My take on the Glytec-sponsored HIMSS webinar, Virtual diabetes care: Unlocking the keys to real results.
As the American Diabetes Association 79th Scientific Sessions came to a close June 11, 2019, it was evident to me that we continue to have many options for managing diabetes. The exhibit hall was filled with leading pharmaceutical, device and technology companies highlighting their latest innovations and research findings, with hundreds of representatives engaged in product demonstrations and conversations surrounding features and benefits.
However, despite what was showcased in the exhibit hall and presented in the continuing education sessions, one thing remains true: less than 50% of patients with diabetes have an A1C less than 7%.1 In fact, the most recent NHANES analysis shows the percent of patients with an A1C greater than 9% has risen by 23% between data collected from 2007 to 2010 and data collected from 2011 to 2014.1 The challenge of managing patients with diabetes is real. Throughout my career as a nurse practitioner and certified diabetes educator, and especially over the past decade, I have often heard from providers that medications and monitoring devices are in an abundance, but limited time and available resources interfere with the ability to help patients. Consequently, desired outcomes are not always achieved.
On May 30, 2019, Glytec sponsored a webinar, Virtual Diabetes Care: Unlocking the Keys to Real Results, featuring Dr. Ronald Dixon, Head of Clinical Affairs at Onduo, and Dr. Andrew Rhinehart, Chief Medical Officer at Glytec. Dr. Dixon introduced us to the rapidly growing concept of the virtual care model, a patient-centric approach that combines “high touch” and “high tech” to bring care to patients remotely.
Dr. Dixon explained that virtual care can save time, overcome challenges of distance and transportation, and reduce cost. Through virtual care, we have the ability to bridge the expectation gap between patients and providers and deliver high-quality, timely care to achieve improved outcomes. Dr. Dixon emphasized that virtual care does not replace traditional care, but rather, complements and extends what is currently being delivered. Dr. Dixon went on to discuss the transition to value-based care and the role of A1C in programs such as MACRA/MIPS and HEDIS. He also highlighted an emerging new measure of diabetes control referred to as ‘time in range,’ enabled through the advent of continuous glucose monitoring, or CGM. “Be on the lookout,” he said, “as CGM becomes more common, and time in range is on the heels of A1C in becoming another way of assessing the quality of care in the diabetic population.”
Dr. Rhinehart spoke about the worsening state of A1C control despite new drugs and devices. Specifically, he highlighted that the burden of managing insulin therapy falls on our nation’s primary care providers, which poses multiple challenges given the complexity and the resources needed to make proper dosing decisions. He explained that therapeutic inertia often occurs due to fear of misjudging doses and causing hypoglycemia. Hypoglycemia is common, costly and extremely serious, he emphasized, and often leads to medication disruption or discontinuation. He described how Glucommander™, Glytec’s decision support software for insulin titration, can be used in combination with virtual diabetes care to overcome the challenges faced by primary care providers and endocrinologists alike.
Both Dr. Dixon and Dr. Rhinehart shared impressive results of their respective solutions: Dr. Dixon of the Onduo Virtual Diabetes Clinic and Dr. Rhinehart of the Glytec Glucommander™ Outpatient Virtual Insulin Titration Service, both solutions used in combination with traditional care.
Dr. Dixon revealed that from baseline to follow-up, the percentage of Onduo Virtual Diabetes Clinic patients with an A1C greater than 9% has been cut in half.
- Based on a 12-month study published in the Journal of Diabetes Science and Technology,2 Dr. Rhinehart revealed that patients enrolled in the Glucommander™ Outpatient Virtual Insulin Titration Service experienced:
- Average reduction in A1C of 2.5% at 3 months and 3.1% at 12 months.
- Median of seven days from initial titration to average daily blood glucose less than 180 mg/dL.
- Only 0.05% incidence of hypoglycemia measured as a percent of blood glucose values less than 40 mg/dL.
- Reduction in average daily blood glucose of 52 mg/dL from baseline (214 mg/dL) to 12 months (162 mg/dL).
In summary, virtual care in combination with traditional care offers both clinical and financial benefits and is a scalable and sustainable way to transform current practices in a rapidly-advancing technology-driven diabetes market.
I joined Glytec a year ago after a busy career seeing patients in clinical practice followed by time with a major pharmaceutical manufacturer where I engaged in conversations with myriad providers about the daily struggles of managing patients with diabetes. In my current role, I have a chance to help patients and providers in a different way, ensuring that we optimize resources and therapies to move beyond the status quo and improve patient outcomes. I continue to educate and train clinicians and engage in discussions around the challenges of patient care and diabetes management, but I focus on medication optimization programs designed to overcome therapeutic inertia and I monitor firsthand the results of virtual diabetes care and insulin titration decision support. I truly believe this is the missing element we’ve been waiting for.
View the recorded webinar and download the slide deck here.
- Carls G, Huynh J, Tuttle E, Yee J, Edelman S. Achievement of glycated hemoglobin goals in the US remains unchanged through 2014. Diabetes Ther. 2017 Aug;8(4):863 873.
- Bode B, Clarke JG, Johnson J. Use of decision support software to titrate multiple daily injections yielded sustained A1c reductions after 1 year. J Diabetes Sci Technol. 2018 Jan;12(1):124 128.