Guest Column | September 18, 2017

Public Enemy Number 1: Transforming Diabetes Care Through Telemedicine

Virtual Telehealth Doctor

By Dustyn Williams, MD, co-founder/chief medical officer, DoseDr

Diabetes remains one of healthcare's most pressing issues. The World Health Organization places it in the top four noncommunicable diseases requiring priority attention, and current trends and statistics are not encouraging.

For instance, the Centers for Disease Control and Prevention’s newly released 2017 National Diabetes Statistics Report reveals that nearly 10 percent of Americans suffer from diabetes, while approximately a quarter of that population remains unaware that they are living with the condition.

A $245 billion-a-year problem, diabetes management is a priority population health strategy for physicians as they position for value-based care. Yet, the reality is that traditional approaches to diabetes care have done little to lessen the mortality rate and financial burden associated with the disease—which often manifests in serious healthcare conditions such as major cardiovascular diseases and lower-extremity amputation, as well as hypoglycemia and hyperglycemic crisis.

Getting ahead of the diabetes challenge—particularly insulin-dependent diabetes—requires a combination of disruptive ideas and innovative technology. Physicians must first acknowledge the existing challenges and gaps in care. Then they must have the tools at their disposal to improve the outlook.

Understanding The Challenge

As long as care delivery is designed around traditional office visits, physicians will remain limited in their ability to improve performance with insulin-dependent diabetic populations. Treating diabetes is complex. To effectively manage the disease, physicians and patients must continually monitor the condition and address the various facets that alter adequate insulin levels. For instance, the patient must calculate each insulin dose based on the time of day, food consumed or activity performed. If they have the wrong formula, the result could be further deterioration of the condition or an adverse drug event.

The current industry reality is that the average diabetic patient spends just two hours a year with their physician or other primary care provider. The significant care gaps that exist between physician office visits lend to fluctuations in diabetes symptoms and risks, often resulting in detrimental and even fatal conditions, and steep costs associated with increased emergency department visits and hospitalizations.

Simply put, patients die needlessly because they don’t know how to manage their disease and they don’t have ready access to their doctor.

Staying ahead of diabetes necessitates greater patient-physician collaboration and continuous medical oversight and support between visits. Otherwise, patients struggle to self-manage their condition and make choices that can be detrimental to their health. Given that half of patients forget dosage instructions given to them by their physicians, and half of those who do remember have incorrect recall, the likelihood of patients successfully self-managing their condition is low. As such, physicians face an uphill battle to minimize the potential for serious health conditions and improve population health among insulin-dependent diabetics.

The reality is that diabetes management is a systematic process with limited variability in treatment. Insulin doses can be adjusted frequently based on the previous days’ glucose values, “dialing in” to the right dose or carb ratio. If physicians can stay connected to patient data and patients have access to real-time feedback regarding what to do in the moment, diabetes can be easily controlled. But primary care physicians have limited resources, such as time, staff, and a scarcity of meaningful tools that can make a real impact.

Physicians and patients both want the same thing: improved health. But the disconnect that is common in today’s healthcare climate leaves patients with inadequate medical support and physicians with limited knowledge to help with day-to-day management of the diabetes. This vicious cycle contributes to avoidable costs, complications and hospitalizations.

Moving forward, providers require a line of sight into impactful strategies for effective diabetes management. Increasingly, healthcare organizations are looking to third-party experts to improve outcomes by closing care gaps between clinic visits. Although there are numerous chronic care management organizations, many lack the capacity to deliver the necessary services needed to move the needle on outcomes. Most attempt to make a difference. But without a real-time feedback loop between physicians and patients, there is simply no way to empower patients in their care and effectively get ahead of the complexities of diabetes management and the titration of insulin.

Leveraging Innovative Care Models

Radical new approaches to treating diabetes are emerging that improve outcomes with some of the most severe—and costly—diabetic patients. Healthcare organizations are increasingly finding success by partnering with third-party organizations that provide the telemedicine tools and collaborative workflows needed to address performance gaps and empower patients in their care.

These solutions are based upon a primarily algorithmic approach to care with well-established guidelines that provide patients with access to best practices for maintaining optimal blood glucose levels through appropriate doses of insulin. Utilization of telemedicine solutions also enables continuous monitoring of patients’ conditions and medication and treatment adherence. Services include suitable, timely follow-ups and interventions, and medication adjustments as needed.

By leveraging an alternative care model and filling critical gaps in chronic care management, primary care clinicians can allocate additional resources to address patients with more severe conditions that require extensive, lengthy individualized treatments and oversight. In one month, this approach reduced a pilot population’s A1c levels from a rate of 9.4 to 6.3. Average blood sugar levels dropped 100 points from 232 to 132—an accomplishment that often takes up to seven years with traditional approaches.

The benefits of using telemedicine solutions to reduce and prevent diabetic-related complications is supported by the findings of a case study highlighting the significant health improvements of an insulin-dependent individual with an original A1c level of 14. Due to uncontrolled diabetes leading to hyperglycemia, the patient had been admitted to the hospital and received emergency care on two separate occasions. Various factors contributed to the patient’s severe state, including lack of disease understanding and limited ability to self-administer the correct insulin dose. Insufficient access to suitable medical facilities due to geographical and economic factors also prevented her from receiving timely care by the appropriate providers.

By empowering the patient with access to a user-friendly, easily-accessible telemedicine solution specifically designed to provide real-time dosage feedback and frequent small titrations, significant improvements were quickly realized. These tools enabled seamless communication and care coordination between the patient and telemedicine physician between visits with her primary care physician. In just nine months, the patient achieved a sustainable A1c level of 7.1 and effectively avoided additional emergency department visits and hospitalizations.

Telemedicine does not replace the need for a primary care physician. Rather, it serves as a means to support these clinicians and their patients with chronic conditions. Disruptive innovations like advanced telemedicine solutions overcome ineffective traditional approaches to diabetes management while addressing significant barriers that prevent individuals from attaining critical, timely access to care. Telemedicine enables impactful approaches that truly enhance outcomes, quality care and costs for individuals living with diabetes throughout the nation.

About The Author
Dr. Dustyn Williams is a hospitalist at Baton Rouge General Medical Center and co-founder/chief medical officer of DoseDr.