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Messer LH, Vigers T, Akturk HK, Forlenza GP, Huss KB, Karami AJ, Malecha E, Oser SM, Polsky S, Pyle L, Shah VN, Wadwa RP, Oser TK. Increasing Use of Diabetes Devices: What Do Health Care Professionals Need? Clin Diabetes 2023; 41:386-398. [PMID: 37456091 PMCID: PMC10338282 DOI: 10.2337/cd22-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Despite evidence of improved diabetes outcomes with diabetes technology such as continuous glucose monitoring (CGM) systems, insulin pumps, and hybrid closed-loop (HCL) insulin delivery systems, these devices are underutilized in clinical practice for the management of insulin-requiring diabetes. This low uptake may be the result of health care providers' (HCPs') lack of confidence or time to prescribe and manage devices for people with diabetes. We administered a survey to HCPs in primary care, pediatric endocrinology, and adult endocrinology practices in the United States. Responding HCPs expressed a need for device-related insurance coverage tools and online data platforms with integration to electronic health record systems to improve diabetes technology uptake in these practice settings across the United States.
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Affiliation(s)
- Laurel H. Messer
- University of Colorado School of Medicine, Barbara Davis Center for Diabetes, Aurora, CO
| | - Tim Vigers
- University of Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, CO
- University of Colorado School of Medicine, Department of Pediatrics, Aurora, CO
| | - Halis K. Akturk
- University of Colorado School of Medicine, Barbara Davis Center for Diabetes, Aurora, CO
| | - Gregory P. Forlenza
- University of Colorado School of Medicine, Barbara Davis Center for Diabetes, Aurora, CO
| | - Kelsey B. Huss
- University of Colorado School of Medicine, Department of Family Medicine, Aurora, CO
| | - Angela J. Karami
- University of Colorado School of Medicine, Barbara Davis Center for Diabetes, Aurora, CO
| | - Emily Malecha
- University of Colorado School of Medicine, Barbara Davis Center for Diabetes, Aurora, CO
| | - Sean M. Oser
- University of Colorado School of Medicine, Department of Family Medicine, Aurora, CO
| | - Sarit Polsky
- University of Colorado School of Medicine, Barbara Davis Center for Diabetes, Aurora, CO
| | - Laura Pyle
- University of Colorado School of Public Health, Department of Biostatistics and Informatics, Aurora, CO
| | - Viral N. Shah
- University of Colorado School of Medicine, Barbara Davis Center for Diabetes, Aurora, CO
| | - R. Paul Wadwa
- University of Colorado School of Medicine, Barbara Davis Center for Diabetes, Aurora, CO
| | - Tamara K. Oser
- University of Colorado School of Medicine, Department of Family Medicine, Aurora, CO
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3
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Phillip M, Nimri R, Bergenstal RM, Barnard-Kelly K, Danne T, Hovorka R, Kovatchev BP, Messer LH, Parkin CG, Ambler-Osborn L, Amiel SA, Bally L, Beck RW, Biester S, Biester T, Blanchette JE, Bosi E, Boughton CK, Breton MD, Brown SA, Buckingham BA, Cai A, Carlson AL, Castle JR, Choudhary P, Close KL, Cobelli C, Criego AB, Davis E, de Beaufort C, de Bock MI, DeSalvo DJ, DeVries JH, Dovc K, Doyle FJ, Ekhlaspour L, Shvalb NF, Forlenza GP, Gallen G, Garg SK, Gershenoff DC, Gonder-Frederick LA, Haidar A, Hartnell S, Heinemann L, Heller S, Hirsch IB, Hood KK, Isaacs D, Klonoff DC, Kordonouri O, Kowalski A, Laffel L, Lawton J, Lal RA, Leelarathna L, Maahs DM, Murphy HR, Nørgaard K, O’Neal D, Oser S, Oser T, Renard E, Riddell MC, Rodbard D, Russell SJ, Schatz DA, Shah VN, Sherr JL, Simonson GD, Wadwa RP, Ward C, Weinzimer SA, Wilmot EG, Battelino T. Consensus Recommendations for the Use of Automated Insulin Delivery Technologies in Clinical Practice. Endocr Rev 2023; 44:254-280. [PMID: 36066457 PMCID: PMC9985411 DOI: 10.1210/endrev/bnac022] [Citation(s) in RCA: 114] [Impact Index Per Article: 114.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/22/2022] [Indexed: 02/06/2023]
Abstract
The significant and growing global prevalence of diabetes continues to challenge people with diabetes (PwD), healthcare providers, and payers. While maintaining near-normal glucose levels has been shown to prevent or delay the progression of the long-term complications of diabetes, a significant proportion of PwD are not attaining their glycemic goals. During the past 6 years, we have seen tremendous advances in automated insulin delivery (AID) technologies. Numerous randomized controlled trials and real-world studies have shown that the use of AID systems is safe and effective in helping PwD achieve their long-term glycemic goals while reducing hypoglycemia risk. Thus, AID systems have recently become an integral part of diabetes management. However, recommendations for using AID systems in clinical settings have been lacking. Such guided recommendations are critical for AID success and acceptance. All clinicians working with PwD need to become familiar with the available systems in order to eliminate disparities in diabetes quality of care. This report provides much-needed guidance for clinicians who are interested in utilizing AIDs and presents a comprehensive listing of the evidence payers should consider when determining eligibility criteria for AID insurance coverage.
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Affiliation(s)
- Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, 49202 Petah Tikva, Israel
- Sacker Faculty of Medicine, Tel-Aviv University, 39040 Tel-Aviv, Israel
| | - Revital Nimri
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, 49202 Petah Tikva, Israel
- Sacker Faculty of Medicine, Tel-Aviv University, 39040 Tel-Aviv, Israel
| | - Richard M Bergenstal
- International Diabetes Center, HealthPartners Institute, Minneapolis, MN 55416, USA
| | | | - Thomas Danne
- AUF DER BULT, Diabetes-Center for Children and Adolescents, Endocrinology and General Paediatrics, Hannover, Germany
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Boris P Kovatchev
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - Laurel H Messer
- Barbara Davis Center for Diabetes, University of Colorado Denver—Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | | | | | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Roy W Beck
- Jaeb Center for Health Research Foundation, Inc., Tampa, FL 33647, USA
| | - Sarah Biester
- AUF DER BULT, Diabetes-Center for Children and Adolescents, Endocrinology and General Paediatrics, Hannover, Germany
| | - Torben Biester
- AUF DER BULT, Diabetes-Center for Children and Adolescents, Endocrinology and General Paediatrics, Hannover, Germany
| | - Julia E Blanchette
- College of Nursing, University of Utah, Salt Lake City, UT 84112, USA
- Center for Diabetes and Obesity, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Emanuele Bosi
- Diabetes Research Institute, IRCCS San Raffaele Hospital and San Raffaele Vita Salute University, Milan, Italy
| | - Charlotte K Boughton
- Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke’s Hospital, University of Cambridge Metabolic Research Laboratories, Cambridge, UK
| | - Marc D Breton
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - Sue A Brown
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA
- Division of Endocrinology, University of Virginia, Charlottesville, VA 22903, USA
| | - Bruce A Buckingham
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA 94304, USA
| | - Albert Cai
- The diaTribe Foundation/Close Concerns, San Diego, CA 94117, USA
| | - Anders L Carlson
- International Diabetes Center, HealthPartners Institute, Minneapolis, MN 55416, USA
| | - Jessica R Castle
- Harold Schnitzer Diabetes Health Center, Oregon Health & Science University, Portland, OR 97239, USA
| | - Pratik Choudhary
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kelly L Close
- The diaTribe Foundation/Close Concerns, San Diego, CA 94117, USA
| | - Claudio Cobelli
- Department of Woman and Child’s Health, University of Padova, Padova, Italy
| | - Amy B Criego
- International Diabetes Center, HealthPartners Institute, Minneapolis, MN 55416, USA
| | - Elizabeth Davis
- Telethon Kids Institute, University of Western Australia, Perth Children’s Hospital, Perth, Australia
| | - Carine de Beaufort
- Diabetes & Endocrine Care Clinique Pédiatrique DECCP/Centre Hospitalier Luxembourg, and Faculty of Sciences, Technology and Medicine, University of Luxembourg, Esch sur Alzette, GD Luxembourg/Department of Paediatrics, UZ-VUB, Brussels, Belgium
| | - Martin I de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Daniel J DeSalvo
- Division of Pediatric Diabetes and Endocrinology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX 77598, USA
| | - J Hans DeVries
- Amsterdam UMC, University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands
| | - Klemen Dovc
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children’s Hospital, Ljubljana, Slovenia, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Francis J Doyle
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
| | - Laya Ekhlaspour
- Lucile Packard Children’s Hospital—Pediatric Endocrinology, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Naama Fisch Shvalb
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, 49202 Petah Tikva, Israel
| | - Gregory P Forlenza
- Barbara Davis Center for Diabetes, University of Colorado Denver—Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | - Satish K Garg
- Barbara Davis Center for Diabetes, University of Colorado Denver—Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Dana C Gershenoff
- International Diabetes Center, HealthPartners Institute, Minneapolis, MN 55416, USA
| | - Linda A Gonder-Frederick
- Center for Diabetes Technology, School of Medicine, University of Virginia, Charlottesville, VA 22903, USA
| | - Ahmad Haidar
- Department of Biomedical Engineering, McGill University, Montreal, Canada
| | - Sara Hartnell
- Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Irl B Hirsch
- Department of Medicine, University of Washington Diabetes Institute, University of Washington, Seattle, WA, USA
| | - Korey K Hood
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Diana Isaacs
- Cleveland Clinic, Endocrinology and Metabolism Institute, Cleveland, OH 44106, USA
| | - David C Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA 94010, USA
| | - Olga Kordonouri
- AUF DER BULT, Diabetes-Center for Children and Adolescents, Endocrinology and General Paediatrics, Hannover, Germany
| | | | - Lori Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA
| | - Julia Lawton
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Rayhan A Lal
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Lalantha Leelarathna
- Manchester University Hospitals NHS Foundation Trust/University of Manchester, Manchester, UK
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA 94304, USA
| | - Helen R Murphy
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen and Department of Clinical Medicine, University of Copenhagen, Gentofte, Denmark
| | - David O’Neal
- Department of Medicine and Department of Endocrinology, St Vincent’s Hospital Melbourne, University of Melbourne, Melbourne, Australia
| | - Sean Oser
- Department of Family Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Tamara Oser
- Department of Family Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, and Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Michael C Riddell
- School of Kinesiology & Health Science, Muscle Health Research Centre, York University, Toronto, Canada
| | - David Rodbard
- Biomedical Informatics Consultants LLC, Potomac, MD, USA
| | - Steven J Russell
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Desmond A Schatz
- Department of Pediatrics, College of Medicine, Diabetes Institute, University of Florida, Gainesville, FL 02114, USA
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Denver—Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jennifer L Sherr
- Department of Pediatrics, Yale University School of Medicine, Pediatric Endocrinology, New Haven, CT 06511, USA
| | - Gregg D Simonson
- International Diabetes Center, HealthPartners Institute, Minneapolis, MN 55416, USA
| | - R Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado Denver—Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Candice Ward
- Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Stuart A Weinzimer
- Department of Pediatrics, Yale University School of Medicine, Pediatric Endocrinology, New Haven, CT 06511, USA
| | - Emma G Wilmot
- Department of Diabetes & Endocrinology, University Hospitals of Derby and Burton NHS Trust, Derby, UK
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, England, UK
| | - Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, UMC - University Children’s Hospital, Ljubljana, Slovenia, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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4
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Walker AF, Cuttriss N, Haller MJ, Hood KK, Gurka MJ, Filipp SL, Anez-Zabala C, Yabut K, Roque X, Wong JJ, Baer L, Figg L, Bernier A, Westen S, Lewit E, Sheehan E, Basina M, Lal R, Maizel J, Maahs DM. Democratizing type 1 diabetes specialty care in the primary care setting to reduce health disparities: project extension for community healthcare outcomes (ECHO) T1D. BMJ Open Diabetes Res Care 2021; 9:9/1/e002262. [PMID: 34244218 PMCID: PMC8268922 DOI: 10.1136/bmjdrc-2021-002262] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/05/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Project ECHO (Extension for Community Healthcare Outcomes) is a tele-education outreach model that seeks to democratize specialty knowledge to reduce disparities and improve health outcomes. Limited utilization of endocrinologists forces many primary care providers (PCPs) to care for patients with type 1 diabetes (T1D) without specialty support. Accordingly, an ECHO T1D program was developed and piloted in Florida and California. Our goal was to demonstrate the feasibility of an ECHO program focused on T1D and improve PCPs' abilities to manage patients with T1D. RESEARCH DESIGN AND METHODS Health centers (ie, spokes) were recruited into the ECHO T1D pilot through an innovative approach, focusing on Federally Qualified Health Centers and through identification of high-need catchment areas using the Neighborhood Deprivation Index and provider geocoding. Participating spokes received weekly tele-education provided by the University of Florida and Stanford University hub specialty team through virtual ECHO clinics, real-time support with complex T1D medical decision-making, access to a diabetes support coach, and access to an online repository of diabetes care resources. Participating PCPs completed pre/post-tests assessing diabetes knowledge and confidence and an exit survey gleaning feedback about overall ECHO T1D program experiences. RESULTS In Florida, 12 spoke sites enrolled with 67 clinics serving >1000 patients with T1D. In California, 11 spoke sites enrolled with 37 clinics serving >900 patients with T1D. During the 6-month intervention, 27 tele-education clinics were offered and n=70 PCPs (22 from Florida, 48 from California) from participating spoke sites completed pre/post-test surveys assessing diabetes care knowledge and confidence in diabetes care. There was statistically significant improvement in diabetes knowledge (p≤0.01) as well as in diabetes confidence (p≤0.01). CONCLUSIONS The ECHO T1D pilot demonstrated proof of concept for a T1D-specific ECHO program and represents a viable model to reach medically underserved communities which do not use specialists.
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Affiliation(s)
- Ashby F Walker
- University of Florida Diabetes Institute, Gainesville, FL, USA
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Nicolas Cuttriss
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Michael J Haller
- University of Florida Diabetes Institute, Gainesville, FL, USA
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Korey K Hood
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Stephanie L Filipp
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | | | - Katarina Yabut
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Xanadu Roque
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Jessie J Wong
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Linda Baer
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Lauren Figg
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Angelina Bernier
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Sarah Westen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Eugene Lewit
- Department of Health Research and Policy, Stanford, Palo Alto, California, USA
| | - Eleni Sheehan
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Marina Basina
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
- Department of Medicine, Division of Endocrinology, Gerontology & Metabolism, Stanford University, Palo Alto, California, USA
| | - Rayhan Lal
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
- Department of Medicine, Division of Endocrinology, Gerontology & Metabolism, Stanford University, Palo Alto, California, USA
| | - Jennifer Maizel
- College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - David M Maahs
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
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