LearningObjectives

Better communicate with patients through

understanding and analyzing three

defining events that shape the

characteristics of each generation.

1 2 3Develop communication

strategies that incorporate differences in thought and

approach to diet management for people with diabetes across the

five generations.

Strategize ways to create communication bridges

across generations to enhance diabetes management and

improve overall health education.

2

MyStory…

@diabeteseveryday

DiabetesEveryDay and TobySmithson

TobySmithson

Diabetes EveryDay

DiabetesEveryDay.com

4

Generations…Write me

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WhatDefinesaGeneration?

CommonContextofExperiences

• Group of people born in the same time frame – usually about 20 years

• Events, trends, and technology

• Share a common context of experiences – shapes beliefs, values, and preferences

Educators:MindtheGap

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SilentGeneration:1928- 19459

MeetKeith– SilentGeneration

DefiningWorldEvents• The Great Depression

• The New Deal

•WWI, WWII

• Penicillin and polio vaccine

• Parents: Immigrants

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Characteristics• Loyalty

• Duty

• Patriotism

• Delayed gratification

• Strong work ethic - saves for a rainy day

• Personal sacrifice

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SignificantDevelopmentsinDiabetes

• Commercial production of insulin (1923)

• Joslin Pregnancy Clinic for Women with Diabetes (1924)

• ADA is founded to address increasing incidence of diabetes and complications (1940)

• Lack of data about type 2 diabetes; it was a rare diagnosis

Keith’sTakeonHealthyEating

MilestonesinDietHistoryDiet:

• Early 1900s (1900-1920): Starvation• 1925: The Line Ration Diet

• Lawrence weighed diabetic diet

Low Calorie Sweeteners:

• Saccharin (discovered in 1878) came out in the marketplace in 1945

• A low-calorie, low-carbohydrate, sweet-tasting option for people with diabetes

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EffectiveCommunicationwiththeSilentGeneration• Use testimonials and expert endorsements • Don’t rush or pressure them to make a decision;

they like to take their time • Offer them time with others; they rely on

connectedness and social activities • Promote patriotism, teamwork, and doing more

with less • Use the rules of conduct, respect for authority, and

a top-down, “chain of command” approach • Provide detailed directions on how to do something

Sugarman J: 4GenNow 2018 (7) Four Key Communication Strategies Each Generation Uses: How to become a “Generational Whisperer”16

BabyBoomers:1946– 196417

MeetTerry– BabyBoomerGeneration

DefiningWorldEvents• End of WWII• Vietnam War begins• First human in space• Assassination of JFK•Womens’ Right’s Movement• Traditional parents•Mom stays home• Financially secure

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DefiningEvents

Characteristics• Optimism• Idealism• Devotion• Competitive: people to job ratio• “Me” generation•Want to leave their mark

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SignificantDevelopmentsinDiabetes

• 1949: Dr. Levine discovers insulin works as a key into cells

• 1950: ADA meal planner with six food groups – “exchanges”

• 1953: Tablets for urine testing; urine test strips developed

• 1955: Sulfonylureas available

• 1961: Glucagon as a treatment for severe hypoglycemia introduced (Eli Lilly)

Terry’sTakeonHealthyEating

MilestonesinDietHistoryDiet:• The Exchange System was developed in the 1950s

• 1700 calorie plan consisting of • 43% carbohydrate• 19% protein• 37% fat

• Was used until carb counting began • Swap foods within the same food group as an equal

exchange • Revisions in 1976, 1986, and 1995• Diet for Baby Boomers and the Silent Generation

Low Calorie Sweeteners • Cyclamate used as a blend with saccharin (1950s-1960s)

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• Are familiar and accustomed with email and the internet• Prefer face-to-face or a phone call, and after business

hours they prefer email unless it's urgent in which case they prefer telephone• Provide knowledge; this group likes to understand the big

picture • Offer them a new experience; this group is adventurous

and likes to try new things • Provide choices; this group likes to weigh their options • Discuss technology; this group spends the most on

technological products

EffectiveCommunicationwithBabyBoomers

25Sugarman J: 4GenNow 2018 (7) Four Key Communication Strategies Each Generation Uses: How to become a “Generational Whisperer”

• Talk about their well-being; help them to see they are ageless • Speak less about the past and more about the future • Consider communicating via social media• Baby boomers use Facebook, LinkedIn, have smartphones,

and tablets• They rarely use these devices for texting

• Focus on their achievements and the goals they want to attain

EffectiveCommunicationwithBabyBoomers

26Sugarman J: 4GenNow 2018 (7) Four Key Communication Strategies Each Generation Uses: How to become a “Generational Whisperer”

Cusper27

GenerationX: 1965– 198028

DefiningWorldEvents• End of Vietnam War•Watergate scandal• Religious scandals – Jim Baker,

Catholic priests• AIDS• Technology explosion• Latchkey kids, many with

divorced parents

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DefiningEvents

Characteristics• Skepticism• Self-reliant and competent• Disillusionment• Demand work/life balance

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TechnologyinDiabetes

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SignificantDevelopmentsinDiabetes• 1967: Laser treatment for retinopathy

• 1969: First blood glucose monitoring device

• 1979: A1C developed

• 1979: First insulin pump introduced

• 1980s – 1990s: New types of insulin

• 1980s – 1990s: very short acting insulin developed

• Support system: 1970 – Juvenille Diabetes Research Foundation (JDRF) established

MilestonesinDietHistoryExchange System: • Early 1970s:

• 45% of calories from carbohydrate• 20% from protein• 40% from fat

• In 1979:• 50-60% of calories from carbohydrate• 12-20% from protein • The rest of the percentage from fat

Low Calorie Sweeteners (LCSs):• Saccharin-only LCSs on the market from 1970-1981• Sucaryl (1937 for medications) 1966, banned in 1969

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EffectiveCommunicationwithGenerationX• Are familiar with and accustomed to using email and the

internet• Believe they must always be connected to peers via cell

phone, instant messaging, and other forms of contact, even at work• May avoid meetings and phone calls (i.e., leave a message)

because they are busy and don't see the potential gain • Baby Boomers often see this as not team-oriented

• Do not like meetings

35Sugarman J: 4GenNow 2018 (7) Four Key Communication Strategies Each Generation Uses: How to become a “Generational Whisperer”

EffectiveCommunicationwithGenerationX(Cont.)• Use motivational Interviewing

• Offer suggestions rather than telling them what to do

• Provide a variety of choices

• Let this group make their decision at their own pace; don’t use hard selling techniques

• Promote quality

• Share images and graphics to gain buy-in

• Involve their friends in the experience and decision-making

• Approach these individuals from a global point of view rather than a local one

• Steer away from anything that threatens their lifestyle, be it political, social, or business

• Go straight to the point rather than hinting at something

• Deliver what you promise, or you will be dropped

• Let them get to know you and trust you

36Sugarman J: 4GenNow 2018 (7) Four Key Communication Strategies Each Generation Uses: How to become a “Generational Whisperer”

Millennials:1981– 199637

MeetAsha– Millennial

Choices…

Insteadof…40

• Collapse of the Soviet Union

• South Africa repeals apartheid laws

• Use of the Internet grows exponentially

• Knowledge of the World Trade Center Tragedy

DefiningWorldEvents

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Characteristics• Independent

• Community-oriented

• Explorative, experiential, “hands on learners”

• “Digital Native”

• Ability to embrace innovation and new ideas

• They’re not afraid to think outside the box, so get creative with them!

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DevelopmentsinDiabetes• Basal/Bolus insulin concept for intensive insulin

treatment• FDA approved human insulin

• MiniMed conducted the first clinical trial of a continuous glucose sensor in the United States

• MiniMed received FDA approval for the first Continuous Glucose Monitor (CGM) in the USA

• ADA releases the first Standards of Care (1989)• Many new meds for Type 2 Diabetes released

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Asha’sTakeonHealthyEating

MilestonesinDietHistory

• Millennials bought into carbohydrate counting immediately - no foods were off limits

• Aspartame (1965) - in 1981, aspartame received FDA approval to be added to foods

• Acesulfame Potassium (1988), appeared on the market (200x sweeter than sugar) approved as a tabletop sweetener

• Sucralose (1998) - FDA approved sucralose for use in 15 broad food and beverage categories and as a tabletop sweetener (600x sweeter than sugar)

• In 1999, sucralose was approved by the FDA as a general-purpose sweetener

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NewName:PeerSupportCommunities

FromDiabetesOnlineCommunitiestoPeerSupportCommunities

EffectiveCommunicationwithMillennials• EMBRACE TECHNOLOGY• Stay updated on diabetes apps and digital

devices• Not linear learners – seek input from

multiple sources• Shorter attention span – “hypertext” mindset• Prefer visual over textual or graphic – not

readers as a whole!• Informatically illiterate – can sort info, but poor

judge of quality

47Sugarman J: 4GenNow 2018 (7) Four Key Communication Strategies Each Generation Uses: How to become a “Generational Whisperer”

ConnectingwithYourPatientsUpdates on technology/research:• Diatribe: www.diabtribe.org• A Sweet Life: www.asweetlife.org• DiabetesMine: www.healthline.com/diabetesmine

Community Connections:• Diabetes Sisters: https://diabetessisters.org/• We Are Diabetes: http://www.wearediabetes.org/• BeyondType1: https://beyondtype1.org/

Community Events• Friends For Life http://www.childrenwithdiabetes.com/• Take Control of Your Diabetes https://tcoyd.org/• JDRF http://www.jdrf.org/• American Diabetes Association http://www.diabetes.org/in-my-community/events-calendar.html• ADCES – The Importance of Peer Support https://www.diabeteseducator.org/practice/practice-tools/app-

resources/peer-support-for-healthcare-professionals48

GenZ:Bornafter199749

MeetLiam– GenZ

DefiningWorldEvents• Technology continues to be

developed = tech Savvy

• September 11th

• The Great Recession

• Unemployment rates increase –8.7 million jobs were shed from February 2008 to February 2010

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Characteristics• Uncertainty• Insecurity

*Both of these traits can stem from a combination of potential economic distress during youth as well as social media influence

• Shorter attention spans• Less optimistic than previous generations• Independent• Fast-paced lifestyle

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DevelopmentsinDiabetes• First Continuous Glucose

Monitor becomes available for patient use

• New insulins come to the market

• Flash blood glucose meters

•More to come…awaiting FDA approval

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Liam’sTakeonHealthyEating

MilestonesinDietHistoryDiet• People diagnosed with diabetes in this

generation use carbohydrate counting = no foods are off limits

Low Calorie Sweeteners• In 2002, Neotame was approved as a tabletop

sweetener by FDA (7,000-8,000x sweeter)• In 2008, Stevia sweeteners received GRAS

(generally recommended as safe) status through FDA for use as a low-calorie sweetener

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EffectiveCommunicationwithGenZ• Stay focused on positive aspects of patient’s self care to build trust• Approach high A1Cs, lack of checking, etc., as a challenge to tackle together vs allowing the patient to feel as if they must do it all themselves• Focus on integrative options: Dexcom share/Dexcom clarity • Glooko• MySugr

• Let your patient decide how they want to manage their diabetes• Pumps are not for everyone• Some will prefer CGM without closed loop • Focus on what will help them feel secure and independent• Remember this generation are digital learners

56Marvez M: Benefit News. 2017 How to communicate with all five generations in the workplace

GroupExerciseThink about the multiple generations you communicate with on a daily basis and think of one individual. Reflect on how something you heard today might change your interactions with someone. Would you do anything different when interacting with this individual the next time?

Resources:• American Diabetes Association http://www.diabetes.org/research-and-

practice/student-resources/history-of-diabetes.html

• International Food Information Council Foundation http://www.foodinsight.org/Content/76/Low-Calorie-Sweeteners-and-Health.pdf

• Splenda for Healthcare Professional https://www.splendaprofessional.com/

• Standards of Medical Care in Diabetes 2018 http://care.diabetesjournals.org/content/41/Supplement_1/S1

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Questions?

@diabeteseveryday

DiabetesEveryDay and TobySmithson

TobySmithson

Diabetes EveryDay

DiabetesEveryDay.com

58

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CREDIT CLAIMING INSTRUCTIONS: 1. Login to www.CE.TodaysDietitian.com.

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