Integrated Healthcare and Diabetes Management
How can advancements in diabetes technologies be leveraged for even more benefit?
Diabetics have benefited from ongoing advancements in technology since the turn of the century. Continuous glucose monitors (CGMs) provide a constant, and reliable, stream of glucose information to users without the need for painful finger sticks. Similarly, insulin pumps have advanced from early manual-entry models to more sophisticated delivery systems based on artificial intelligence and machine learning. The latest insulin pump models even integrate with CGMs to achieve a hybrid “closed-loop” system that independently adjusts insulin delivery based on real time glucose levels. Research into these newest systems support their perceived benefit, as well: one recent study of the closed-loop system found an HbA1c improvement of 0.3% in patients, highlighted by an 8.4% improvement of time in range (70–180mg/dL; 3.9–10.0 mmol/L) during evening and overnight hours. But is there a way that these technologies can deliver more value to the patient?
Diabetes management, whether type 1 or type 2 diabetes, provides daily challenges that can overwhelm even the most well-controlled diabetics. Food and drink intake, activity, and stress levels are just a few of the many factors that impact glucose control hourly. Sure, constant information to the user is a benefit which research supports, not to mention the inherent advantage of a closed-loop system to a user’s daily quality of life. However, there’s another element that’s critical to maximizing the positive impact of these technologies: timely professional feedback. Welcome to the world of diabetes management and integrated healthcare.
Integrated healthcare has many different definitions to many different people, but at its basic level it is understood as an organizational arrangement of stakeholders around a patient’s central needs. This concept can carry a number of different names, from ‘multidisciplinary care’ to ‘team-based support,’ but the fundamental concept is consistent: a patient’s whole health is considered, and care is coordinated, across a group of providers with the goal of delivering the best outcomes. In the medical field, this is known as the biopsychosocial model and refers to the interconnection between biology, psychology, and socio-environmental factors. Studies have shown that it is particularly important in the management of chronic diseases, particularly diabetes. One study by McKinsey & Company found that diabetic care from multidisciplinary teams resulted in positive impacts in 81% of cases, and reduced hospitalizations by 15% — 30%. Most importantly, the study found that integrated healthcare reduced HbA1c values by an average of 0.5 percentage points- a value that correlates to a 10.5% reduction in diabetes-related complications.
What’s the best way a patient can effectively leverage the benefits of their medical devices with integrated healthcare? First, talk to the primary care physician. A diabetic’s healthcare team is large, generally consisting of a primary care provider, endocrinologist, ophthalmologist, podiatrist, pharmacist, dentist, registered nurse, dietitian/nutritionist, diabetes educator, mental health professional, fitness coach, and, of course, the patient. Most of these providers should have the ability to access device data continuously via web-based platforms with the patient’s permission, provided that standardized health data sets are accessible and structured. The patient should take initiative to discuss integrated care with their primary care doctor to establish goals, feedback loops, and information sharing. From there, the primary care doctor should serve as the head for the rest of the team- consulting with the other providers, setting goals, and maintaining accountability. Each provider on the team can have access to the most up-to-date device data and make the best decisions for the patient in the context of their overall care.
For example, imagine a scenario in which, while analyzing a patient’s 3-month historical CGM data, an endocrinologist notices a regular spike in weekend glucose levels from 10:30am — 11:30am. Knowing the patient has an appointment with their nutritionist in two weeks, the endocrinologist flags this data with the nutritionist and asks that they review and discuss it with the patient. From the conversation with the nutritionist, it’s realized that the patient was underestimating the amount of carbs and serving portions in their weekend breakfast pastries. The decision is made, rather than increase insulin, to instead cut back on weekend sweets because the patient has started a new workout program on Saturday and Sunday afternoons with a fitness coach recommended by the diabetes educator after an appointment highlighting the benefits of physical activity to diabetics. Two months later, the primary care doctor would be excited to see that the patient’s HbA1c score has dropped a full percentage point and mentions that the podiatrist is no longer concerned about a foot wound that wasn’t healing properly.
It’s clear that combining the ease of diabetic device data sharing with the holistic approach of integrated healthcare benefits the disease management and quality of life of diabetics. As technologies continue to advance and develop, more and more diabetics will have access to these synergies. DiaMonTech, an early growth MedTech company pioneering non-invasive blood glucose measurement methods, is currently developing a handheld device, called the D-Pocket that will estimate blood glucose non-invasively and with clinical accuracy. That means no more pesky finger sticks to draw blood- especially for the majority of diabetics who don’t use CGMs. And, just like CGMs and insulin pump devices, the data it collects can be easily shared with a patient’s healthcare team. So talk to your doctor today about integrating your healthcare and start realizing these benefits first hand!
