David Klonoff: 0:14

Welcome to Diabetes Technology Report. I'm Dr David Klonoff. I'm an endocrinologist at Sutter Health and UCSF. We have a special guest today. My co-host, Dr David Kerr, will introduce himself and we'll ask her the first questions.

David Kerr: 0:29

Thanks, david, and hello to everyone listening today. This is our first Diabetes Technology Report of 2025. It's not a happy new year to everyone and we're beginning with a bang. Here We've got a really special guest, dr Jing Wang, who's speaking to us from Florida, where the weather's been a little bit unusual, but, jing, welcome aboard, and we always like to begin these podcasts with just finding a little bit about you how you ended up being interested in diabetes in general and technology in particular. What kind of led you to this situation? Yeah, sure.

Jing Wang: 1:08

Happy New Year everyone and thank you, david and David, it's such an honor to be here with both of you and everyone. I think I started at University of Pittsburgh. I was a trainee at University of Pittsburgh where you know the diabetes prevention program and look ahead study, and I was just kind of solely focused in this behavior concept of self-monitoring, which at the time we're still using paper diaries and we're comparing paper diaries with personal digital assistants. So that's kind of very natural for me to kind of work in the area of diabetes, diabetes progression, obesity, diabetes management. I have to sort of get myself into the technology because my concept is self-monitoring and by the time I graduate the PDAs became obsolete.

Jing Wang: 2:06

So my whole area of self-monitoring went into smartphones, bluetooth-enabled devices, glucometers to wirelessly connected glucometers and then incorporating wearables such as the jawbone at the time.

Jing Wang: 2:24

So all kinds of different wearables such as the jawbone at the time, so all kinds of different wearables, connected applications. So that's kind of how I started was a focusing self-monitoring kind of getting into the whole area of digital health technology and I started a couple of research center of excellence in the area of mobile health, connected house, smart and connected house, and now you call it, digital health, and we can also have to just get ourselves into this whole what I call multiple behavior self-monitoring, because diet, exercise and both play a role in not only glucose levels but also weight. So how these behaviors and weight and glucose intertwine together with multiple behaviors and multiple disease outcomes, because you know our patients our diabetes patients often have to manage their weight and some other conditions such as hypertension. So we actually end up developing a platform where we're just kind of getting all of these wearables, remote monitoring devices all together and optimize and visualize this for a patient I have to ask you.

David Kerr: 3:37

I mean, some of those things you've just mentioned. It's like a blast from the past. You know all these different ancient now technologies and we're now into multimodal monitoring, to use the jargon. But what about the view from the other side, from people with diabetes? What do you find? Are you finding that people are kind of going, whoa, this is too much, or whoa, this is really interesting. Why haven't we done this before, and what's your feeling about that?

Jing Wang: 4:09

Yes, so our research has always been grounded with patient needs. You know we do a lot of qualitative research, kind of interviewing patients and kind of understanding their needs, and this involvement of connected technology kind of all came from patient needs. So at the time, at the old Asian time, you know, the diabetes educators and patients would spend the whole visit time kind of just doing a dietary recall for the whole 30 minutes and kind of the technology with, you know, wearables and app-based nutrition monitoring kind of. Our connected platform that we developed actually reduced that time of recall into less than a minute so that the patients and the educators actually against and the counselors can actually spend the rest of the 29 minutes to actually focus on individualized education, what we call diabetes self-management education and support, and it is overwhelming.

Jing Wang: 5:07

The other part is well, because you cannot really ignore any part, both diet and exercise and what we find is the best way of losing weight for diabetes patients and if you do both right, and even for the diabetes prevention program, look ahead, you need to look at how both diet and exercise work together so kind of with this, how the evidence supports it, but it's too much work for patient to monitor and that's how, like what we try to actually recently, use digital twin-based ai tools to make multi-modal self-monitoring simpler.

Jing Wang: 5:44

And what we are doing research is also trying to see can we actually use some of the home-based monitoring to mimic what is more, like you have to put efforts in entering what you eat into, like right now, the technology where you can have a refrigerator and we can actually you don't have to do any of the actual active monitoring by passive monitoring through your refrigerator where you get your food, or if you have food from outside, you scan the barcode of food, can make these things much easier for you. I still give you that self-awareness that you will be able to use to guide your behavior change.

David Klonoff: 6:26

Jing currently who's using your platform. Is it being used by patients in the clinic or is it a research tool?

Jing Wang: 6:34

Currently it's a research tool, so we have also like trying to expand it to be more a community-based tool, but so far we actually have supported over 20 studies. Right now, um, as it starts and because of the capacity and the tools kept changing, so we we're actually not like a married with any particular brand of device. So we're trying to make this platform where we can. You know, different projects can use different like like some projects monitor salt intake from their diets and high blood pressure with a blood pressure monitor. Some use, you know, glucometer, some use continuous glucometer and add the Fitbit or other dietary monitoring tools.

David Klonoff: 7:19

Um, some people who use an app will lose interest. Much of the research shows the first three months people have good results and then by a year, very few people are using the product. What do you do to keep people interested and allow persistence?

Jing Wang: 7:37

Yeah, actually what? When I started, even my concept is self monitoring actually started? Actually, I started the concept was adherence and in the area of adherence, what you see is what you just described. It's a shape where people will suddenly become very interested in the new thing and then the adherence and the adherence to self-monitoring will drop. Actually, in one of our most recent studies, what I kind of briefly mentioned the digital twin is that we're using all of the self-monitoring data to develop sort of a digital twin version of the person based on how their glucose and their weight will change in response to their diets and exercise changes. And we are actually trying to send that feedback based on the digital twin data to the patients to say, next day, if you continue with your behavior today, your next day is good, because it's possible to be very high or very low, and to see that kind of tailored and AI-enhanced message will actually help patients to be more adherent, because some of the self-monitoring and there needs to be feedback right the role in a behavior concept is all about how can we help people to manage their behaviors so that they can get to the blood glucose and weight balance where it's hard to have.

Jing Wang: 9:01

And if you're just monitoring, um, it kind of it doesn't kind of get to the behavior change and kind of, right now, uh, you have to generate that self-awareness and also how that self-awareness in your environment to actually create that behavior change. So what we have found although self-monitoring itself can be really boring, um, the digital tools actually can make it a little bit more fun, especially right now. A lot of apps can have more like game-based rewards, even financial rewards. You know some insurance company-based companies. They will have those financial incentives or behavioral incentives, all as a way to go beyond self-monitoring to see. Well, actually, if you do this, self-monitoring is just a tool for you to become awareness. Actually, I think in the future it'd be great to see if you know, when the behavior change becomes a habit, actually self-monitoring is no longer needed. So we actually probably don't need a consistent self-monitoring in order to get to where we want to be, unless you know you have your blood glucose is out of control again or you would like to, you know, achieve to a new level of blood.

David Kerr: 10:14

This is really, really exciting stuff. So what you're saying is putting the effort into self-monitoring is going to be confined to the dustbin of history because everything is going to be automated. And then you're giving people rewards, you're showing a glimpse into their personal health future. If they do this, then a good thing will happen. If they don't do that, this is astonishing and exciting at the same time. What about people saying, well, hold on a minute, where's my data going? I mean, are people saying to you well, this is all very well, but I don't want to be controlled by some multinational, you know for-profit company that's just going to make more money on the back of me. Are you hearing any of that? Or is that again something of historical interest only?

Jing Wang: 11:09

Yes, I think the majority of our patients don't care too much, I have to say, like we actually have done large field survey on this topic, as a researcher, we're very serious. Right, we need to make sure patients understand, through consent, where we're securely save your data and we want them to kind of read all the small find information when they sign up for a commercial app, right, but that's kind of our role as nurses, as an educator, but in reality, if you ask patients, well, do they care much? Well, they care about. What they care about is will I have a better quality of life and will I live longer? What other tools are you giving me to help me do that?

Jing Wang: 11:57

And so I think you know, as a researcher, as a scientist, but also as a clinician, I think our role is to make sure that we do our job, to communicate with patients clearly, and that's why, when I develop tools, I always kind of try to be transparent about what are the risks.

Jing Wang: 12:14

Of this data may end up in someone else's hand. We always have to have that right, that right. I think it's about being transparent and also kind of working with people like engineers, computer science and others to ensure we are actually patients' advocates, right? Patients not necessarily have all those knowledge, but us, as healthcare professionals, I take it that we actually need to have those knowledge and skills and to kind of be our patients' advocate to make sure you know their information will not be shared with parties or will not be purchased, or at least we need to let them know what may happen when you know things happen. So I don't know if that answered your question, but like, if you kind of ask patients, the majority of them will say I care less. In a way, some will pay attention, but that's not the majority.

David Kerr: 13:07

Yeah, we find the same thing. Patients want to be better and they're less concerned about regulations than perhaps we are, but there needs to be a balance.

David Klonoff: 13:19

Jing, we recently collaborated on a project which we called the Green Diabetes Project, to see how much waste people with diabetes generate. What do you think about the waste issue for people with diabetes who use devices?

Jing Wang: 13:36

Yeah, I think all of the digital health-related waste is an area nobody actually pays much attention. So I'm so glad you know Diabetes Technology Society and we get to partner with you to kind of work on a study to bring this to people's awareness with how much waste. We call it waste, but somebody else may think, well, it is a very necessary tool to support patient care, but what are the alternatives? Right Again, I think from the patient perspective, they probably don't have any kind of knowledge or even like attention to this matter. But I do feel like because right now, if you look at sort of the landscape of digital health, is that people are actually using more technologies than sometimes than what they need to to kind of manage their conditions.

Jing Wang: 14:29

So, I think, paying attention to all the ways and exploring what are some alternative options that can actually help us um, better, both better managed conditions and also kind of reduce the the from a, you know, manufacturer perspective, and how can we collaborate with manufacturers to think about for all of these tools? And one example actually, like right now, CGM Continuous Glucose Monitor monitor previously is not a tool where, like, everyone can easily access or it's only reserved for people, you know, with very serious conditions. And now consumers, just like consumers and households. There are companies that are focused on using CGM for behavior change. So even for patients who people who do not have a condition like diabetes are using CGM to be healthier or to be fit. So that's kind of a waste that nobody ever pay attention and how can we kind of better work together to kind of draw much attention to it?

David Klonoff: 15:43

Jing, you've spoken about your research. You're also Dean of the Nursing College at Florida State. Could you say something about your work there? Are you currently recruiting people to join you, or what's it like being a Dean?

Jing Wang: 15:56

Yes, I think the exciting part of being a Dean is that, like, you get to like, draw the big picture and recruit work-class talent. We have recently recruited a lot of very successful. We've recruited a lot of work-class researchers and bring over 100 million NIH funding and become top in the nation actually among all the nursing schools. But what I'm most excited is actually we're building a smart healthcare suite in our new academic health center building where we'll have 11 smart clinic rooms, one smart apartment and one smart hospital room where we will train our next generation of students nursing students, medical students all together to actually understand these digital health tools but embedded in clinics inpatient homes. We're also actually building an actual smart home in a 55 plus community where we will partner with the developer, the community developer and smart home technology companies to kind of reimagine what home-based care can look like, because you know we talk about hospital at home, stipulated by COVID. So, as we're kind of experiencing this post-COVID era, what can we do in managing patient health in their own home? That can be a little bit more like passive monitoring, but also supporting and connected with their healthcare providers. So, I think all of these things that I'm very excited about, but also, I think, as a dean, is.

Jing Wang: 17:39

I look at it because I have always been in this like first few people who have uh, who does things in area of digital health, and now was a AI.

Jing Wang: 17:50

We actually became the nation's first to launch a master of science in nursing, with a concentration in AI applications in health care, and launched an AI, um, nursing and AI innovation consortium.

Jing Wang: 18:04

So, like I strongly believe, you know, we can't just wait until they graduate and, you know, throw all of these new tools to them. Even these tools will change. I still believe that we need to train these students when they are still in medical school or nursing school. They are still in medical school or nursing school so they understand. They have this thinking on how to best to support them in their future roles, where everything they do may have AI they may not know, but has an AI component in it. And how can we set the guardrails all together? A lot of people are on two extremes One is very pro, one is very against and, where I see it, it needs to be somewhere in the middle where there will be guardrails and things that we need to pay attention, but we also need to have the knowledge about how to leverage AI to automate some you know laborious processes and administrative processes.

David Kerr: 19:05

Jen, I just wanted to ask you a little question. You mentioned about the smart home for the seniors At the other end of the spectrum. Are you also involved in digital health AI for children? You know toddlers, young people as well, because of the concerns about particularly type 2 diabetes, obesity and that sort of thing.

Jing Wang: 19:26

Yes. So for the youth and children, actually the majority of our NIH-funded research portfolio are among US youth and adolescents, and also we look at families right, including children. So some of this we didn't look at in particular for type 1 diabetes area, but our sort of use of digital technology-based home is really cutting across different areas. We're starting with the 55-plus community because, it happens, they have the most interest, they want to collaborate very eagerly, happens they have the most interest, they want to collaborate very eagerly. But there are actually other smart home technologies that with some of our industry partners in other areas that are specifically focused on actually children who have disabilities and need special needs that will benefit from these smart home technologies. So we're looking at really, who are the sort of what I call most underserved populations, and people always think that seniors are the generation of. Well, they don't really use technology or they're afraid of technology. But they also happen to be the people who can benefit the most and we need to have all the specialty or skills to help them and support them.

Jing Wang: 20:47

And my research has always been primarily with a senior population. But what I find is that, even for those who never touched technology before doing the times when the smartphone just came out within a week or four weeks. They get to be pro and they kind of gave me a feeling like, well, a few seconds, I got this done, where four weeks ago it took me 30 minutes right? Or we see so much technology that is like what I call over-engineered, like, for example, it's not a critique with some of the current wearables, but if you look at the senior population, they cannot really handle that many complex details in a little tiny watch. So how can we have all the specialty that are focused on different populations with their different needs of the technology With our kids and children? Actually, they are the technology helper at home or the seniors for those that are multi-generational households.

David Klonoff: 21:51

Well, jing, that's really interesting. The work you're doing, both in your research and building a huge, successful program at Florida State number one in the country in NIH grants. That's fantastic. I'd like to thank you on behalf of me and Dr Kerr for speaking with us today. This podcast is available at the Apple Store and at Spotify and we invite people to listen to this and we invite people to return to our next Diabetes Technology Report. So thank you and goodbye. Thank you.

Jing Wang: 22:27

Jane, thank you, thank you everyone.