Diabetes Care Innovation Research Articles

Hydrogel innovations in diabetes care: Advanced drug delivery and flexible diagnosis techniques

Hydrogel innovations in diabetes care: Advanced drug delivery and flexible diagnosis techniques

The uncomfortable truth about kidney disease in type 1 diabetes

Decades ago, the renowned epidemiologists Andrzej Krolewski and James Warram, together with colleagues, drew attention to an uncomfortable truth: shockingly, even 50 years after the discovery of life-saving insulin, more than half of people diagnosed with type 1 diabetes died with kidney failure by middle-age.1 Where do we stand, 100 years after the discovery of insulin, after astonishing innovations in diabetes care?

The Need for Ethnoracial Equity in Artificial Intelligence for Diabetes Management: Review and Recommendations.

There is clear evidence to suggest that diabetes does not affect all populations equally. Among adults living with diabetes, those from ethnoracial minority communities—foreign-born, immigrant, refugee, and culturally marginalized—are at increased risk of poor health outcomes. Artificial intelligence (AI) is actively being researched as a means of improving diabetes management and care; however, several factors may predispose AI to ethnoracial bias. To better understand whether diabetes AI interventions are being designed in an ethnoracially equitable manner, we conducted a secondary analysis of 141 articles included in a 2018 review by Contreras and Vehi entitled “Artificial Intelligence for Diabetes Management and Decision Support: Literature Review.” Two members of our research team independently reviewed each article and selected those reporting ethnoracial data for further analysis. Only 10 articles (7.1%) were ultimately selected for secondary analysis in our case study. Of the 131 excluded articles, 118 (90.1%) failed to mention participants’ ethnic or racial backgrounds. The included articles reported ethnoracial data under various categories, including race (n=6), ethnicity (n=2), race/ethnicity (n=3), and percentage of Caucasian participants (n=1). Among articles specifically reporting race, the average distribution was 69.5% White, 17.1% Black, and 3.7% Asian. Only 2 articles reported inclusion of Native American participants. Given the clear ethnic and racial differences in diabetes biomarkers, prevalence, and outcomes, the inclusion of ethnoracial training data is likely to improve the accuracy of predictive models. Such considerations are imperative in AI-based tools, which are predisposed to negative biases due to their black-box nature and proneness to distributional shift. Based on our findings, we propose a short questionnaire to assess ethnoracial equity in research describing AI-based diabetes interventions. At this unprecedented time in history, AI can either mitigate or exacerbate disparities in health care. Future accounts of the infancy of diabetes AI must reflect our early and decisive action to confront ethnoracial inequities before they are coded into our systems and perpetuate the very biases we aim to eliminate. If we take deliberate and meaningful steps now toward training our algorithms to be ethnoracially inclusive, we can architect innovations in diabetes care that are bound by the diverse fabric of our society.

Diabetes And Obesity - Inextricable Diseases

Diabetes and obesity are global epidemics and the prevalence of both has increased in parallel. The relationship between obesity and diabetes is clear as nearly 90% of people with diabetes have obesity. Multiple factors contribute to obesity and include dietary, environmental and iatrogenic causes all of which can affect metabolism directly and independently of caloric intake alone. Studies focused on the pathophysiology of the relationship between diabetes and obesity has led to innovations in diabetes care with a focus on obesity.

Costs and its drivers for diabetes mellitus type 2 patients in France and Germany: a systematic review of economic studies

BackgroundType 2 diabetes represents an increasingly critical challenge for health policy worldwide. It absorbs massive resources from both patients and national economies to sustain direct costs of the treatment of type 2 diabetes and its complications and indirect costs related to work loss and wages. More recently, there are innovations based on remote control and personalised programs that promise a more cost-effective diabetes management while reducing diabetes-related complications. In such a context, this work attempts to update cost analysis reviews on type 2 diabetes, focusing on France and Germany, in order to explore most significant cost drivers and cost-saving opportunities through innovations in diabetes care. Although both countries approach care delivery differently, France and Germany represent the primary European markets for diabetes technologies.MethodsA systematic review of the literature listed in MEDLINE, Embase and EconLit has been carried out. It covered interventional, observational and modelling studies on expenditures for type 2 diabetes management in France or Germany published since 2012. Included articles were analysed for annual direct, associated and indirect costs of type 2 diabetes patients. An appraisal of study quality was performed. Results were summarised narratively.ResultsFrom 1260 records, the final sample was composed of 24 papers selected according to predefined inclusion/exclusion criteria. Both France and Germany revealed a predominant focus on direct costs. Comparability was limited due to different study populations and cost categories used. Indirect costs were only available in Germany. According to prior literature, reported cost drivers are hospitalisation, prescriptions, higher HbA1c and BMI, treatment with insulin and complications, all indicators of disease severity. The diversity of available data and included costs limits the results and may explain the differences found.ConclusionsComplication prevention and glycaemic control are widely recognized as the most effective ways to control diabetes treatment costs. The value propositions of self-based supports, such as hybrid closed-loop metabolic systems, already implemented in type 1 diabetes management, are the key points for further debates and policymaking, which should involve the perspectives of caregivers, patients and payers.

Diabetes care innovation in the Mexican Institute for Social Insurance: Scaling up the preventive chronic disease care model to address critical coverage constraints

BackgroundWith diabetes prevalence in Mexico at 11.3% of adults, the Mexican Institute of Social Insurance (IMSS) is piloting the Chronic Disease Preventive Model (CDPM). CDPM includes intensive patient education, care by multidisciplinary teams and risk management in primary care. The objective of this article is to determine CDPM coverage bottlenecks and to explore facilitators and barriers to implementation. MethodsThe National Health and Nutrition Survey 2018 was processed to identify key diabetes prevalence, coverage, quality and outcome indicators. Key IMSS informant interviews and document content analyses were undertaken following the Tanahashi coverage decay model and the Consolidated Framework for Implementation Research (CFIR). ResultsIMSS screens 49% of adult beneficiaries for diabetes but only 26% with presumptive diagnosis proceed to confirmation. Out of 4.1 million adults with diabetes, IMSS diagnoses 94% and treats 85%. Medications are received by 90% of patients but only 63% of those requiring insulin receive it. The overall quality of care indicator attains 37% of potential. Coverage of diabetes education, monitoring with HbA1c and interdisciplinary care are 20%, 15% and 3%, respectively. Among IMSS beneficiaries treated by the institute 38.1% have HbA1c levels below 7% and 26.1% have levels above 9%. CDPM facilitators are the perceived threat of uncontrolled diabetes, compatibility of innovation values and willingness for institutional learning. Barriers are centralized decision making, functional differentiation across managers and practitioners and lack of incentives, resource shortages and the lack of measures to ensure fidelity. ConclusionsCDPM scale-up has to address organizational and process barriers while ensuring the necessary resources for sustainability.

Rapid Innovation in Diabetes Care During Covid-19.

Rapid Innovation in Diabetes Care During Covid-19.

Innovations in Diabetes Care for a Better "New Normal" Beyond COVID-19.

The coronavirus disease pandemic has created opportunities for innovation in diabetes care that were not possible before. From the lens of this “new normal” state, we have an opportunity to rapidly implement, test, and iterate models of diabetes care to achieve the quadruple aim of improving medical outcomes, patient experience, provider satisfaction, and reducing costs. In this perspective, we discuss several innovative diabetes models of care which promote collaborative care models and improve access to high-quality specialty diabetes care. We discuss ongoing threats to diabetes care innovation, and offer practical solutions to foster evolution and sustain current strides made during the pandemic.

AMCP Partnership Forum: Navigating Innovations in Diabetes Care.

The AMCP Partnership Forum on Navigating Innovations in Diabetes Care and the development of this proceedings document were supported by Boehringer Ingelheim, Lilly, Dexcom, Insulet Corporation, Intarcia Therapeutics, and Merck.

Progress in Diabetes Technology: Developments in Insulin Pumps, Continuous Glucose Monitors, and Progress towards the Artificial Pancreas

Type 1 diabetes (T1D) is one of the most common chronic diseases of childhood with an estimated prevalence of more than 166 000 cases in children younger than 20 years of age in the US in 2010. 1 Pettitt D.J. Talton J. Dabelea D. Divers J. Imperatore G. Lawrence J.M. et al. Prevalence of diabetes in U.S. youth in 2009: the SEARCH for diabetes in youth study. Diabetes Care. 2014; 37: 402-408 Crossref PubMed Scopus (314) Google Scholar The rate of new-onset diabetes also is increasing worldwide, with an increased incidence of 3%-5% per year. 2 Forlenza G.P. Rewers M. The epidemic of type 1 diabetes: what is it telling us?. Curr Opin Endocrinol Diabetes Obes. 2011; 18: 248-251 Crossref PubMed Scopus (89) Google Scholar In 1993 the Diabetes Control and Complications Trial established the benefit of intensive insulin therapy in reducing long-term complications, including retinopathy, nephropathy, and neuropathy. 3 The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993; 329: 977-986 Crossref PubMed Scopus (22760) Google Scholar Despite this now longstanding knowledge, vascular complications attributable to hyperglycemia remain a significant issue in the population with T1D, even in the young-adult population. 4 James S. Gallagher R. Dunbabin J. Perry L. Prevalence of vascular complications and factors predictive of their development in young adults with type 1 diabetes: systematic literature review. BMC Res Notes. 2014; 7: 593 Crossref PubMed Scopus (33) Google Scholar , 5 Maahs D.M. Daniels S.R. de Ferranti S.D. Dichek H.L. Flynn J. Goldstein B.I. et al. Cardiovascular disease risk factors in youth with diabetes mellitus: a scientific statement from the american heart association. Circulation. 2014; 130: 1532-1558 Crossref PubMed Scopus (123) Google Scholar Recent evidence from the T1D Exchange clinic registry shows that during childhood mean hemoglobin A1c (HbA1c) remains above the target of 7.5% for all age groups, with a peak of 9.2% in the late teenage years. 6 Miller K.M. Foster N.C. Beck R.W. Bergenstal R.M. DuBose S.N. DiMeglio L.A. et al. Current state of type 1 diabetes treatment in the U.S.: updated data from the T1D Exchange Clinic Registry. Diabetes Care. 2015; 38: 971-978 Crossref PubMed Scopus (923) Google Scholar This evidence points toward the urgent need for better therapeutic interventions to improve glycemic control across the pediatric population. Innovations in diabetes care are being pursued on many fronts, including education, behavioral interventions, pharmaceutical development, beta-cell transplantation, and immunomodulation to prevent autoimmune beta-cell destruction. Although these therapies aim to provide benefit now and more so in the future, many in the diabetes community believe that the most impactful near-term benefit will be achieved by innovation in the technologies used to manage diabetes.

Innovations In Diabetes Care Around the World: Case Studies Of Care Transformation Through Accountable Care Reforms.

The rising prevalence, health burden, and cost of chronic diseases such as diabetes have accelerated global interest in innovative care models that use approaches such as community-based care and information technology to improve or transform disease prevention, diagnosis, and treatment. Although evidence on the effectiveness of innovative care models is emerging, scaling up or extending these models beyond their original setting has been difficult. We developed a framework to highlight policy barriers-institutional, regulatory, and financial-to the diffusion of transformative innovations in diabetes care. The framework builds on accountable care principles that support higher-value care, or better patient-level outcomes at lower cost. We applied this framework to three case studies from the United States, Mexico, and India to describe how innovators and policy leaders have addressed barriers, with a focus on important financing barriers to provider and consumer payment. The lessons have implications for policy reform to promote innovation through new funding approaches, institutional reforms, and performance measures with the goal of addressing the growing burdens of diabetes and other chronic diseases.

Insulin degludec early clinical experience: does the promise from the clinical trials translate into clinical practice—a case-based evaluation

Background:Clinical experience of patients is an additional source of information that can inform prescribing decisions for new therapies in practice. In diabetes, for example, patients with recurrent hypoglycemia may be excluded from trials conducted for regulatory purposes. Using insulin degludec (IDeg), a new basal insulin with an ultra-long duration of action as an example, an interim analysis is presented describing whether the decision to prescribe IDeg to patients experiencing treatment-limiting problems on their existing insulin regimes represented good clinical and economic value.Methods:Records from the first 51 consecutive patients with diabetes (35 type 1 [T1D] and 16 type 2 [T2D]) switching to insulin degludec from either insulin glargine (IGlar) or insulin detemir (IDet), mostly due to problems with hypoglycemia (39/51, 76.5%), were reviewed at up to 37 weeks. Patients indicated frequency of hypoglycemia and completed a disease-specific questionnaire reporting six measures of confidence and treatment satisfaction. For the largest group of exposed patents, the T1D module of the IMS Core Diabetes Model (CDM) was used to evaluate the cost-effectiveness of the treatment decision.Findings:HbA1c decreased by 0.5 ± 0.3% points and 0.7 ± 0.3% points for T1D and T2D, respectively. Hypoglycemic events decreased by >90%. Combined mean scores were ≥3.7 (1 = much worse, 3 = no change, 5 = much improved) for all six satisfaction and confidence items. In T1D, the treatment decision was highly cost-effective in the CDM lifetime analysis. Even when excluding benefits beyond hypoglycemia reduction, predicted cost per quality-adjusted life-year for IDeg vs IGlar/IDet was £10,754.Interpretation:These data illustrate the complementary nature of clinical trial and practice data when evaluating the value of therapeutic innovations in diabetes care. There were reductions in patient-reported hypoglycemia, reduced HbA1c, and improved treatment satisfaction in relation to the decision to prescribe IDeg. Initial health economic evaluation suggested that the decision to prescribe IDeg in this phenotypic group of T1D patients represented good value for money.

Innovations in Diabetes Care From One of America's Most Wired Communities: Effects of an Electronic Emergency Department/Admission Alert System in Cincinnati, Ohio

Managing costs and improving care associated with type 1 and type 2 diabetes has proven to be as difficult as managing the disease itself. Diabetes care is costly, complications are common, and prevalence is growing. In addition, the need for improved coordination and management of care is hindered by barriers in the monitoring and tracking of diabetes care across multiple clinical settings.1–7 To better manage patients and improve care, many hospitals and primary care practices have adopted electronic health records (EHRs), many with clinical decision support (CDS) functionality that facilitates closer monitoring of A1C, LDL cholesterol, blood pressure, and eye and foot exams.8 The use of EHRs with CDS has been associated with improved outcomes for patients with diabetes; decreased use of outpatient, specialist, and inpatient services; and reduced overall costs, particularly when integrated into quality improvement (QI) activities.9,10 However, a sizeable proportion of primary care providers (PCPs) and emergency departments (EDs) do not have or adequately leverage EHRs, and many communities are just beginning to develop the health information exchange (HIE) infrastructure necessary to share meaningful clinical information across care settings.6,11 Without EHRs and more advanced HIE infrastructure, providers often lack the resources to capture QI data and communicate clinical patient information across care settings. The alternatives—phone, mail, or fax communication—can lead to inefficiencies, opportunities for error, and misplacement of records.12 In September 2010, the Greater Cincinnati Beacon Collaboration (GCBC), a group of six organizations in Cincinnati, Ohio, representing different stakeholders in the health care system, was awarded a Beacon Community cooperative agreement grant from the Office of the National Coordinator for Health Information Technology (IT). The purpose of the Beacon Community program is to develop and test health information technology and QI innovations to improve health outcomes …

Self-Monitoring of Blood Glucose: An Underutilized Tool

I magine trying to bake a cake without knowing the temperature of the oven or trying to judge how much gas is left in the car's tank during a long trip without a gas gauge. Although it would not be impossible to do these tasks without the proper measurement tools, it would take much more time and you wouldn't have the information you need to solve any problems that occur. Similarly, during previous generations, people with diabetes, working only with urine testing or retrospective laboratory glucose results, had limited information on which to base day-to-day self-care decisions. The advent of self-monitoring of blood glucose (SMBG) in the late 1970s gave people with diabetes a valuable tool for self-management. No longer dependent on inconvenient laboratory diagnostics or inaccurate urine testing, patients now had accurate glucose values within minutes, using a hand-held meter and a small drop of blood. Having access to blood glucose values whenever they choose to perform the test enables patients to improve their glycemic control, preventing acute and chronic complications. The frequency for performing SMBG varies depending on the needs of each patient. Insulin-using patients (with type 1 or type 2 diabetes) are advised to perform SMBG three or more times daily.1 Most practitioners agree on the relevance of glucose monitoring in this group. There has been much controversy about the efficacy of SMBG among patients who do not use insulin. However, guidelines for these patients with type 2 diabetes are vague, and no specific frequency is recommended. When first developed, this innovation in diabetes care held such promise: it would encourage a new level of patient-provider collaboration, empower patients to become more active participants in their own care, and act as a personal guide for trouble-shooting glucose control issues related to diet, physical activity, travel, and …

A Look at the Current Reimbursement Environment for Continuous Glucose Monitoring (CGM): Understanding the Fundamentals

As reimbursement continues to decline for diabetes management technologies and practice overhead continues to rise, it is becoming increasingly important to understand the current reimbursement environment for new technological innovations in diabetes care. The current environment demands a strong partnership among providers, key stakeholder groups, and industry to advocate for favorable coding, coverage, and payment of these new advancements, in order to improve accessibility to the patient. This article describes trends in the current reimbursement environment for continuous glucose monitoring and provides recommendations on how to maneuver through the intricacies of coding and coverage related to this emerging category of glucose monitoring.

Overcoming the barriers for achieving standards of diabetes care: the formation of CADRE.

Diabetes remains one of the leading causes of death and disability in the United States. Despite significant breakthroughs in treatment of diabetes, recent reports suggest a large number of patients are not at target goals for blood pressure, lipids, and glucose levels. Failure to achieve these goals is most likely not due to the unavailability of drugs and innovations, as numerous drugs have been released over the past 10 years, and monitoring of blood glucose is now considered routine. Therefore, other obstacles must exist at the primary care level preventing adherence to suggested targets. Based on the above, the Council for the Advancement of Diabetes Research and Education (CADRE), a membership organization, was launched in an effort to address the problem of understanding diabetes and its treatment. The ultimate goal of CADRE is to expand understanding of diabetes and its treatment by providing educational programs enabling healthcare professionals to manage and empower patients with diabetes. In particular, by focusing on innovations in diabetes care, CADRE hopes to promote optimal therapy for meeting the treatment goals as outlined by governing bodies such as the American Diabetes Association. This article will focus on the formation of CADRE, and, in particular, identification of the problem contributing to the obstacles of care, and review various surveys conducted by CADRE designed in an effort to identify the problem.

Fast-acting human insulin analogs: a promising innovation in diabetes care.

Fast-acting human insulin analogs: a promising innovation in diabetes care.