We recently got a chance to connect with Asheesh Dewan, MD, an endocrinologist and founder of The DOCS, Nevada’s only American Diabetes Association Certified Center and a designated “Center of Excellence” for Medtronic, a manufacturer of insulin technology.

Dr. Dewan’s practice treats more than 44,000 endocrinology patients annually, successfully helping his patients navigate their diabetes treatment and use medical devices to manage their conditions. We wanted to find out how Twistle supports his team in the delivery of holistic care.

Stephanie Ginger (SG): Let’s start by gaining a better understanding of how you are using Twistle today in your practice.

Dr. Asheeh Dewan (AD): We have a very busy practice, so one of the first opportunities we saw for Twistle was to reduce the number of incoming calls. Many calls we receive are administrative and can be managed using the Twistle platform. Patients like it better since they’re not on hold and can get their issue resolved in real time, without waiting to speak to someone.

The second important application for Twistle is to provide step by step guidance for patients who have more complicated treatment regimens, for instance my patients who require an insulin pump to manage their condition. Medical devices can be confusing to set up and use, so we provide at least two hours of training in the office. Once the patient gets home, they can still become overwhelmed and frustrated, and may discontinue use of the device, which leads to poor glycemic control. I believe the return rate nationwide for the insulin pumps can range from 8-12%. The impact of that is not insignificant – my staff’s time providing training and support, the cost to the payer and device manufacturer, and ultimately potentially poorer outcomes for patients. 

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Twistle helps organizations overcome barriers, measurably improve adherence, manage reimbursement and device returns, and optimize patient satisfaction and health.

SG: Do you think Twistle has had a positive impact for patients using an insulin pump?

AD: Absolutely. Remember, the national average return rate for the insulin pump is 8-12% – it’s gone to 0% for our patients. They are enrolled in a Twistle care pathway that we have carefully designed to proactively address known barriers and challenges for the device. Patients have information, resources and guidance every step of the way – from getting it set up to changing out infusion sets. That results in successful device adherence, and significantly reduces phone calls from these patients. It also decreases calls to the manufacturer’s help center as patients have the information they need at their fingertips.

Another great benefit is that patients gain a better understanding of the pump’s menu functionality so they can really take advantage of the full benefit of the device. This is a powerful tool in managing diabetes and I want my patients to have the best experience possible.

SG: It sounds like there’s also a positive impact for device manufacturers when Twistle digital care pathways are deployed. Have you noticed that?

AD: From our experience, there is a definite learning curve with medical devices. There are points at which the experience can turn negative without support – not just onboarding and getting started, but also understanding the device’s functionality. So beyond insulin pumps, I see potential benefit for other devices to provide this type of asynchronous communication to support patients and improve outcomes. The technology can help patients avoid known complications, give them confidence in operating the device, and, like I mentioned earlier, that extra support ensures that patients know how to access and use all of the device’s features – adding substantially to its value for the patient.

For Medtronic, in particular, we identified the common areas of confusion and misunderstanding with their insulin pump and incorporated those into the Twistle secure messaging pathway. We are eliminating device returns and reducing calls that the manufacturer’s call centers would normally receive and handle. Our patients are well prepared to manage and benefit from the pump.

SG: How did COVID-19 impact your practice? Were you able to leverage Twistle as you responded to the pandemic?

AD: We have a high-risk population, so keeping them as safe as possible was our main priority. Twistle allows us to communicate with and manage patients at home; they enter data and complete assessment forms, and we can make treatment adjustments, monitor labs, and connect using digital tools. Because I was able to deliver a lot of patient care digitally and asynchronously through Twistle, I was actually able to increase my patient load from about 45 to 65 patients a day throughout the pandemic.

For our patients getting started on an insulin pump, we could even do much of that remotely, such as supporting them in downloading the software on their smartphones and changing glucose sensors at home. Understanding where the ‘crises’ points are in adopting a new technology, Twistle allowed us to circumvent these challenges whilst monitoring their onboarding and progress, and decreasing the failure rate on the pump to 0% (down from national average of 10%).

SG: Do you see other applications for Twistle’s technology?

AD: Yes, definitely. We are expanding our Twistle pathways beyond the single specialty to include postoperative podiatry, wound care for diabetics, catheter management, and limb salvage.

We have seen some really positive impacts of this type of automated digital communication to keep patients on track, improve patient outcome, allow for ‘micro visits’ between formal appointments, foster device adherence, and empower patients as active participants in their care.


Many thanks to Dr. Dewan for sharing how Twistle can positively impact the patient experience, support device management and adherence, and increase staff efficiency. Interested in learning more? Contact us today