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 1 Current state of diabetes Current state of diabetes Stages of the disease continuum & interventions 2 Barriers to diabetes treatment 3 4 Importance of two specific NDHI components

Presentation Slide no 3 Why we need to address diabetes – Human Toll ll • 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

Presentation title Date Why we need to address diabetes – Economic Toll i ll • Diabetes costs the U.S. $322 billion annually • 1 in 3 Medicare dollars is spent on people with diabetes • Healthcare costs are 2.3 times l h 2 3 i 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 35 2003-2006 s (%) 30 2007-2010 Patients 25 20 15 15 10 5 0 <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 persist: treatment goals i l % of diabetes patients who met treatment goals f from 2006-2009 1 2006 2009 1 100% 80% • • Another analysis found that Another analysis found that complications resulting from inadequate control of these parameters may 57% 60% account for as much as 20% of total 47% 46% diabetes spending 2 diabetes spending 2 40% 20% 12% % 0% A1C BP LDL-C Composite Defined Goals: A1C<7%; BP<130/80 mmHg; LCL-C<100 mg/dL; Composite: Combined all three 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

Why aren’t patients achieving their goals? FEAR LANGUAGE BARRIERS POOR FAMILY SUPPORT POOR FAMILY SUPPORT NEEDLE PHOBIA INJECTION ANXIETY SOCIAL STIGMA PATIENT-PHYSICIAN DISCONNECT DIETARY CUSTOMS TIME MYTHS ABOUT INSULIN INSURANCE COVERAGE 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 include the use of care coordinators to address the l d th f di t t dd th multitude of daily issues facing persons with diabetes. • Assess treatment adherence • Coordinate with providers about patient t treatment needs t t d • 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 Diabetes-Related Hospitalization Care Costs Care Costs Risk Risk * * * $10,000 35% $8,812 * * 30% % * * * 30% 30% lization Risk, 26% $8,000 $6959 tal Costs, $ 25% 25% $6,237 $5,887 20% $6,000 20% $3,808 Tot 15% Hospita 13% $4,000 10% $2,000 5% $0 0% 1-19 20-39 40-59 60-79 80-100 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].

Presentation title Date Improving Adherence and Outcomes in Individuals with Diabetes and Depression I di id l ith Di b t d D i • 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.

Improving Adherence and Outcomes in Presentation title Date Individuals with Diabetes and Depression Individuals with Diabetes and Depression Patients who received Patients who received the the intervention were the intervention were intervention were more intervention were more more adherent to OADs likely to achieve A1c < 7% 100 80 80 rence to Oral * cemic, % * 60 30.7 % 30.7 %  80% Adher Hypogly 40 * * 60.9 % 20 0 Baseline 6 Weeks 12 Weeks OAD: Oral Anti-Diabetic OAD: Oral Anti Diabetic Usual Care Intervention * p <0.01 ** <0.001 Bogner, et al. Ann Fam Med. 2012;10:15-22

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 Pre-discharge interventions di h i t ti • Patient education, discharge planning, medication reconciliation, scheduling a follow-up appointment 1 • Post-discharge interventions P t di h i t ti • Follow-up phone calls, communication with ambulatory health care providers, home visits 1 and Telemonitoring 2 • Bridging interventions d • 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 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 USPSTF guideline is now more closely aligned with ADA and • • other guidelines, which means less confusion at the practice level. A1c is now recognized as a valid screening test : “Because • hemoglobin A1c measurements do not require a fasting state, it is i i h l b d f 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”

15 New USPSTF guideline Millions More Could Get Screened Millions More Could Get Screened 180 170 160 160 138.7 140 120 100 100 80 69.1 62.8 61.2 60 30 2 30.2 40 40 20 7.6 7.3 4.5 0 Number screened u be sc ee ed U UDM detected detected UPDM 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 masd@novonodrisk.com d d k