The power of real-world data to disrupt the progression of diabetes

With unique investments in big data and cloud computing, physicians and public health experts have joined forces with expert engineers to design frameworks capable of performing large-scale population health research. These teams are developing predictive models utilizing the most cutting-edge advanced analytics tools today. In fact, the models can potentially disrupt delivery of clinical decision support to the point of care with more intuitive and seamless algorithms, helping to minimize clinician burnout while providing the most up-to-date standards of care delivered to populations at risk.

One area of research where we are seeing tremendous progress is around diabetes.  Diabetes is a chronic condition, which impacts the body’s ability to produce insulin; a key regulator of glucose levels.  It is estimated that today 10 percent of the U.S. population is living with diabetes.  According to the Centers for Disease Control, if this trend continues, 1 in 3 Americans could have diabetes by 2050.

The precursor to diabetes, known as prediabetes, is important because it is reversible. Per the American Diabetes Association, before people are diagnosed with Type 2 diabetes, they always have “prediabetes.” This is when blood glucose levels are higher than normal but not yet high enough to be categorized with as Type 2. Patients with prediabetes are at higher risk for developing cardiovascular disease and those with Type 2 diabetes.

With diet, lifestyle and education advice, individuals can delay or prevent the onset of diabetes if identified in this stage. Unfortunately, because prediabetes is often silent, 90 percent of those with this condition today don’t even know they have it, necessitating new campaigns for screening and awareness.

If prediabetes can be halted, there is potential to make a huge impact in the battle against diabetes, its comorbidities, and costly complications.  For the more than 30 million people diagnosed with diabetes in 2017, medical costs totaled $327 billion, including $237 billion for direct medical costs and $90 billion for reduced productivity, according to the American Diabetes Association.

Who is at  risk for diabetes?
Prediabetes can also be identified through screening blood tests (HbA1c) and oral glucose tolerance tests at primary care visits.   Once individuals have been identified as having pre-diabetes, they should be referred to Diabetes Prevention Programs which can help individuals make lifestyle changes including losing weight, eating healthy, and encouraging exercise.   Risk surveys for prediabetes are readily available, taking into account individual patient characteristics, such as age, sex, weight, and other medical problems.

We are working to uncover patterns in the progression of diabetes and prediabetes and looking to identify additional risk factors, including environmental and social determinants of health, which can contribute to how quickly prediabetes progresses to diabetes.  Such factors may include the county where people live, access to healthcare and screening, or local food consumption patterns.

What began as an attempt to validate the Centers for Disease Control statement that 1 in 3 people with prediabetes will convert to diabetes in 5 years, ended up uncovering new findings consistent with far more rapid rates of progression.  Furthermore, we discovered results differed based significantly with geography and race, amongst other factors.

Clinician burden – A daily challenge with an IT solution

 The burden of work often makes it difficult for clinicians to keep up with the most recent published guidelines.  Physicians often have limited time with patients, and diabetes is frequently just one of many chronic diseases physicians have to manage and simply don’t have the time to read and absorb the information in the 142-page standards of care document.

Each year, the American Diabetes Association updates its standards-of-care document for primary care physicians, so that they know how to take care of persons with diabetes or prediabetes, including relevant orders for referrals to diabetes education programs, or medications to optimize management of diabetes.  Delivering these standards of care intuitively within workflows for physicians to use every day can help reduce physician burden.

Thus, utilizing clinical decision support (CDS), we can ensure that all patients receive the best possible standard of care, versus trying to overcome variations in clinical practices between different clinicians – an approach that positively affects the people cared for in their practice in addition to making a difference at the population level.

 A personal connection to prediabetes
As my mom was struggling to lose weight a few years ago, she visited her primary care physician who completed a number of screening tests.  When her HbA1c came back, the results were consistent with prediabetes.

Given her demographics, we already knew she was higher risk for diabetes.  Unfortunately for her, her primary care physician was not informed about the standard of care to manage those with prediabetes.  He mentioned to her that her HbA1c was “a little high” but reassured her that she didn’t have diabetes, and there was nothing she should really worry about at that time and that he would continue to monitor her for development of diabetes.

Being empowered with the ability to perform research, a huge part my job is to educate people.  Thankfully, I had no issue with communicating to my mother’s primary physician more about the ADA’s standards of care document, which he had not seen, explained that my mom was actually eligible for referral to a number of diabetes prevention programs in her area, which was covered under her insurance.  We were able to get her referred to a Diabetes Prevention Program at her local YMCA, and upon completing the program she had met her goal of losing 5 to 7 percent of her body weight. She has kept all of the weight off and has become much more aware of what she eats. I would definitely call that a success – and if I can scale these types of interventions to all people living with prediabetes through a little clinical decision support delivered at the right time, that would make a significant difference in people’s lives.

As a clinician, I understand the value of clinical decision support (CDS) reminders in treating patients, especially those with complex chronic diseases. Doing the right thing means making sure patients have access to quality and affordable care, while clinicians maintain the highest standard of care delivery without becoming burnt out. Technology, such as the CDS guidelines for diabetes care, plays a key role in making this possible with consistent and needed interventions for patients when and where they need them the most.

Photo: filipefrazao, Getty Images

 

 

 

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