support diabetes self-care on a national basis dr. sheldon silver credit valley hospital, june 20,...
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Support Diabetes Self-Care Support Diabetes Self-Care On A National BasisOn A National Basis
Dr. Sheldon Silver
Credit Valley Hospital, June 20, 2007
HHA1CA1C
Glycosylated hemoglobin
Adapted from Stratton IM, et al. UKPDS 35. BMJ 2000; 321:405–412.
UKPDS: decreased risk of diabetes-related complications UKPDS: decreased risk of diabetes-related complications associated with a 1% decrease in A1Cassociated with a 1% decrease in A1C
UKPDS: decreased risk of diabetes-related complications UKPDS: decreased risk of diabetes-related complications associated with a 1% decrease in A1Cassociated with a 1% decrease in A1C
Per
cen
tag
e d
ecre
ase
in r
ela
tive
ris
k co
rres
po
nd
ing
to
a 1
% d
ecre
ase
in A
1C
**
Any diabetes-related endpoint
21%
**
Diabetes-related death
21% **
All cause
mortality
14%*
Stroke
12%
**
Peripheral vascular disease†
43%
**
Myocardial infarction
14%
**
Micro-vascular disease
37%
**
Cataract extraction
19%
Observational analysis from UKPDS study data
†Lower extremity amputation or fatal peripheral vascular disease*P = 0.035; **P < 0.0001
21.935.864%
6.915.2
210%
20.925.823%
1.32.2
69%
5.511.6
111%
World2000 = 159 million2025 = 280 million
Increase 76%
102.2189.485%
Number of Diabetics: 2000-2025
Numbers are millions
Hoy et al.
A Solution for Improving A Solution for Improving OutcomesOutcomes
Motivate the patient to take responsibility for their own care
Easy to useInexpensive > significant cost savingsImprove the MD – patient or RN – patient
therapeutic relationshipEfficient use of the MD’s / RN’s time
Wireless Diabetes Wireless Diabetes Management ProtocolManagement Protocol
Patient’s phone is loaded with a program & ID# Enter blood sugar readings. The data is sent back electronically and wirelessly to their MD; Data consists of only an ID# and blood sugar as well as date
and time of reading No identifying data; privacy is protected; Avoids hoarding of data. MDs/RNs monitor data on Palm / RIM / PC Action plan sent back to patient. Excellent MD/RN – patient relationship Community team approach with DCC & CCAC
Action Request i.e. ”Keep up the good work”
Diabetes Management System (Bayer WinGlucofacts & INET Sync)
Nurse
Patient Privacy: No identifiable information is transmitted.
Peoplew/Diabetes
Supporting Diabetes Self Care
Receive Sugar Levels
Send Action Request
Enter Sugar Level
GlycemiCare Server
Prevent Diabetes Related Complications with Better
Control of Glycemic Levels, Measured by HA1C
Pilot ProjectsPilot Projects
1. The first project ending in July 2005 tested the program in a family practice. The pilot project lasted ~3 months with 5 patients.
2. A second project ended in February 2007, working with a diabetes care centre. Twenty patients completed the pilot.
3. In November 2006 a third pilot project began with family physicians across Ontario.
4. A fourth project is planned to start in Chicago Illinois in 2007
Pilot Project: Diabetes Care Centre, Pilot Project: Diabetes Care Centre, Credit Valley Hospital (CVH)Credit Valley Hospital (CVH)
Pilot was support with an Education Grant Funded by Bayer Diabetes Care Division
Pilot started in 2006 with approval from CVH Ethics Review Broad.
25 patients enrolled and 20 completed. 15 patients participated > 3 months, 7 patients =>
5 months. 20 patients submitted both pre and post HA1C.
HA1C ResultsHA1C ResultsINET Wireless Diabetes Program
Patient
Change in HAIC Levels
Change in HAICPre-Pilot Post-Pilot
1 0.083 0.071 -0.012
2 0.067 0.065 -0.002
3 0.105 0.096 -0.009
4 0.072 0.080 0.008
5 0.073 0.071 -0.002
6 0.068 0.066 -0.002
7 0.050 0.049 -0.001
8 0.112 0.057 -0.055
9 0.082 0.079 -0.003
10 0.117 0.075 -0.042
11 0.077 0.059 -0.018
12 0.073 0.070 -0.003
13 0.077 0.063 -0.014
14 0.057 0.057 0.000
15 0.096 0.072 -0.024
16 0.080 0.078 -0.002
17 0.099 0.058 -0.041
18 0.081 0.070 -0.011
19 0.088 0.064 -0.024
20 0.081 0.075 -0.006
Patient SurveyPatient SurveyPrior to the pilot 10 of 20 patients recorded their readings once a Prior to the pilot 10 of 20 patients recorded their readings once a day or more. After the pilot 19 of 20 patients recorded daily.day or more. After the pilot 19 of 20 patients recorded daily.
Patient SurveyPatient Survey
Eleven patients said it was “much better” than the previous method (log book.), saying the main reason was it made them accountable or kept them honest (5.)
Almost all of the respondents (19) said the program made a “moderate” to “substantial impact” on their ability to control their sugar levels.
Eleven were “very” or “extremely” interested in continuing the program and 16 said they would recommend it to their physicians.
Diabetes Care Centre (CVH) Lessons Learned Diabetes Care Centre (CVH) Lessons Learned
In Supporting Patient Transition To Self-CareIn Supporting Patient Transition To Self-Care
For newly diagnosed people with diabetes, the patient should be assessed for their willingness and readiness to learn additional information. Often, it is better to wait for follow-up sessions to introduce this program as an additional support for them.
Introduce the program to nurses that are familiar with current technology tools such as the Internet, e-mail, word, spreadsheets and calendars.
Access systems to provide reminder alerts in the nurses schedules to prevent missing incoming data (i.e. using calendaring system such as outlook to activate an alert on a daily basis.)
Do not replace all communication methods with a wireless program; find the best mix, i.e. use the wireless program to receive data as a complement to the telephone, for use when providing clinical advice.
To Scale This Chronic Disease To Scale This Chronic Disease Management Program NationallyManagement Program Nationally
Looking at the enrollment challenge.Physicians’ awareness of the program.Must be intuitive to both the healthcare team
and patients.
Three Easy Steps To Program Three Easy Steps To Program EnrollmentEnrollment
1. E-mail program instructions to MDs and/or Diabetes Care Centres.
2. Instruction can be printed for patients.
3. Enroll patients by checking databases or during regular visits.
Patient Patient Cellphone Cellphone InstructionsInstructions
Thank YouThank You
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