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Improving Patient Outcomes in Diabetes Matt Petersen Managing Director, Medical Information & Professional Engagement American Diabetes Association Improving Patient Outcomes Trends in age-standardized rates of diabetes-related complications among U.S. adults with diabetes, 1990-2010 Acute MI Stroke Amputation ESRD Death from Hyperglycemic Crisis 140 Cases/10,000 persons 120 100 80 60 -52.9% -67.8% 40 20 -51.4% -28.3% 0 -64.4% 1990 1995 Gregg et al. N Engl J Med 370: 1514—1523, 2014 2000 2005 2010 Improving Patient Outcomes 1. Improve A1C and other measures of quality care 2. HCP tools to make that happen 3. Supporting patient resources Case Study: Diabetes Inside • 403 randomly selected patients with diabetes • 13% at goal: – – – – – A1C <8% LDL <100 mg/dL BP <130/90 mmHg Aspirin therapy if indicated Non-smoker ADA Resources for Intervention • HCP: Grand Rounds presentation and referral to ADA Standards of Medical Care – – – – Intensified glucose control Foot exams Referral to diabetes education Adequate follow-up • Patient: Living With Type 2 Diabetes HCP Insulin Attitude Survey • Clinician agreement on insulin barriers and benefits • Lack of consensus on the role of insulin – Implies important knowledge gaps and confusion Second Grand Round 810 T2D patients with A1C >7% • 39% A1C >9% • No variation among individual providers Patients with Diabetes A1C>9% A1C 8-8.9% A1C 7-7.9% Type 2 Treatment Algorithm © American Diabetes Association 2016 Insulin Workshop Follow-up Attended workshop Yes No More aggressive medications/insulin initiation Referral to DISH/group class/health coach/pharmacist More frequent patient followup More diligent with pt education 0% 10% 20% 30% 40% 50% 60% 70% Actions to Improve Glycemic Control Yes Attended workshop? No Actions to Improve Glycemic Control Attended workshop? Yes No Case Study Results 57% of patients with reduced A1C • Earlier insulin initiation • More aggressive oral therapy • Higher use of patient education and community programs Case Study Conclusion • Data analysis + visualization • Nationally endorsed messages • Non-judgmental environment • Entire clinical care team ADA resources for professionals and patients ADA resources for professionals and patients ADA Health Care Professional Tools ADA Health Care Professional Tools Professional Education • Self-assessment programs • Webcasts • Point of Care • Local events Diabetes Self-Management Education • Recognized program • DSME referral algorithm • Education resources • Chronical Diabetes HCP Resources for Patients Print resources: • Living With Type 2 Diabetes • Patient education library ADA Online Resources My Food Advisor Create Your Plate Diabetes 24/7 For the Workplace • Wellness Lives Here – Health Champion Designation • Mission Engagement Days • Stop Diabetes @ Work • Signature Physical Activity Events Patient Resources National resources: • diabetes.org • 800-DIABETES • Diabetes Forecast Local resources: • Local page on diabetes.org • 888-DIABETES professional.diabetes.org
