Diabetes as a case study of chronic disease management with a personalized approach: The role of a structured feedback loop

Ceriello, Antonio; Barkai, László; Christiansen, Jens Sandahl; Czupryniak, Leszek; Gomis, Ramón; Harno, Kari; Kulzer, Bernhard; Ludvigsson, Johnny; Némethyová, Zuzana; Owens, David R.; Schnell, Oliver; Tankova, Tsvetalina; Taskinen, Marja‐Riitta; Vergès, Bruno; Weitgasser, Raimund; Wens, Johan

doi:10.1016/j.diabres.2012.07.005

Cited by 69 publications

(59 citation statements)

References 40 publications

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“…A recent paper focusing on personalized diabetes management presents a case for structured SMBG within an overall e-health model incorporating a feedback loop in diabetes and provides a framework to support the premise of this review. 31 Telehealth RPM technology creates an opportunity to provide education while at the same time increasing access to frequent structured SMBG data to intervene in a timely manner with appropriate feedback and treatment plan modification, capitalizing on the benefits of telehealth RPM.…”

mentioning

confidence: 99%

Telehealth Remote Monitoring Systematic Review

Greenwood

Young

Quinn

2014

J Diabetes Sci Technol

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Approximately 26 million Americans have diabetes. When uncontrolled, diabetes is the seventh leading cause of death and the leading cause of kidney failure, blindness, and nontraumatic amputations in the United States. 1 Researchers have found a decrease in complications and improved quality of life when persons with type 2 diabetes achieve national diabetes outcomes targets for blood glucose, blood pressure, and blood fats. 2 Identifying evidence-based solutions to improve outcomes in this population is critical. Patient self-management is an integral component of effective diabetes care and improves diabetes short-term outcomes. 2-4 The American Association of Diabetes Educators (AADE) identifies healthy eating, being active, monitoring, taking medications, problem solving, healthy coping, and reducing risks as 7 essential self-management skills, the AADE7, 5 required for successful behavior change to promote health for persons with diabetes. 6 Clinical studies have demonstrated the importance of self-monitoring of blood glucose (SMBG) in improving hemoglobin A1C (A1C) for persons with type 2 diabetes who use insulin. 7 However, critics cite meta-analyses that demonstrate small improvements in A1C in studies of type 2 diabetes not managed with insulin that, although significant, may not be clinically meaningful. 8 Because the majority of individuals with type 2 diabetes are not treated with insulin, studying and understanding this population independently is important. 9,10 In 2009 the International Diabetes Federation (IDF) published guidelines that focus on structured SMBG protocols to 519311D STXXX10.

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confidence: 99%

Telehealth Remote Monitoring Systematic Review

Greenwood

Young

Quinn

2014

J Diabetes Sci Technol

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“…When accuracy results from the four-and three-lot assessment study were scrutinized further using the current ISO 15197 standard, only one meter system passed the full test: the Accu-Chek Aviva system. 30,31 Hattemer concluded his talk by stating that only the AccuChek Aviva system had successfully passed all three hurdles: the lot-to-lot variability, the within-lot variability, and the important issue of bias.…”

Section: Discussionmentioning

confidence: 99%

“…31 Each step has been shown in dedicated studies to be of clear and proven benefits. The driving force within the entire loop system is information related to BG levels.…”

Section: Six Steps To Successmentioning

confidence: 99%

“…This is precisely what Weitgasser and his European partners decided to do recently. 31 Weitgasser shared the idea of how structured SMBG (structured testing) within the context of a continuous feedback loop system can improve diabetes outcome.…”

Section: The Importance Of a Structured And Continuous Feedback Loop mentioning

confidence: 99%

“…A good example of this is the structured feedback loop. 31 Schweitzer further suggested that to improve services in the future, the different elements of diabetes management should be technologically interconnected and, at least partly, Web-enabled, with the information free for all so that everyone can see the full picture.…”

Section: Medical Devices-part Of a Bigger Picturementioning

confidence: 99%

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6^thAnnual Symposium on Self-Monitoring of Blood Glucose (SMBG) Applications and Beyond, April 25–27, 2013, Riga, Latvia

Alzaid

Schlaeger²,

Hinzmann³

2013

Diabetes Technology & Therapeutics

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International experts in the fields of diabetes, diabetes technology, endocrinology, and pediatrics gathered for the 6 th Annual Symposium on Self-Monitoring of Blood Glucose (SMBG) Applications and beyond. The aim of this meeting was to continue setting up a global network of experts in this field and provide an international platform for exchange of ideas to improve life for people with diabetes. The 2013 meeting comprised a comprehensive scientific program, parallel interactive workshops, and two keynote lectures. All these discussions were intended to help identify gaps and areas where further scientific work and clinical studies are warranted. Opening Lecture: News from the World of DiabetesSatish Garg, University of Colorado Denver, Aurora, Colorado Drugs can't do it alone, we need technology too S atish Garg, in his opening lecture, gave insights into the status of diabetes care in general, described the direction of the ongoing diabetes research, and unveiled exciting technological advances coming our way in the near future. He argued that diabetes technology has a major contribution to make on the quality of life and the day-to-day interaction between patient and disease. He put forward a poignant question, saying that we are almost spoiled for choice by the number of antidiabetes agents currently available to treat diabetes, but has that changed patient outcome?Garg advocated that drugs cannot do it alone and that there is a clear gap in the management of diabetes that may be filled in by diabetes-related technologies. Diabetes: uncontrollable costGarg presented recently published data that show the cost of diabetes alone amounts to a staggering $245 billion per year in the United States.1 This figure is expected to rise in the future. Almost one-third of people with diabetes belong to the elderly age group (above 65 years of age), meaning that most individuals have been systematically excluded from research trials and clinical studies. Garg made a timely and passionate plea that elderly people with diabetes must not be left out of the diabetes research agenda.A closer examination of the cost of diabetes expenditure reveals that 80% of the money is used to pay for services and late complications. Eight percent of the total expenditure is used for diabetes technology. Garg suggested that people with diabetes should be cared for from the outset to reduce the expense incurred due to late complications. Glycated hemoglobin and hypoglycemia as measures of healthcare outcomeRecent clinical data of 25,000 people with type 1 diabetes attending 67 leading diabetes centers across the United States were presented by Garg. The T1D Exchange Study 2 is an observational study that showed several interesting findings. First, despite all existing efforts, the pursuit of the target glycated hemoglobin (HbA1c) level remains elusive for many people with diabetes across the United States. Second, the incidence of hypoglycemia remains a major concern for many people with diabetes, especially the elderly. Another and...

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Visit and Between-Visit Interaction Frequency Before and After COVID-19 Telehealth Implementation

Nouri,

Lyles,

Sherwin

et al. 2023

JAMA Netw Open

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ImportanceTelehealth implementation associated with the COVID-19 public health emergency (PHE) affected patient–clinical team interactions in numerous ways. Yet, studies have narrowly examined billed patient-clinician visits rather than including visits with other team members (eg, pharmacists) or between-visit interactions.ObjectiveTo evaluate rates of change over time in visits (in-person, telehealth) and between-visit interactions (telephone calls, patient portal messages) overall and by key patient characteristics.Design, Setting, and ParticipantsThis retrospective cohort study included adults with diabetes receiving primary care at urban academic (University of California San Francisco [UCSF]) and safety-net (San Francisco Health Network [SFHN]) health care systems. Encounters from April 2019 to March 2021 were analyzed.ExposureTelehealth implementation over 3 periods: pre-PHE (April 2019 to March 2020), strict shelter-in-place (April to June 2020), and hybrid-PHE (July 2020 to March 2021).Main Outcomes and MeasuresThe main outcomes were rates of change in monthly mean number of total encounters, visits with any health care team member, visits with billing clinicians, and between-visit interactions. Key patient-level characteristics were age, race and ethnicity, language, and neighborhood socioeconomic status (nSES).ResultsOf 15 148 patients (4976 UCSF; 8975 SFHN) included, 2464 (16%) were 75 years or older, 7734 (51%) were female patients, 9823 (65%) self-identified as racially or ethnically minoritized, 6223 (41%) had a non-English language preference, and 4618 (31%) lived in the lowest nSES quintile. After accounting for changes to care delivery through an interrupted time-series analysis, total encounters increased in the hybrid-PHE period (UCSF: 2.3% per patient/mo; 95% CI, 1.6%-2.9% per patient/mo; SFHN: 1.8% per patient/mo, 95% CI, 1.3%-2.2% per patient/mo), associated primarily with growth in between-visit interactions (UCSF: 3.1% per patient/mo, 95% CI, 2.3%-3.8% per patient/mo; SFHN: 2.9% per patient/mo, 95% CI, 2.3%-3.4% per patient/mo). In contrast, rates of visits were stable during the hybrid-PHE period. Although there were fewer differences in visit use by key patient-level characteristics during the hybrid-PHE period, pre-PHE differences in between-visit interactions persisted during the hybrid-PHE period at SFHN. Asian and Chinese-speaking patients at SFHN had fewer monthly mean between-visit interactions compared with White patients (0.46 [95% CI, 0.42-0.50] vs 0.59 [95% CI, 0.53-0.66] between-visit interactions/patient/mo; P &lt; .001) and English-speaking patients (0.52 [95% CI, 0.47-0.58] vs 0.61 [95% CI, 0.56-0.66] between-visit interactions/patient/mo; P = .03).Conclusions and RelevanceIn this study, pre-PHE growth in overall patient-clinician encounters persisted after PHE-related telehealth implementation, driven in both periods by between-visit interactions. Differential utilization based on patient characteristics was observed, which may indicate disparities. The implications for health care team workload and patient outcomes are unknown, particularly regarding between-visit interactions. Therefore, to comprehensively understand care utilization for patients with chronic diseases, research should expand beyond billed visits.

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Diabetes as a case study of chronic disease management with a personalized approach: The role of a structured feedback loop

Cited by 69 publications

References 40 publications

Telehealth Remote Monitoring Systematic Review

Telehealth Remote Monitoring Systematic Review

6^thAnnual Symposium on Self-Monitoring of Blood Glucose (SMBG) Applications and Beyond, April 25–27, 2013, Riga, Latvia

Visit and Between-Visit Interaction Frequency Before and After COVID-19 Telehealth Implementation

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Diabetes as a case study of chronic disease management with a personalized approach: The role of a structured feedback loop

Cited by 69 publications

References 40 publications

Telehealth Remote Monitoring Systematic Review

Telehealth Remote Monitoring Systematic Review

6thAnnual Symposium on Self-Monitoring of Blood Glucose (SMBG) Applications and Beyond, April 25–27, 2013, Riga, Latvia

Visit and Between-Visit Interaction Frequency Before and After COVID-19 Telehealth Implementation

Contact Info

Product

Resources

About

6^thAnnual Symposium on Self-Monitoring of Blood Glucose (SMBG) Applications and Beyond, April 25–27, 2013, Riga, Latvia