The Need to Focus on Diabetes Marilyn Staniland, CDE, MBA, MSN - - PowerPoint PPT Presentation

Presentation title

The Need to Focus on Diabetes

Marilyn Staniland, CDE, MBA, MSN Executive Director, Field Medical Affairs West

AGENDA AGENDA

1

Current state of diabetes

1 2

Current state of diabetes Stages of the disease continuum & interventions

3

Barriers to diabetes treatment Importance of two specific NDHI components

4

Why we need to address diabetes – ll

Presentation Slide no 3

Human Toll

• 29 1 million with diabetes
• 29.1 million with diabetes
• 8.1 million are undiagnosed
• 86 million with prediabetes

p

• One in eight knows they have it
• By 2050, one in three

Americans will have diabetes

Why we need to address diabetes – i ll

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Economic Toll

• Diabetes costs the U.S.

$322 billion annually

• 1 in 3 Medicare dollars is spent
• n people with diabetes

l h 2 3 i

• Healthcare costs are 2.3 times

higher for people with diabetes

Despite Improvement in Glycemic Control, 48% of Patients Are Not at ADA Control, 48% of Patients Are Not at ADA A1C Goal of <7%

40 1999-2002 30 35 s (%) 2003-2006 2007-2010 15 20 25 Patients 5 10 15 <6.0 6.0 - 6.9 7.0 - 7.9 8.0 - 8.9 9.0 - 9.9 ≥10.0 A1C (%)

Figure adapted with permission. Ali MK et al. N Engl J Med. 2013;368(17):1613-1624..

Gaps in the quality of diabetes care i l persist: treatment goals

% of diabetes patients who met treatment goals f 2006 20091

• Another analysis found that

80% 100%

from 2006-20091

• Another analysis found that

complications resulting from inadequate control of these parameters may account for as much as 20% of total diabetes spending2

57% 46% 47% 60%

diabetes spending2

12% 20% 40% % 0%

A1C BP LDL-C Composite

Defined Goals: A1C<7%; BP<130/80 mmHg; LCL-C<100 mg/dL; Composite: Combined all three 1.Cheung BM, Ong KL, Cherny SS, Sham PC, Tso AW, and Lam KS. Am J Med. 2009; 122: 443–453. 2. Milliman. The cost and quality gap in diabetes care: An actuarial

• analysis. 2012. Available at http: / / us.milliman.com/ uploadedFiles/ insight/ health-published/ cost-quality-gap-diabetes.pdf

Defined Goals: A1C<7%; BP<130/80 mmHg; LCL C<100 mg/dL; Composite: Combined all three

Why aren’t patients achieving their goals?

LANGUAGE BARRIERS

POOR FAMILY SUPPORT

FEAR

NEEDLE PHOBIA

INJECTION ANXIETY

POOR FAMILY SUPPORT

PATIENT-PHYSICIAN DISCONNECT

SOCIAL STIGMA

INSURANCE COVERAGE

TIME

MYTHS ABOUT INSULIN

DIETARY CUSTOMS

LACK OF EDUCATIONAL RESOURCES

PHYSICIAN LACK OF KNOWLEDGE

• 1. Nam S, et al. Diabetes Res Clin Pract. 2011;93(1):1-9; 2.Kuritzky L. J Fam Pract. 2009;58(suppl 8):S25-S31.
• 3. Hu J, et al. Diabetes Educ. 2013;39(4):494–503; 4. Fukunaga LL, et al. http://www.cdc.gov/pcd/issues/2011/mar/09_0233.htm. Accessed January 5, 2015.

Com ponent 1 .2 : Comprehensive care planning should i l d th f di t t dd th include the use of care coordinators to address the multitude of daily issues facing persons with diabetes.

• Assess treatment adherence
• Coordinate with providers about patient

t t t d treatment needs

• Provide health education
• Manage care transitions
• Manage care transitions
• Reduce hospital readmissions

High Adherence is Associated with Lower Diabetes Related Medical Costs and Hospitalization Risk Related Medical Costs and Hospitalization Risk

Diabetes-Related Medical Care Costs Diabetes-Related Hospitalization Risk

*

$8,812 $10,000

Care Costs Risk

30% 30% 35%

% * * * * * * *

$6959 $6,237 $5,887 $3,808 $6,000 $8,000

tal Costs, $

26% 25% 20% 20% 25% 30%

lization Risk,

$2,000 $4,000

Tot

13% 5% 10% 15%

Hospita

$0 1-19 20-39 40-59 60-79 80-100 0% 1-19 20-39 40-59 60-79 80-100

Adherence Rate, % Adherence Rate, % * I ndicates a value that is significantly higher than the 8 0 – 1 0 0 % adherence group ( p< 0 .0 5 ) Sokol MC, et al. Med Care. 2005;43:521-530 [pg 525 table 2-data].

Improving Adherence and Outcomes in I di id l ith Di b t d D i

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Individuals with Diabetes and Depression

• 12 week- Randomized Controlled Trial (n= 180)
• Interventional group vs Usual Care
• Inclusion Criteria:

Type 2 Diabetes Mellitus and Depression

• Type 2 Diabetes Mellitus and Depression
• Current antidepressant therapy and oral hypoglycemic agent
• Interventional Group:

p

• Integrated care manager as supplement to primary care

visits

• Addressed patient level non-adherence factors such as
• Addressed patient level non-adherence factors such as

depression, chronic medical conditions, function, cognition, social support, cost of medications, side effects, and past experiences with medications experiences with medications

Bogner, et al. Ann Fam Med. 2012;10:15-22.

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Improving Adherence and Outcomes in Individuals with Diabetes and Depression Individuals with Diabetes and Depression

Patients who received the intervention were Patients who received the intervention were more

100 80

the intervention were more adherent to OADs intervention were more likely to achieve A1c < 7%

rence to Oral cemic, % 80 60 * * 30.7 % 80% Adher Hypogly 20 40 60.9 % 30.7 %

* *

Baseline 6 Weeks 12 Weeks

OAD: Oral Anti-Diabetic

*p<0.01 ** <0.001 Bogner, et al. Ann Fam Med. 2012;10:15-22 Usual Care Intervention

OAD: Oral Anti Diabetic

Manage Care Transitions Manage Care Transitions

• To improve transitions of care, efforts have been made to

To improve transitions of care, efforts have been made to re-engineer the discharge process via a variety of interventions

• One classification of interventions includes

P di h i t ti

• Pre-discharge interventions
• Patient education, discharge planning, medication reconciliation,

scheduling a follow-up appointment 1

P t di h i t ti

• Post-discharge interventions
• Follow-up phone calls, communication with ambulatory health care

providers, home visits1 and Telemonitoring2

d

• Bridging interventions
• Transition coaches, patient-centered discharge instructions, physician

continuity between inpatient and outpatient settings (i.e., transition clinics) 1 clinics) 1

• 1. Hansen. Annals of I nternal Medicine. 2011:155(8):520 2. Chaudhry S et al, J Card Fail. 2007;13(1):56

Com ponent 2 .1 : Care planning should promote screening and identification of risk factors for patients all along the and identification of risk factors for patients all along the disease spectrum.

2008 USPSTF risk factors 2015 USPSTF risk factors

High blood pressure

40-70 & overweight/ obese Family history GDM or PCOS Ethnic/ racial minority

New USPSTF guideline Details and Implications

• Health plans must cover cost of screening test with no co-pay
• USPSTF guideline is now more closely aligned with ADA and

Details and Implications

• USPSTF guideline is now more closely aligned with ADA and
• ther guidelines, which means less confusion at the practice level.
• A1c is now recognized as a valid screening test: “Because

h l b d f i i hemoglobin A1c measurements do not require a fasting state, it is more convenient than using fasting plasma glucose or the oral glucose tolerance test.”

• For the first time ever, USPSTF recommends screening for

prediabetes.

• Lifestyle intervention is recognized as evidence-based resource

Lifestyle intervention is recognized as evidence based resource and the “first line of therapy for the prevention of IFG, IGT, and diabetes”

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New USPSTF guideline Millions More Could Get Screened

170 160 180

Millions More Could Get Screened

138.7 100 120 140 160 69.1 62.8 61.2 30 2 40 60 80 100 7.6 7.3 4.5 30.2 20 40 Number screened UDM detected UPDM detected u be sc ee ed U detected U detected 2015 USPSTF ADA 2008 USPSTF

Source: Analysis by Tim Dall for NNI, IHS Global insights, November 2014, Based on study published in American Journal of Preventive Medicine

Presentation title Date 16

Thank You

d d k masd@novonodrisk.com