Assessing Technology Use, Problem-Solving & Risk-Reduction Behaviors
Key Takeaways
- Technology assessment (I.B.7) covers glucose monitors, insulin delivery systems, mobile apps, and patient portals — both what devices a person has and how effectively they use the data.
- Problem-solving assessment (I.B.9) evaluates how a person actually responds to real-world disruptions such as illness, unexpected highs or lows, and schedule changes, not just their theoretical knowledge.
- Risk-reduction assessment (I.B.8) evaluates current behaviors around preventing acute complications (hypoglycemia, hyperglycemia) and chronic complications (foot, eye, kidney, cardiovascular).
- Data-sharing friction, device cost, and digital literacy are common technology barriers that assessment should surface before a plan recommends a new device.
- A validated problem-solving deficit (for example, not knowing when to call the care team) is a patient-safety finding that should escalate education priority, not just a knowledge gap.
Extending the Behavioral Assessment
Section 4.1 covered the core self-management behaviors of Domain I.B. This section covers the remaining three items in that same sub-area: use of technology (I.B.7), risk-reduction behaviors for acute and chronic complications (I.B.8), and problem-solving (I.B.9). These three areas share a common thread — they measure how a person functions independently, outside the exam room, when something does not go according to plan.
Assessing Technology Use
Diabetes technology assessment covers a wide device landscape: blood glucose meters, continuous glucose monitors (CGM), insulin pens, insulin pumps, automated insulin delivery (hybrid closed-loop) systems, connected apps, and patient portals. The assessment has two layers:
- Access and ownership — What devices does the person currently have, and can they afford to continue using them (sensors, pump supplies, data plans)?
- Functional use — Does the person know how to operate the device, troubleshoot common errors, and interpret the data it produces?
A person can own a CGM and still have a technology gap if they never look at trend arrows or time-in-range reports. Conversely, a person on multiple daily injections with a basic meter may have excellent technology literacy within the tool they actually use. The assessment should never assume that more advanced technology equals better self-management — fit between the person and the device matters more than the device's feature set. For automated insulin delivery systems specifically, the assessment should also confirm the person understands which decisions the system makes automatically versus which decisions still require manual input, since a mistaken belief that the system "handles everything" can lead to missed manual boluses or unaddressed alarms.
Common Technology Barriers
| Barrier | Assessment Question |
|---|---|
| Cost / insurance coverage | "Is anything about affording your supplies or sensors difficult?" |
| Digital literacy | "How comfortable are you syncing your device or reading the app?" |
| Data overload | "Do you look at your CGM reports, or just react to the number on the screen?" |
| Alarm fatigue | "Do you silence or ignore alarms? Which ones, and why?" |
| Portal engagement | "Do you check your online portal for lab results or messages from your care team?" |
Assessing Problem-Solving Skills
Problem-solving assessment asks how a person actually responds when something disrupts their routine — not what they know in theory. Useful prompts include: "Tell me about the last time your blood sugar was unexpectedly high or low — what did you do?" and "What would you do if you were sick and couldn't keep food down?" These scenario-based questions reveal whether a person can generate and evaluate options under real conditions, a skill distinct from rote knowledge. A person who can recite the correct sick-day protocol from memory but freezes or guesses when actually feeling unwell has a problem-solving gap, not a knowledge gap, and needs practice-based teaching (see Chapter 12) rather than more information.
Problem-solving assessment should also identify a critical safety marker: does the person know when a situation exceeds self-management and requires contacting the care team or seeking emergency care? A person who does not recognize this threshold is at elevated risk regardless of how well they manage routine days, and this finding should raise the priority of that education topic above topics the person has simply not yet mastered.
Assessing Risk-Reduction Behaviors
Risk-reduction assessment covers what a person currently does — not just what they know — to reduce both acute and chronic complication risk. For acute risk, this includes hypoglycemia-prevention habits (carrying fast-acting carbohydrate, adjusting insulin around activity) and hyperglycemia-prevention habits (medication timing, monitoring during illness). For chronic risk, this includes self-foot-checks, adherence to recommended eye and kidney screening, blood pressure and lipid management engagement, and smoking status. As with problem-solving, the goal is behavioral reality, not stated intention: "Do you check your feet?" often yields a more optimistic answer than "Show me how you check your feet" or "When did you last actually look at the bottoms of your feet?"
Integrating the Three Areas
Technology use, problem-solving, and risk reduction are interdependent. A person with strong technology use (CGM with alarms set appropriately) but poor problem-solving (doesn't know how to respond to a low alarm) is not actually protected by the technology. Conversely, a person with excellent problem-solving skills but no access to technology may still manage safely using simpler tools. The DCES assessment should evaluate the whole system — device, data, decision-making, and follow-through — rather than any one piece in isolation, because that combined picture is what predicts real-world safety between visits and identifies exactly where the individualized education plan should concentrate its limited teaching time.
Documenting Findings for Risk Stratification
Findings from this section should feed a simple risk-stratification judgment: does this person have adequate technology, problem-solving capacity, and risk-reduction behavior to manage safely between visits, or are there specific gaps that require closer follow-up? A person with a documented problem-solving gap around hypoglycemia recognition, for instance, may warrant a shorter interval to next contact than a person whose only gap is imperfect foot-check technique. Documenting the specific gap — not a global label like "poor self-management" — lets the rest of the care team, and the DCES at the next visit, pick up exactly where the assessment left off and target follow-up teaching efficiently rather than re-covering ground the person has already mastered.
A person with diabetes owns a CGM but reports she 'only glances at the number' and never reviews trend arrows or time-in-range reports. This scenario best illustrates which principle of technology assessment?
During assessment, a person recites the correct sick-day protocol accurately but says they 'just wing it' whenever they actually feel unwell. What does this response most likely indicate?