Healthcare organizations turn to technology to reduce the far-reaching, costly impact of diabetes.
Written by Alison Diana
Healthcare providers, payers, and patients expect new technologies and shifts to patient engagement and population health will help the nation's 29.1 million diabetics manage their condition and reduce the costs associated with this dangerous and expensive disease.
In 2012, diagnosed diabetes cost the US $176 billion, and reduced productivity cost another $69 billion, according to the Centers for Disease Control. After adjusting for age and gender differences, average medical expenses for people with diabetes were 2.3 times higher than they would have been without diabetes, the American Diabetes Association reported.
More than 1.5 million Americans have Type 1 diabetes; the vast majority of cases are Type 2 diabetes, which typically is linked to obesity. In Type 2 cases, patients still produce insulin and may improve with lifestyle and diet changes. Unchecked, diabetes can lead to more medical complications and even death.
Without attention, US diabetes cases will increase, fueled by Americans' diet of sugar and processed food, Dr. Brett Osborn, author of Get Serious: A Neurosurgeon's Guide to Optimal Health and Fitness, told InformationWeek.
"More than 30% of Medicare dollars are spent on diabetics and/or related complications. Likely diabetes, or more specifically 'insulin resistance,' will be linked to many more disease processes -- i.e., Alzheimer's disease is also referred to as 'Type III diabetes,' as one of its underpinnings is insulin resistance," he says.
In an effort to improve health, reduce costs, and slow down future cases, healthcare providers are educating non-diabetics about how to avoid the condition and using new and long-established tools to help diabetics live healthier lives.
They're influenced by healthcare's transition to patient engagement -- with its growing reliance on patient portals, mobile apps, and the creation of health-focused communities -- plus population health, which considers the multiple factors that make up the population's individual and overall health.
In Cities for Life, a diabetes management program supported by Sanofi US and conducted by the American Academy of Family Physicians Foundation, patients were connected with community resources to help manage their condition. Partners at the University of Alabama researched resources at local churches, YMCAs, gyms, and other sites, then created a database and website -- MyDiabetesConnect.com -- where residents could locate farmers' markets, exercise programs, and other items conducive to health living.
"Obviously what happens in their doctors' offices is very important, but they need to carry out what they plan in their doctors' offices throughout the year," Dr. Edwin Fisher, global director of Peers for Progress at the American Academy of Family Physicians Foundation, tells us. "We really need comprehensive approaches that bring together clinical care, community care, social support, friends, and neighbors, to help people with diabetes live their lives well and take care of their diabetes well."
Increasingly, that care involves technology.
The information pouring in from glucose meters provides developers, researchers, payers, and other members of the healthcare world with a plethora of data for analysis that could provide insight into new treatments or devices. Tens of thousands of diabetics also use the more than 1,000 apps now available to monitor and manage the condition, further fueling both improved health and big-data solutions.
"Ultimately, more aggressive monitoring -- implantable, continuous -- will lead to tighter glucose control. This equates to reduced formation of advanced glycation products and lower bodily inflammation (the damaging, diabetes-associated epiphenomena)," says Osborn. "Google will likely be introducing a contact lens-based glucose monitor in the next several years. This will allow for real-time monitoring of blood glucose, essentially providing a number upon which people can rapidly act. Aggressive treatment early on is the key -- although prevention obviously is ideal."
Tech companies are venturing into the diagnostics and treatment market. Patients can use smartphones to monitor their condition. In addition to Google's under-development smart contact lens, other companies are creating a bionic pancreas and exploring genomes to control diabetes.
Take a look at some of the technologies currently in use, and let us know what your organization is doing to help diabetic patients control costs and improve their health.
Earlier this year, Google took the wraps off its smart contact lens project, "built to measure glucose levels in tears via a tiny wireless chip and miniaturized glucose sensor embedded between two layers of soft contact lens material." The developer also is investigating whether integrated LED lights could show when glucose levels have passed above or below particular thresholds.
"We're in discussions with the FDA, but there's still a lot more work to do to turn this technology into a system that people can use. We're not going to do this alone: we plan to look for partners who are experts in bringing products like this to market," wrote project co-founders Brian Otis and Babak Parviz on Google's blog. "These partners will use our technology for a smart contact lens and develop apps that would make the measurements available to the wearer and their doctor."
Engineers from Boston University created a closed-loop bionic pancreas system that uses continuous glucose monitoring and subcutaneous delivery of rapid-acting insulin and glucagen as directed by an algorithm. The system, currently being tested on people with Type 1 diabetes at Massachusetts General Hospital, could one day make automated blood glucose control a reality, according to the developers' blog.
The manmade pancreas makes a new decision about insulin and glucagen doses every five minutes. Previous bionic pancreases could not administer glucagen, which raises blood glucose in response to hypoglycemia.
"Achieving and maintaining near-normal blood glucose concentrations are critical for the long-term health of people with diabetes. Unfortunately, the therapy required to achieve this goal is extremely demanding, requiring frequent blood glucose checks and either multiple daily insulin injections or the use of an insulin pump," the researchers wrote. "Even with current state-of-the-art insulin replacement, it is almost impossible to completely avoid hyperglycemia and hypoglycemia."
Improving Medication Adherence
The Accountable Care Organization of Greater New York (ACCGNY) and AllazoHealth are partnering on a pilot aimed at improving medication adherence among ACCGNY's Medicare-eligible beneficiaries. Many people in this group are elderly and/or have intellectual and developmental disabilities, and many have multiple conditions, including diabetes, hypertension, epilepsy, and/or hyperlipidemia. The pilot, sponsored by a grant of $91,914 from 2014 Pilot Health Tech NYC, will use AllazoHealth's AllazoEngine to determine which patients are most at risk of not taking their prescribed medications and to predict which interventions are most likely to promote adherence.
Clinical staff will use the results from AllazoEngine to deliver patients' interventions via calls or in-person counseling. The analytics engine bases its results on ACCGNY's historical claims data. In addition to reducing medical costs, the pilot should improve care for IDD patients.
"Our goal is to provide affordable, high quality care to our Medicare beneficiaries. Partnering with AllazoHealth will give us the tools to improve our population's medication adherence and reduce medical costs," said Gabriel Luft, executive director of ACCGNY, in a statement
Former American Idol judge Randy Jackson teamed up with digital health and wellness company Everyday Health to create consumer-facing resources about diabetes on a platform dubbed "Diabetes Step by Step." Jackson will provide blogs, videos, and a diabetes awareness-screening program, slated to run live in a number of cities through November -- American Diabetes Month.
Jackson, who was diagnosed with Type 2 diabetes in 1999, wrote about his experiences in Body With Soul: Slash Sugar, Cut Cholesterol, and Get a Jump on Your Best Health Ever. He also has served as the spokesman for the American Heart Association's "Heart of Diabetes" campaign. "Diabetes is an issue that is near and dear to my heart, and this is a tremendous opportunity to educate people on diabetes prevention and control," Jackson said in a statement.
Once big, bulky machines, glucose monitors are now as sleek as an iPhone. Vendors like Gmate integrate an app and smart meter that connects to the iPhone headphone jack, then measures a patient's blood glucose reading.
The Gmate Smart is compatible with Apple's iPhone 3GS, 4, 4S, and 5; the iPod Touch 4th generation; plus iPad and iPad 2. Users download the app from iTunes, insert Gmate's smart device and test strip, apply the sample, and see their results on the Apple device screen.
Researchers, payers, and providers are exploring the connections between a host of potential causes and effects on diabetics thanks to powerful, lower-cost, and user-friendly big-data and analytics tools. The move to collapse silos and combine multiple research studies to seek trends from greater pools of subjects is generating pilot programs, reallocation of resources, and additional benefits.
Startup Databetes, founded by a person with Type 1 diabetes, uses a data-driven approach to diabetes management that combines apps and smartphones, as well as food and lifestyle data, to help patients manage the condition. Explorys and Accenture are collaborating on an initiative to improve population health approaches for diabetes care.
There are more than 1,100 iOS and Android apps designed expressly to help people manage diabetes. They include cookbooks and a wide array of management apps that help diabetics track their insulin, exercise, and sugar intake.
Glooko, for example, allows patients to download blood glucose readings to their smartphones, integrate food and lifestyle data, then share that information with health providers. Glooko also makes available diabetes-related data and analytics to healthcare providers and payers to support research into the condition. Diabetes Pilot records glucose, insulin, and other measurements; tracks food nutrients; includes a food database; and allows patients to share data with healthcare providers. And GlucoseBuddy, for iOS, lets users record meals, exercise, insulin levels, and share records with physicians.
As part of the 2013 Data Design Diabetes Sanofi US Innovation Challenge, Common Sensing developed GoCap, a pen cap that tracks insulin and wirelessly connects with a smartphone. A replacement cap for insulin pens, the GoCap reads insulin amounts and times, then communicates via Bluetooth with a phone or connected glucometer, HIT Consultant reported.
Developers offer several tools for people who look after individuals with diabetes, as well as patients themselves. Developers such as Dexcom, Medtronic, Glucose Buddy, and American Association of Diabetes Educators offer apps filled with training, education, and other items of use for caregivers.
Telemedicine can help diabetics save time and money, and can help healthcare systems improve population health and profitability.
For example, the University of Mississippi Medical Center, North Sunflower Medical Center, GE Healthcare, Intel-GE Care Innovations, and C-Spire formed the Diabetes Telehealth Network -- an 18-month remote care management program to serve the region's high percentage of diabetic patients. Harvard's Joslin Diabetes Center and American Well teamed up to provide telehealth services to diabetics nationwide
Diabetes breakthrough drug can work for two days from a single jab
By Andrew Gregory
Scientists say the two-day diabetes jab will help millions and tests have found no side
A jab that can reverse diabetes for up to two days has been developed by scientists.
One injection of the groundbreaking drug brings blood sugar levels back to normal and restores sensitivity to insulin.
More than three million people suffer from the condition in the UK.
US researchers tested the drug – FGF1 – on mice and were stunned by the “dramatic” results.
The next stage will be clinical trials on patients.
At the moment diabetes can only be managed through diet, exercise and conventional drugs, which work by reversing insulin resistance.
But these drugs can cause sugar levels to dip and spark potentially life-threatening hypoglycaemia.
They also carry risks of weight gain, and heart or liver problems.
But even at high doses, researchers found that FGF1 does not trigger these side effects.
Dr Michael Downes, co-author of the study published in the US medical journal Nature, said: “Many previous studies that injected FGF1 showed no effect on healthy mice. However, when we injected it into a diabetic mouse, we saw a dramatic improvement in glucose.”
Diabetes is a growing problem in the UK, with 163,000 new cases diagnosed last year – the biggest annual increase since 2008.
It means 6% of UK adults are registered as diabetic. Experts believe another 850,000 may have the condition but don’t know it.
Diabetes UK says the rise is largely fuelled by type 2 diabetes, linked to obesity and a unhealthy lifestyle.
Being overweight raises the risk of not producing enough insulin, or cells failing to react to insulin, which controls the amount of energy-giving glucose in the blood.
Dr Ronald Evans, professor at the Salk Institute in La Jolla, California, said: “Controlling glucose is a major problem in our society. FGF1 offers a new method of controlling it in a powerful and unexpected way.”