Evaluation of the Cascade of Diabetes Care in the United States, 2005-2016

Kazemian, Pooyan; Shebl, Fatma M.; McCann, Nicole C; Walensky, Rochelle P.; Wexler, Deborah J.

doi:10.1001/jamainternmed.2019.2396

Cited by 201 publications

(211 citation statements)

References 38 publications

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“…In Table 2, we review 12 of these offerings, along with a series of differentiating factors that we believe to be most meaningful for healthcare providers (HCPs) and patients: (1) health conditions managed, (2) presence/absence of a peer support component, (3) presence/absence of prescribing medical providers on the care team, (4) provision of connected medical devices, (5) whether the company curates devices/software for its members (i.e., not everyone enrolled in a program receives the same devices/software), and (6) examples of effectiveness data (randomized controlled trial [RCT] and other). This is a very rapidly evolving field, but the table includes a snapshot of today's leading offerings listed in alphabetical order.…”

Section: Overview Of Connected Diabetes Care Landscapementioning

confidence: 99%

“…4 For those with diagnosed diabetes, outcomes are falling short-only 23% of U.S. patients with diabetes are achieving comprehensive diabetes and cardiovascular risk factor goals (meeting target A1c, blood pressure, low-density lipoprotein cholesterol, and smoking status) with little change over the past decade. 5 Why is the current health care system falling so woefully short on preventing and managing diabetes at a population level? For one, the U.S. and most other countries face a dramatic shortage of specialists and general practitioners who can help people stave off or effectively manage diabetes.…”

Section: Introductionmentioning

confidence: 99%

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Reviewing U.S. Connected Diabetes Care: The Newest Member of the Team

Levine

Gabbay

2020

Diabetes Technology & Therapeutics

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Recent years have brought about an explosion in the number of companies offering connected diabetes care products, defined as digital diabetes management systems based around (1) smartphone apps, (2) devices with built-in connectivity, and (3) remote human and automated coaching and support. These nascent models aim to provide more continuous and on-demand care, aligning with the 24/7 demands of chronic disease. It has been enabled by multiple factors, including the rising use of connected devices and apps to help people manage their chronic conditions, growing appreciation for the importance of outcomes beyond A1c, and the lofty and growing cost of health care. Despite the potential of these programs to improve the outcomes and well-being of people with diabetes and reduce the burdens on health care providers and systems, awareness and use of these programs and approaches remain low in the medical community. In this article, we present a snapshot of this dynamic field, including a taxonomy of various connected diabetes care products available to employers, health plans, health systems, and people with diabetes in the United States, and we identify meaningful distinctions among them: (1) health conditions managed, (2) peer support interactions, (3) prescribing providers on the care team, (4) provision of connected medical devices and/or continuous glucose monitors, (5) degree of treatment personalization, and (6) clinical and real-world evidence. We also discuss broad trends in connected diabetes care. Given the urgency and scale of the diabetes epidemic, it is vital that a range of medical and clinical communities find meaningful ways to scale individualized, timely care under reimbursement models that better align incentives for various stakeholders, particularly health care providers themselves. This would not only address deficiencies in care but could also make diabetes care more attractive to future clinicians.

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Section: Overview Of Connected Diabetes Care Landscapementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reviewing U.S. Connected Diabetes Care: The Newest Member of the Team

Levine

Gabbay

2020

Diabetes Technology & Therapeutics

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“…Despite the introduction of several new classes of type 2 diabetes medications onto the market over the last decade, there have not been observable improvements in achieving diabetes treatment targets at a population level 6 . Currently, at least 45% of patients with type 2 diabetes do not achieve adequate glycemic control (hemoglobin A1c <7%) 7 , and poor medication adherence has been well documented as a common contributor to not only poor glycemic control but also increased morbidity and mortality 7 .…”

Section: Diabetes As a Public Health Crisismentioning

confidence: 99%

Acceptance-based therapy: the potential to augment behavioral interventions in the treatment of type 2 diabetes

et al. 2020

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Diabetes is a complex and multifactorial disease affecting more than 415 million people worldwide. Excess adiposity and modifiable lifestyle factors, such as unhealthy dietary patterns and physical inactivity, can play a significant role in the development of type 2 diabetes. Interventions that implement changes to lifestyle behaviors, in addition to pharmacological treatment, may attenuate the development and worsening of diabetes. This narrative review delineates how standard behavioral interventions (SBTs), based in "first wave" behavioral therapies and "second wave" cognitive behavioral therapies, serve as the foundation of diabetes treatment by supporting effective lifestyle changes, including improving adherence to healthful behaviors, medication, and self-monitoring regimens. Moreover, "third wave" "acceptance-based therapies" (ABTs), which integrate techniques from acceptance and commitment therapy, are proposed as a potential novel treatment option for diabetes management. Further research and long-term, randomized controlled trials will clarify the feasibility, acceptability, and effectiveness of ABT for improving glucose control via enhancing medication adherence and promoting effective lifestyle changes in people with diabetes.

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“…Current antidiabetic drugs, except of metformin and thiazolidinediones, consist of agents that promote insulin secretion (sulphonylureas, GLP1 analogs, DPP4i), increase glucose excretion in urine (SGLT2i), or decrease dietary glucose absorption (acarbose), followed by insulin(s). However, in spite of the pharmacological efforts and economic burden [26] made in controlling hyperglycemia, about 40% of T2D patients still fail to reach glycemic control (A1C < 7%) [27][28][29]. Moreover, failure is more common in patients prescribed insulin(s), whereby 65% of patients fail to reach glycemic targets [27].…”

mentioning

confidence: 99%

“…However, the recommended SOC is only partially productive in delaying the diabetes stage of pre-diabetes patients [41] or in alleviating the macrovascular disease of T2D patients [42]. Also, the success in targeting concomitantly the glycemic, dyslipidemic and hypertensive diseases of T2D is less than 25% [28,29]. Also, some of the drugs designed to treat the non-glycemic aspects of T2D (e.g., beta-blockers, thiazides, statins) may counteract glycemic control [43][44][45].…”

mentioning

confidence: 99%

Type 2 diabetes – unmet need, unresolved pathogenesis, mTORC1-centric paradigm

Bar‐Tana

2020

Rev Endocr Metab Disord

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The current paradigm of type 2 diabetes (T2D) is gluco-centric, being exclusively categorized by glycemic characteristics. The gluco-centric paradigm views hyperglycemia as the primary target, being driven by resistance to insulin combined with progressive beta cells failure, and considers glycemic control its ultimate treatment goal. Most importantly, the gluco-centric paradigm considers the non-glycemic diseases associated with T2D, e.g., obesity, dyslipidemia, hypertension, macrovascular disease, microvascular disease and fatty liver as 'risk factors' and/or 'outcomes' and/or 'comorbidities', rather than primary inherent disease aspects of T2D. That is in spite of their high prevalence (60-90%) and major role in profiling T2D morbidity and mortality. Moreover, the gluco-centric paradigm fails to realize that the non-glycemic diseases of T2D are driven by insulin and, except for glycemic control, response to insulin in T2D is essentially the rule rather than the exception. Failure of the glucocentric paradigm to offer an exhaustive unifying view of the glycemic and non-glycemic diseases of T2D may have contributed to T2D being still an unmet need. An mTORC1-centric paradigm maintains that hyperactive mTORC1 drives the glycemic and non-glycemic disease aspects of T2D. Hyperactive mTORC1 is proposed to act as double-edged agent, namely, to interfere with glycemic control by disrupting the insulin receptor-Akt transduction pathway, while concomitantly driving the non-glycemic diseases of T2D. The mTORC1-centric paradigm may offer a novel perspective for T2D in terms of pathogenesis, clinical focus and treatment strategy.

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Evaluation of the Cascade of Diabetes Care in the United States, 2005-2016

Cited by 201 publications

References 38 publications

Reviewing U.S. Connected Diabetes Care: The Newest Member of the Team

Reviewing U.S. Connected Diabetes Care: The Newest Member of the Team

Acceptance-based therapy: the potential to augment behavioral interventions in the treatment of type 2 diabetes

Type 2 diabetes – unmet need, unresolved pathogenesis, mTORC1-centric paradigm

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