Key Findings

• The period of initiation informally begins when a PwD explores the idea of using digital medicine products and, formally, when a PwD accesses and begins to use a digital medicine product for the first time. This phase also encompasses PwD upgrades to a new digital medicine product, and renewed use of a prior digital medicine product after a pause. This phase generally lasts about 30 days and is characterized by the PwD adjusting to the “newness” of a digital medicine product and becoming accustomed to it. 
• The next phase is optimization, in which the PwD increasingly achieves familiarity with their digital medicine product and begins to customize and integrate the digital medicine product into their lifestyle. The PwD may include seeking advice and input from the clinical care team and/or PwD community on how best to use the digital medicine product. This phase may last for 30-60 days and can be an ongoing process based on PwD aspirations for the use of the digital medicine product and desired outcomes. 
• The period of sustained use refers to the longer period of time in which the PwD has become accustomed to using a digital medicine product and has achieved steady and ongoing use of selected digital medicine products. During this phase, the PwD ideally attains a sense of routine and satisfaction with the use of the digital medicine product, which has enabled them to achieve desired outcomes. 
• Though presented as a linear construct, movement through these phases may be experienced at varying time intervals, with the occasional need to revisit a phase. Each phase is managed in collaboration with healthcare professionals and other care support.  These phases may be repeated throughout the course of a PwD’s experience engaging with digital medicine products, with progression dependent on the PwD’s experience, support, and desired outcomes. 

It can be difficult for PwD to navigate the myriad of diabetes management options available to them and their associated opportunities and challenges 

• In the initiation phase, selection of a digital medicine product is informed by the PwD’s care aspirations, lifestyle, HCP guidance, and coverage options provided by the PwD’s insurer.  If PwD and HCP choice align with product coverage, commencing to product use is seamless.  If there is a coverage barrier, the PwD and HCP must identify alternate options that may not align with elements informing PwD and HCP choice. 
• The optimization phase can present certain challenges, such as acclimating to product capability and early use, as well as managing alarms that inform the user of issues, such as blood glucose trending in a certain direction and a significant increase in data.  PwD must also learn how to manage system data access and transfer data to their HCP, all the while developing confidence in the digital health product’s capabilities.
• After initial use of a digital medicine product, a PwD may also find that the product’s design, capability, and methods for management don’t meet their pre-use perception, and are more or less advanced than anticipated.  
• The sustained use phase is critical by the time the PwD, HCP, and related support services have collaborated to optimize PwD use of the digital medicine product. The PwD is ideally realizing value — leading to health system value — from the digital medicine product and is enabled for sustained use and benefit.  Achieving sustained use may also hinge on the PwD’s ability to integrate the chosen product into their routine, versus adjusting their routine and lifestyle to fit the needs of the digital medicine product.

Uptake and use of digital medicine products can be strengthened by prioritizing the user experience

• Supporting PwD in initiating the use of digital medicine products is essential, as it sets the course for developing value for PwD. Possible opportunities may include empowering PwD to engage in digital medicine product discussions by providing PwD with data or information in the forms of in-person or online training opportunities or by increasing accessibility of information related to clinical effectiveness, interoperability, data privacy, usability, and accessibility. PwD may also benefit from improved access to digital medicine products via the development of user-friendly guidelines or additional product support from payers and manufacturers in the initial 30 days of use. 
• From an optimization perspective, potential solutions may take the form of providing ongoing and tailored support to PwD in using digital medicine products based on their individual use patterns and desired outcomes. There may also be an opportunity to improve the ability of HCPs and PwD to communicate (particularly in the COVID-19 era of largely telehealth or virtual appointments) to share meaningful data “stories” that enable constructive telehealth appointments. In the long term, additional value may be harnessed by increasing overall health system integration and developing products that are easy-to-use for all stakeholders, with all relevant activities reimbursed by the healthcare system.
• To improve sustained use of diabetes digital medicine products, the design of digital medicine products should integrate behavioral science-approaches to effectively support product-use. Manufacturers, payers, and government agencies — independently or in partnership with academic or research organization — could develop insights regarding behavior change and change management for PwD, HCPs, and support services alike, which, when broadly deployed, are likely to improve health outcomes for PwD, HCPs and payers.