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Institute Report
Innovation in Diabetes Care Technology: Key issues impacting access and optimal use
May 06, 2020
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About the Report

As the COVID-19 pandemic sweeps across the world, it has had an outsized effect on people with diabetes. Preliminary data suggests that people with diabetes and other preexisting conditions are more likely to experience serious complications and death from COVID-19 than people without diabetes and other conditions.1 A recent observational study found that people with diabetes who contract COVID-19 are four times more likely to die in the hospital.2,3 To ensure such critical data continues to emerge, the application of human data science techniques will be crucial to track the associations between COVID-19 infection and chronic conditions such as diabetes.

Even prior to this challenging period, assessments of glucose control through metrics like HbA1c and Time-in-Range (TIR) have indicated that many people with diabetes (PwD) have struggled to meet treatment targets. Recent developments in diabetes digital medicine products offer the potential to address challenges in the current care paradigm, better connecting PwD to their care teams, even as the COVID-19 pandemic hinders in-person interaction. Devices that can continuously assess insulin requirements and administer drug dosing as needed have the potential to better personalize treatment to individual needs. As patients with a range of chronic diseases face new challenges managing their conditions during the COVID-19 pandemic, at least in diabetes space new digital tools may relieve some of the psychosocial challenges facing PwD and improve quality of life. Data generated on glucose levels through digital medicine products allows for remote monitoring and analysis of trends critical to the management.  To attain optimal use of digital medicine products going forward multiple aspects of the healthcare ecosystem may need to shift including payer and market approval assessment paradigms, user experience, and data privacy and security, among others.

Report Summary

Diabetes care and blood glucose management have advanced significantly over the last century, however, significant gaps remain. Current HbA1c levels in the U.S. average around 8.4% for people with Type 1 Diabetes (T1D) where the consensus target is 7%, and conservative estimates of mean Time in Range (TIR) for people with T1D are between 42% and 58% when the consensus target is >70%. Such gaps in glucose management can have serious consequences. Poor glucose management is related to a host of microvascular and macrovascular complications that have substantial impacts for people with diabetes, HCPs, and the healthcare system alike.

New diabetes digital tools and care technologies are being developed to address the complexity of care in a more holistic way to make more seamless and remote chronic disease management possible. Advances in diabetes digital medicine products (via connected devices, digital applications, and algorithms) offer the potential to provide more precise information and simplify diabetes management, leading to better outcomes. From a clinical perspective, studies report that optimal use of connected devices may result in improved HbA1c and increases in TIR. Studies of pump systems and hybrid closed-loop systems have reported an improvement in glycemic control, while studies on the use of digital applications have reported reductions in HbA1c amongst users. From a psychosocial perspective, early research suggests the use of connected devices, including insulin pumps and continuous glucose monitors (CGMs), can result in reduced anxiety, improved sleep, improved confidence, and an increased sense of relief or “time-off” from diabetes demands. From an economic perspective, studies report that the use of connected devices like continuous glucose monitors and digital coaching systems can significantly reduce medical costs. More research is needed to paint a full picture of the benefits and challenges associated with the uptake of digital medicine products and ensure they provide more seamless care.

Unlocking the value of these new approaches hinges on optimally understanding and harnessing new digital medicine products to advance healthcare delivery and healthcare policy. There are several issues across the healthcare ecosystem that impact access to and optimal use of these digital medicine products. These include issues related to reimbursement, the adoption of new technologies, data privacy and security, and most importantly, the experience of people with diabetes using these digital medicine products.

1Guan WJ, Ni ZY, Hu Y, Liang WH, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Feb 28. doi:1056/NEJMoa2002032.
2Bode B, Garrett V, Messler J, McFarland R, Crowe J, Booth R, Klonoff DC. Glycemic Characteristics and Clinical Outomes of COVID-19 Patients Hospitalized in the United States. J Diabetes Sci Technol. 2020; In press.
3COVID-19 study shows more than 4 times in-hospital mortality rate and increased length of stay for patients with diabetes and hyperglycemia. Business Wire. 2020 Apr 17. https://news.yahoo.com/covid-19-study-shows-more-120100977.html

 

Key Findings


As the COVID-19 pandemic changes healthcare, evidence-based digital medicine products that take health measurements or intervene to further human health are playing an increasingly critical role

  • Tools that help in chronic disease management and allow a care team track changes in patient health are likely to be increasingly valued in the post-COVID world.
  • Overall, digital medicine products can address complexities in the current healthcare system by providing enhanced access to information, enhancing precision of information, and improving patient engagement and self-management, thereby possibly leading to better outcomes.
  • There is substantial and growing interest in understanding and measuring the value of digital medicine products from a clinical, psychosocial, and economic perspective, where initial findings suggest they offer benefits, and those efforts are likely to see further impetus due to the pandemic.


Connected devices, as part of the digital ecosystem, are being developed to address the complexity of diabetes care in a more holistic way and enable remote chronic disease management


  • Beyond recording and analyzing data from biometric measurements to help PwD achieve improved care outcomes more easily and consistently, continuous glucose monitors, smart pens and automated insulin delivery (AID) devices like hybrid closed-loop systems may automatically adjust basal rate insulin dosing to the amount needed or deliver insulin in an automated fashion. 
  • The ability of care teams to track glucose data generated by digital tools enables remote disease management, which may reduce the need for in-person interaction.  This is particularly helpful when PwD cannot access providers, as has occurred during the COVID-19 pandemic. 
  • Earlier studies have reported that people with Type 1 Diabetes using continuous glucose monitors and automated insulin delivery devices obtained lower HbA1c levels, improvements in TIR and reduced hypoglycemic events.

 

 

As the COVID-19 pandemic emphasizes the need for telemedicine and remote monitoring, issues across the healthcare ecosystem remain that may hinder access to and optimal use of digital medicine products 

  • The innovations provided by digital medicine products are moving diabetes care towards a new care paradigm; one in which more seamless and remote chronic disease management is possible.
  • An evaluation of the overall healthcare ecosystem is needed to understand what must change so new digital medicine products, as they begin to showcase their value, can be appropriately assessed and accessed to lead to optimal diabetes care.
  • Unlocking the value of these new approaches hinges on optimally understanding and harnessing new digital medicine products to advance healthcare delivery and healthcare policy.
  • While the willingness of payers to cover new diabetes digital medicine products and compensate HCPs for their time spent remotely monitoring data can be limited, in the post-COVID environment we may see shifts in reimbursement.
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