How Do We Measure Successful Diabetes Care?

This content originally appeared on diaTribe. Republished with permission.

By Arvind Sommi, Andrew Briskin

Quality measures are tools to evaluate the effectiveness and quality of healthcare. Measures such as A1C, blood pressure, and cholesterol are used to understand health at the population level to ensure people with diabetes are getting the best care possible. At The diaTribe Foundation, we believe that Time in Range would be a valuable addition to the quality measures for diabetes care.

During a routine office visit, your healthcare provider may check certain health measures such as your A1C, blood pressure, and cholesterol. These tests are primarily used to assess your individual health and the effectiveness of your diabetes treatment plan. They are also used to evaluate the overall quality of care provided when these results are combined across all patients in a healthcare professional’s office, healthcare system, or health plan.

Recent advances in glucose monitoring, and the increasing use of continuous glucose monitors (CGM), has led to wider use of the metric Time in Range (TIR), which is a helpful supplement to A1C in assessing your glucose management. Because of this, TIR could be a valuable addition to the quality measures for diabetes care if it became a more widespread metric – a feat that is challenged by barriers to accessing CGM and integrating it into electronic health records.

What is a quality measure?

Quality measures can encompass many things but generally include different types of measurement domains, as outlined below.

Diabetes care

Source: diaTribe

Some tests, such as A1C screening or blood pressure monitoring, can serve as both a healthcare process and an outcome measure.

At the population level, outcome measures evaluate whether certain established goals are reached for a group of people. For example, this might be the percentage of patients in a healthcare practice with an A1C greater than or less than 9.0%. Quality measures, in this way, are used by insurance providers, people with diabetes looking for the best healthcare professionals to use, researchers, employers, and reporting agencies to better understand the effectiveness of diabetes treatments and evaluate how effective healthcare professionals or health systems are.

How are quality measures used in diabetes care?

Quality measures are important in diabetes care because achieving these goals can decrease the risk of diabetes complications and lead to improved health outcomes for everyone. There are several quality measures in diabetes care, many of which you may be familiar with through routine office visits with your healthcare team, such as:

Primarily, the combined data from these tests across many people with diabetes is used to determine if certain treatment methods are effective for the entire population. The data can also be used to reinforce or dispute established standards of diabetes care and respond to new care innovations (such as the latest technology or treatments).

Along with their use in evaluating treatments and standards of care, quality measures can also be used to evaluate healthcare professionals. In some cases, healthcare provider reimbursements from Medicare or other insurance providers may be tied to results, particularly under a value-based care model (learn more about value-based care here). For example, A1C screenings might be reimbursed only if enough patients meet A1C targets below certain thresholds.

Why might including Time in Range in quality measures be helpful to you?

While A1C is the current quality measure used to assess glucose management in people with diabetes, A1C has limitations. The accuracy of A1C measurements can vary based on factors such as race/ethnicity or chronic kidney disease. A1C tests are also generally limited to every two to three months and only represent an average blood glucose level over that time, which means daily highs and lows are not explicitly captured. Additionally, while low blood sugar may lower your A1C, it can also increase your risk of severe hypoglycemia – meaning a lower A1C may be dangerous if you experience frequent low blood sugars or mild hypoglycemia.

Time in Range is a glucose metric typically measured by a CGM. It is the amount of time you spend in the target range – generally between 70 and 180 mg/dL. The goal for most people with diabetes is to have at least 70% of your glucose readings within this range. Understanding your TIR as well as your time above and below range can help you and your healthcare provider assess how your body responds to medications, food choices, daily activities, stress, and a variety of other factors that affect your glucose. The increased use of TIR could help equip people with diabetes and their healthcare team with the information they need to make vital healthcare decisions and experience better diabetes care.

Time in Range allows for quick, actionable steps to improve diabetes management and corresponding health outcomes,” said Dr. Diana Isaacs, a diabetes care and education specialist from the Cleveland Clinic. “Time in Range can be assessed more frequently and provides more actionable insight into glucose management. Making it a quality measure would increase the utilization of this powerful tool. It has the potential to revolutionize how we take care of people with diabetes.”

Increases in TIR have been associated with a reduced risk of microvascular complications such as eye (retinopathy) and nerve disease (neuropathy), with similar evidence emerging for other macrovascular complications such as heart disease. Plus, the use of CGM has increased dramatically over the last few years (for example in people with type 1 diabetes in the T1D Exchange registry, this number rose from 6% in 2011 to 38% in 2018), allowing more people with diabetes to use TIR data on a regular basis.

However, there are still barriers to integrating TIR as a quality measure for diabetes care. One major challenge is the many barriers to using a CGM. For instance, most insurers cover CGM only for a limited number of people with diabetes (for example, those with type 1 diabetes who take insulin). Until access is substantially expanded and more people are able to use CGM who wish to, TIR adoption into the standard quality measures will be difficult.

An additional challenge is that TIR data is not integrated into most electronic health records (EHR) used by clinicians, making it difficult for providers to analyze TIR data for all patients and to assess TIR at the community level. Efforts are currently underway to change these systems so that TIR can be integrated into her systems, similar to metrics like A1C and blood pressure; at the ADA Scientific Sessions this year Dr. Amy Criego spoke to the success that the International Diabetes Center in Minnesota has had with integrating Abbott LibreView data into their EHR.

Through the efforts of the Time in Range Coalition, diaTribe is working to increase awareness and hopefully the eventual adoption of TIR as a meaningful quality measure in diabetes care.

Source: diabetesdaily.com

Review: Withings Connected Devices Help You Manage Your Health

Featured in Newsweek Best Products of 2020, Withings products and services can provide a range of accurate real-world data, including weight, heart rate, temperature, and blood pressure readings, as well as activity and sleep—so you can be on top of your health and also have data that can be very useful for your healthcare provider to help manage your care. With much of healthcare going remote, these products are more important than ever to stay on top of your health.

Who They Are

A start-up company founded in 2008 by Eric Carreel sought out to develop connected devices and apps that allow people to measure, and track what is important for their health and then take the information to make educated decisions to achieve their goals.

Today, Withings connected scales, hybrid watches, blood pressure monitors and sleep monitors, are used by millions of people around the world.

What Products Do They Offer

Withings carries scales, watches, blood pressure monitors, thermometers and sleep monitors–all of which are synced to one app for easy tracking. You can also share this data with your medical care team, which will make your appointments that much more productive. And now with most healthcare professionals switching over to telehealth in the wake of COVID-19, having useful information to share with your provider will help you get the most out of these virtual appointments.

My Review

I received the Withings Body + scale which was voted best body composition scale of 2019 by Verywell and the BPM connect blood pressure monitor. The company provided me with the product at no charge. I received no additional compensation for this review and all opinions are my own.

Withings Scales

Withings offers 3 different scale options all of which give you a comprehensive view of your health by performing a 30-second reading when you step on the scale. Within seconds you can get a complete body analysis–an accurate weight, BMI, body fat, water %, muscle and bone mass. Each of the scales offers slightly different features, with the Body Cardio scale also offering cardiovascular health via heart rate. Another great feature on all of the scales is the local weather. This is great for me since I usually weigh in before I step outside for the day.

Every time you weigh-in, the information appears in the Health Mate’s easy to set up app, automatically, via WI-FI or Bluetooth sync. It can store information for up to eight people at a time and also connects to over one hundred other apps. There is also a baby and pregnancy mode, which helps new moms or moms-to-be during this exciting time. Having all of this information at your fingertips can help you keep up the good work and make better decisions regarding your health.

For me, personally, as a person who weight trains, I love having the muscle mass feature and body fat % feature since I am much more concerned with my body composition than my weight. I am also constantly trying to stay hydrated so being able to see my water % gives me the motivation I need to go refill my cup. Having a full body composition scale allows me to measure so much more than just the number on the scale. This scale also isn’t an eyesore with its sleek look and chrome finish, it is easy to tuck away or display.

Withings reports that two-thirds of their users having a weight loss goal reported losing weight within the first six months of installing their scales. They also found that 7 out of 10 users lost a significant amount of fat loss after tracking using their new Withings scale.

Blood Pressure Monitor

High blood pressure is the most preventable cause of cardiovascular disease and can often go without symptoms. The American Heart Association recommends home monitoring for anyone with hypertension in order to continuously reassess and make any necessary medication changes.  Now, with telehealth appointments becoming the new normal, having a blood pressure monitor system at home is of the utmost importance.

Developed alongside cardiologists, Withings blood pressure monitors are clinically validated, ensuring you are getting the most accurate results. The arm monitor is easy to use and only takes one push of a button. It then syncs to the Health Mate app via Bluetooth and WiFi, providing you with key information using international standards and explains your results in an easy to understand manner.

Both the BPM Connect and BPM Core offer blood pressure and heart rate readings immediately on both the device and the app. Both models allow you to share the information with your doctors so your doctor can also track your health. The BPM Core also offers ECG records and a digital stethoscope. A bonus perk of the BPM connect model is that it is FSA (flexible savings account) eligible.

For someone looking to invest in some useful technology that can help track their health goals as well as weight goals, the Withing products are of the highest quality and accuracy. Making an investment in your health is always a good idea but now, more than ever, having home monitoring products like this is so beneficial for maintaining your overall health. These products are also extremely useful to healthcare providers so they can track their patients remotely, conduct research studies as well as other wellness programs. Withings is a company whose products are exactly what we need as we embark on this new way of healthcare.

Source: diabetesdaily.com

Appetite, Genetics, and Diabetes

This content originally appeared on Wildly Fluctuating. Republished with permission.Are thin people thin because they have incredible self-control whereas overweight people have very little? Or could their genetics play a large role? A story in the New York Times suggests the latter. They describe people with a version of a particular gene, MCR4, who are simply almost never […]
Source: diabetesdaily.com

Diabetes Medicines That Help Your Waistline and Your Heart

This content originally appeared on TCOYD: Taking Control of Your Diabetes. Republished with permission.By Daniel Einhorn Among the dirty little secrets of the older diabetes medicines was that they usually made you gain weight, they could cause low blood sugar suddenly and unexpectedly, and they had no particular benefit to the most important consequence of […]
Source: diabetesdaily.com

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