people on intensive insulin therapy.
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Melissa Holloway, CEO & Founder of SmartStart, says there’s too much smiling and nodding in healthcare. “It’s a big problem in communication,” says Holloway. It’s a situation we’re all familiar with, whether we’ve experienced it with a doctor or some other expert, like a teacher or car mechanic. We smile, we nod, and later on we struggle to recall something important. Holloway, who has Type 1 diabetes, was particularly concerned about people using continuous glucose monitoring (CGM) missing out on or misunderstanding information about diabetes self-management. As a solution, she developed SmartStart CGM. The mobile-first platform streamlines the process of patient education through interactive learning tools easily accessible on one’s phone.
The Challenge
“There’s all this great technology, but then you look at the outcomes data around the achievement of key targets for diabetes management, and we’re not there yet,” says Holloway. She points to an international consensus stating that most people with diabetes should aim to spend 70% of the time in the target range for blood sugar levels (70–180 mg/dL) and no more than 4% of the time below the target range. “The familiar figure seems to be about 30–50% of people reaching both goals, even with automated insulin delivery technologies,” says Holloway. She has observed this firsthand, including in patients receiving quality care from enthusiastic and knowledgeable healthcare professionals.
Holloway spends a lot of time in Facebook groups where people with T1D ask questions about using diabetes technology. She finds herself sharing knowledge and tips — a role she has adopted on an ad-hoc basis since her days as a graduate student, when she established a support group for other students with T1D. Discussions on social media opened her eyes to the ways that people struggle to reach diabetes management goals. “A lot of it has to do with the way that people make diabetes decisions using their data,” says Holloway. Many people aren’t able to accurately interpret or proactively use data from their CGM. Many also don’t heed the advice of the healthcare providers, whether intentionally or unintentionally. They might have been nodding and smiling in their doctor’s office, but they’re not necessarily able to put principles into practice.
Holloway’s intention is not to shame people. Inspired by experience, SmartStart CGM even includes an interactive case study about someone out drinking with friends who doesn’t want to interrupt the moment to correct a high glucose level. “People make tradeoffs,” she says. She also finds that healthcare providers tend to make assumptions about how much people living with T1D know about treatments and technologies. “You don’t know what they know unless you actually ask,” says Holloway. “And it’s very difficult for healthcare providers to assess knowledge in routine care. We don’t have great validated tools and there’s never enough facetime,” she says.
What They Built
SmartStart CGM is designed to help the intensive-insulin-using population use CGM. Its content modules orientate users to the technology, developing their understanding of the numbers, trends, and graphs that provide insight into glucose levels. SmartStart CGM fosters engagement through games, stories, and interactive case studies about interpreting CGM data in realistic hypothetical scenarios. Holloway hopes learning experiences in SmartStart CGM will translate into more informed self-management in real life. So far, those ambitions are looking attainable. In the proof of concept study, participants’ average CGM knowledge scores doubled from baseline to completion. Furthermore, the proportion of participants reaching both the clinical goals for time in range and time below range increased from 29% to 65%.
Origin Story
Holloway’s passion for healthcare communication grew out of her experience supporting other students with T1D while she was studying for a doctorate in Reformation-era British history. She left graduate school to pursue a career in the healthcare industry. An invitation to write an expert patient column for Medscape.com led to a job with Close Concerns, a leading consulting company focused on the business of diabetes and obesity.
Then, after two years with Abbott Diabetes Care, she moved to London as a healthcare consultant and turned to medical copywriting in healthcare advertising. From 2013 to 2018, she also ran a small charity promoting access to diabetes technology and education within the UK National Health Service (NHS).
As a frequent attendee of diabetes conferences, she had a front-row seat to developments in diabetes care. In 2017, the SPECTRUM patient education program on CGM caught her attention. She wondered if it could be delivered digitally. Like many other diabetes education programs, it required in-person attendance, which isn’t always practical for people with diabetes or for healthcare providers.
When COVID happened, she heard about people having NHS funding for CGM withheld because they were required to attend in-person training, but those in-person training sessions were indefinitely postponed. “Finally, we’re going to have an honest conversation about how in-person diabetes education classes aren’t meeting everyone’s needs,” she thought.
Sensing that the timing was right , Holloway got to work developing SmartStart CGM. The Diabetes Center Berne Innovation Challenge in 2021 further focused her efforts and provided necessary funding to realize the project.
Take Away
People using intensive insulin therapy can benefit greatly from CGM. However, the right knowledge goes a long way in improving outcomes. With far too few diabetes specialists on the ground — and evidence of gaps in communication between healthcare providers and patients — SmartStart delivers relevant and relatable information about CGM effectively. This tool helps to leverage CGM’s potential and improve health outcomes for its users.
SmartStart’s value also extends to the space within a clinic, promising to enrich conversations between healthcare professionals and their patients. “We’re going to be able to personalize the learning journey,” says Holloway, who has designed the platform to help focus conversations with providers — and hopefully cut through some that nodding and smiling.
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Published: Nov 22, 2023