Better IT needed in battling diabetes

'It's urgent that we take swift action.'
By Erin McCann
11:20 AM

The U.S. spends 86 percent of its healthcare dollars on chronic disease. Health IT is just beginning to loosen the tight hold these conditions have on the healthcare system. We take a closer look at the effect technology is having on the top three: heart disease, cancer and diabetes. In Part I of a three-part cover story series from our February 2015 issue, we highlight heart disease and cancer. Today, we focus on diabetes.

Howard Wolpert, MD, has spent a greater part of his life researching technology innovations used for diabetes management. And there are some exciting prospects. In his mind, you can’t expect to combat one of the United State’s biggest and costliest epidemics with outdated technology and outdated mindsets. You need innovation, adaption and emerging technologies if you even want a chance against a disease that currently afflicts a staggering 29 million Americans.

As Director of the Joslin Institute for Technology Translation, Wolpert has seen mobile health in particular make a huge difference in the day-to-day lives of diabetes patients. One of the initiatives he and his colleagues are currently working on involves using mHealth tools to provide guidance and feedback to patients related to their glucose monitoring.

It seems rather basic: patients with diabetes need to monitor their glucose levels for successful disease management and to prevent low blood sugar episodes, but it’s not always so simple. Patients are not always able to identify when they have low blood glucose levels, especially because over time the warning symptoms become much less obvious, Wolpert pointed out, a condition known as “hypoglycemia unawareness.” So a technology that monitors blood sugar and is able to detect these often subtle symptoms could end up being a life saver for many.

Joslin has inked a partnership with cloud-based diabetes management platform Glooko to provide the technology. The system allows the user to upload glucose data from various blood glucose platforms into a person’s smartphone, where it can then go into the cloud. Joslin has enrolled some 50 patients for the initial phase of the project.

For the project, Wolpert and his team decided to focus specifically on patients with hypoglycemia, or low blood sugar, for a couple big reasons. First and foremost, he said, “these episodes are potentially very dangerous.”

[See also: Diabetes pilot debuts in Mississippi.]

Indeed, research on hypoglycemia mortality rates suggest that about one in 20 people die from low blood sugar.

There’s also the cost piece, Wolpert added. Consider the fact that all told, the disease costs a hefty $245 billion in medical costs and lost work and pay, according to data from the Centers for Disease Control and Prevention. “The new numbers are alarming,” said Ann Albright, director of CDC’s Division of Diabetes Translation, in a press statement this past June, announcing the updated diabetes statistics. “It’s urgent that we take swift action to effectively treat and prevent this serious disease.”

A chunk of that price tag comes from the annual 100,000 emergency department visits due to insulin-related hypoglycemia, CDC researchers found. And nearly 30 percent of those visits resulted in hospitalizations.

Many industry leaders have made serious headway on these numbers. A February 2014 peer-reviewed piece published by a University of Utah professor in conjunction with mHealth company Telcare, for instance, found that mHealth diabetes monitoring technology resulted in a more than $3,000 reduction in annual employee healthcare costs per person.

“There's an immediate cost,” Wolpert said. But “the return on health systems investing in these types of tools for people with diabetes is kind of more immediate.”

Enter the diabetes management platform. “Basically what the tool does,” Wolpert explained, is “when a person has low blood glucose, it provides them prompts around entering contextual information – what symptoms are they experiencing when they're low, how do they treat their low, what they think caused the low,” he said. “The prompting is meant to kind of get people engaged around understanding the glucose fluctuations.” It's also important, Wolpert continued, because it helps with the data analysis piece, when one looking to identify certain patterns to provide guidance to patients, it provides the contextual information.

It sounds great in theory, but will patients actually use the service on a regular basis? The jury is still out.

For one, patients and consumers have been inundated with apps, with recent PricewaterhouseCoopers’ analysis calling the app market, “highly saturated,” counting a whopping 50,000 healthcare apps available.

And for another, getting patients to actively and regularly use one of these apps has proven difficult. For many, it’s just overwhelming and burdensome, Wolpert acknowledged.

“Giving them self-management tasks that are manageable and achievable and when they see a return on the effort, that's what drives them on further engagement.”

                                                                                                                                                                                               - Howard Wolpert, MD

“The big and important issue is really not to overburden patients with too much to do because then it becomes all or nothing, and too often, that's nothing,” he said. “Giving them self-management tasks that are manageable and achievable and when they see a return on the effort, that's what drives them on further engagement.”

[See also: HEALTHeLINK to pilot diabetes telemonitoring.]

Still, though, you “need to be realistic,” Wolpert said. “People aren't going to use everything all the time, in terms of all the apps.”

In terms of when the industry will reach a turning point with patient engagement and app adoption, it’s already happening now, he opined. The industry is gradually seeing the development of clinical applications in a sector that was previously limited to consumer health apps. “I think where adoption of these mHealth tools is really going to take off is when the apps actually become part of the care process and they're actually prescribed,” he said.

Right now, the diabetes management platform is in its initial phase, but in the next two months, Wolpert added, the next version will be coming out, and this one will be able to pull in a user’s exercise data, activity patterns and blood glucose levels.

It’s exciting, he said, because patients will now be able to see the association between their activity levels and blood glucose lows. “The promise here is not just actually feeding people information,” he said, “but it's actually pulling together data inputs and throwing it together” in a way that’s helpful to people.

For the third phase of the project, Wolpert and his colleagues will be focusing on data integration – so integrating data from other inputs like insulin pumps, continuous glucose monitoring, etc. In terms of numerical evidence, it’s too early to tell, Wolpert said, as they’re still very much in the beginning phase. Right now, they are in the process of developing a formal randomized trial to evaluate the results. Anecdotally, though? “People are finding it beneficial,” Wolpert added, and he anticipates that soon the data will be even more telling.

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