Changing Diabetes in Iowa Technology, Education, Research and

Collaboration

Anuj Bhargava MD, MBA, CDE, FACP, FACE

CEO & Medical Director

Presentation Objectives

1. Become aware of the most popular apps patients use to manage their diabetes

2. Understand the benefits of a unique patient-centered, health care professional friendly, data driven technology platform developed locally

3. Become aware of other local resources and services to help patients with diabetes

4. Explore ways to build a collaborative alliance that can truly help change the face of diabetes in Iowa

810,000Iowans with prediabetes (35.2%)

~$ 2 Billionin direct medical

expenses

300,000Iowans with

Diabetes

~ 545,000 with Diabetes (2030)

~1 million with Diabetes (2050)

Where

can Mike

go to get

help?

Diabetes for 15 yearsNeuropathy

Uncontrolled Sugars

Meet Mike Back at Home….

Mike continues his struggles …-No good way of tracking sugars-Doesn’t remember the advice-Can’t afford his meds

At the Doctor….

Doctor doesn’t have labsMike can’t remember questions he wanted to ask.

HOW CAN WE PROVIDE EXCEPTIONAL CARE TO MIKE AND 300K+ PATIENTS NOW AND A MILLION PATIENTS IN

2050?

Research

ClinicalCare

Education

Technology

Collaboration

TECHNOLOGY

Changing Diabetes in Iowa

Research

Education

Technology

Collaboration

Diabetes and Digital Health

“Diabetes is screaming for digital health because of the nature of the disease (24/7, data-driven) and the trends in the field (declining providers, growing

patients, enormous costs). As with any digital health solution, the key is limiting the additional burden and cost, providing more valuable data, and using those

data to drive better outcomes.”

- DiaTribe.org

www.imshealth.com/en/about-us/news/ims-health-study:-patient-options-expand-as-mobile-healthcare-apps-address-wellness-and-chronic-disease-treatment-needs

http://mhealth.jmir.org/2015/4/e101/

165,000Health Apps in

2015

58%Of Smart Phone Owners Have

Downloaded a Health App

Diabetes Apps Can Track:

Blood Glucose

Medications

Nutrition

Exercise

Glucose Logs

Sugar Sense

MySugr

• Created by people with diabetes for people with diabetes

• Tracks BG patterns, provides education and coaching

• mySugr Bundle ($39.99/mo)– Unlimited test strips

– Accu-Chek Guide meter

– mySugr app and coach

mysugr.com

Glooko

• Syncs blood glucose data from meter to phone/web

• Identify BG patterns and set reminders

• Clinicians can review patient data online

• Ability to track carbs from food database

• Integration with activity trackers

https://www.glooko.com/

Livongo

• Utilizes data science and behavior enablement to help patients live healthier lives

• Real-time support and coaching

• Share data with doctors and family/friends

• Livongo meter, Unlimited test strips

https://www.glooko.com/

Diabetes Management Programs: Reduce Costs of Meter and Supplies

• Provide health coaches, meters, test strips, and other

diabetic supplies for set fee

$19.95 for 50 test strips or $29.95 for

100 test strips

$39.99 per month for meter and

unlimited test strips

$65 per month for coaching and

unlimited test strips

Continuous Glucose Monitoring

• Implanted electrodes measure glucose levels every 5 minutes and create patterns

• Measures interstitial BG rather than plasma BG with an expected sensor lag

• Shows how insulin doses, food, and exercise affects glucose levels

• Detection of highs, lows, and nocturnal hypoglycemia

Continuous Glucose Monitoring Examples

Dexcom G5 & G6Medtronic Guardian

Abbott Freestyle Libre

Sensors: Dexcom vs LibreDexcom G6 Freestyle Libre

Calibration Required

No (can calibrate)No, and not

possible

Sensor Life 10 days 14 days

Warmup time 2 hours 12 hours

Hi/Low Alerts Yes No

Live Data Sharing Yes None

Medication Management

Round Health

Medisafe

• Medication dose reminders

• Interaction warnings

• Refill reminders

• MedFriend: share adherence with family and friends

• Apple Health Records integration

• 4.5 million registered users

MangoHealth

• Track medications, fluid intake, blood sugars, and more

• Dose reminders

• Medication information and education

• Redeem points for gift cards and other prizes

Nutrition Management

MyFitnessPal

• Food diary– Store frequent foods and meals for

quick entry

– Diet profile customized to user

• Track weight, water intake, exercise

• Member of Under Armour family of apps

https://itunes.apple.com/us/app/calorieking-food-search/id454930992?mt=8

Calorie King Food Search

• Contains over 70,000+ foods, including 260 fast food chains and restaurants

• Includes protein, fiber, cholesterol, sodium, and fat levels

• Useful for diabetes management and weight loss

https://itunes.apple.com/us/app/calorieking-food-search/id454930992?mt=8

Activity Trackers

• Track Steps, Distance, Sleep

• Heart rate tracking

• Food tracking

• Integrate with many other health apps

https://itunes.apple.com/us/app/calorieking-food-search/id454930992?mt=8

APPLICATION OVERLOAD

• An all-in-one, patient centered platform for managing sugars, meds, labs, doctor visits, activity and more

• Provider friendly platform focused on transforming clinical care through time saving

• Data driven platform that makes patient data more valuable, useful and available

• Provides hyper-personalized experience to initiate and sustain behavior change

How can We Help Mike?

Mission: Improve the health and lives of people affected

by diabetes.

Iowa Diabetes Portal Modules

mySugars myNumbers

myMeds myCare

myActivity

mySugars – Sugar Log

mySugars – Sugar Graph

mySugars - Analytics

Meter uploads via Tidepool

• No longer allow just manual entry

• Save time by uploading automatically

• Get all the benefits of historical data and analysis

Abbott FreeStyle Lite

Bayer Contour Next Link

OneTouch UltraMini OneTouch Ultra 2

Abbott Freestyle Freedom Lite

Bayer Contour NextAbbott Precision

Xtra

Trividia True Metrix

myMeds

myMeds

myNumbers

myCare

Transforming Clinical Care: Visit Optimizer

• Gets members completely ready for a great doctor visit

• Includes all pertinent health information- meds, latest labs and vitals, sugar logs/graphs, and questions

• Printed, emailed, faxed or pulled up on a mobile device

• Aims to save doctor offices 3-5 minutes per patient per visit!

myActivity - Fitness Trackers

myActivity - Fitness Trackers

Patient Health Data Connection

Patient Health Data Connection

Patient Health Data Connection

World’s Largest Health Data Network• Cover 7 of 10 of the top EMR technologies to institutions.

• Ability to import data from 60-70% of providers with EHR.

• Potential to connect to about 600k doctors in the US.

Plus Thousands

More!

Medicare, Pharmacies, and Labs

• Top 3 pharmacies

• Top 2 Labs

• Connection for 53 million Medicare beneficiaries

– Access to Part A, B, and D

EMR Connections in Iowa

…and more!

Mason City, Dubuque, DyersvilleSioux City, Clinton, New Hampton

Technology in Diabetes Summary

• Technology is the next big blockbuster in diabetes!

• Numerous diabetes apps/websites are available to patients

• Providers need to be aware of the Apps/Websites and prescribe/suggest them to patients

• Iowa Diabetes Portal is a patient centered, provider friendly, data driven, comprehensive platform for both patients and providers

DIABETES EDUCATION

Changing Diabetes in Iowa

Research

Education

Technology

Collaboration

Issues Facing Diabetes Educators

• 32K educators for 30M patients nationwide

• Financial pressures and Reimbursement issues

– 42% of diabetes education programs operated at a loss

• Decreasing number of education programs

• Increasing documentation burdens and complexities

http://www.diabetes.org/diabetes-basics/statistics/

https://journals.sagepub.com/eprint/EZnAgc6SHJbyVJambSdh/full

Iowa Diabetes Educators Survey 2018Challenges and Needs

Current Systems Challenges

• Lack of efficiency

• Inability to personalize

• Time consuming to use

Key Traits Needed

• Ease of use and layout

• Access to information

• Data organization

Building A Bridge Between Professionals and Patients

Iowa Diabetes Portal for Professionals• Novel patient management and engagement platform, never

built before

• Created to make diabetes education/care more effective, efficient and sustainable

• Aims to transform – Patient visits

– Patient interactions

Transform Your Day!

Transform Diabetes Education/Care Coordination

• Understand your patient’s health better with all of their data in one place

• Stop wasting time on data collection

• Have more prepared & engaged patients

• Make recommendations based on current data and trends directly in the moment

Invite Patient

Who Would Benefit From the Iowa Diabetes Portal?

• Diabetes Educators

• Dietitians

• Pharmacists

• Nurses

• Care Coordinators

• Other healthcare professionals

A Diabetes University for Iowa

• Started in 2017 to improve the health and lives of people affected by diabetes through education

– Educate and motivate patients

– Educate healthcare professionals

• An audience-focused, credible, flexible and interactive education platform

Contact partner@iowadiabetes.com for access

Available Lectures

Health Professionals

• Standards of Care

• CV Complications

• Low Testosterone

• Diabetes Medications

• Obesity

• And more!

Patients

• Carb Counting

• Diabetes Apps & Websites

• Insulin Pumps & CGMs

• Blood Sugar Monitoring

• Hyper/Hypoglycemia

• And more!Contact partner@iowadiabetes.com for access

Changing Diabetes in Iowa: Education

• Many issues facing educators and healthcare professionals

• Iowa Diabetes Portal makes patient data (patient generated or EMR) more accessible to all healthcare professionals

• Opportunity to learn together through a Diabetes University for patients and HCPs

• All available for FREE for patients and HCPs in Iowa

DIABETES RESEARCH

Changing Diabetes in Iowa

Research

Education

Technology

Collaboration

Indirect Benefits of Research

• Access cutting-edge treatments

• Help new treatments get to market

• Make the future for those with diabetes better

Direct Patient Benefits

Medical supplies at no cost to

patient

Stipend for each on-site visit

Study medication at no cost to

patient

Expert medical care and

education

Diabetes Research In Iowa

• Fraternal Order of Eagles Diabetes Research Center (FOE DRC) at the University of Iowa

• JDRF

• Broadlawns

• Iowa Clinic

• Unity Point

• Iowa Diabetes Research

Iowa Diabetes Research

Our Experience

1,600+100+ -0.9%Patients enrolled in research trials

Diabetes research trials

Average A1c change

4.7Patient

satisfaction score (out of 5)

Iowa Diabetes– Current Studies

• Diabetes

– Type 1

– Type 2

– Pumps and Sensors

– Pediatric

• Kidney Disease

• Testosterone Replacement

Iowadiabetes.com

Changing Diabetes in Iowa: Research

• Research is necessary to find better treatment options

• Substantial direct patient benefits

– Specially for those struggling with cost of meds

• Be aware of local research options and offer proactively to patients as another treatment option

COLLABORATION

Changing Diabetes in Iowa

Research

Education

Technology

Collaboration

Project Dulce San Diego

Changing Diabetes in IowaA 2025 Vision

Establish Iowa as the global leader in diabetes care.

Transform diabetes management

and improve outcomes for Iowans by

creating a best practice standard of care model

through a state-wide collaboration.

Changing Diabetes in Iowa Key Attributes

• Patient Centered: A patient centered alliance

• Inclusive: All stakeholders working together

• Data enabled: All relevant data available at the right time to the right person in the right context

• Establish Iowa as a model for diabetes care

Bringing All Stakeholders Together

• Patients• Health care providers: physicians, clinics and health systems• Payers/Insurance Companies• Employers• Diabetes educators• Pharmacists• Government• Non profit organizations• Care Coordinators, Case Managers, Social workers• Grocery Stores and pharmacies

Meaningful Collaboration Examples

• Pooling resources in patient education – Complete combined online curriculum– City wide or state wide seminars and webinars

• HCP education– Online curriculum, webinars and seminars

• Statewide support groups: online and offline• Seamless and complete flow of data

– Patients visiting ER or doctor with all the relevant info– Physicians not reordering tests or wasting time in getting test results

Changing Diabetes in Iowa: Collaboration

• Collation of local community resources for patients and HCPs

• Combine educational efforts

• Creation of Iowa Diabetes Alliance Workgroup

– Meet in quarter 1 of 2019 to explore the collaboration

Visit tinyurl.com/IowaDiabetesAlliance to get started!

Key Conclusions

• Diabetes has been and will be a major health issue in Iowa

• A four pronged approach can substantially improve diabetes outcomes– Technology: Patient centered, provider friendly & data driven

– Education for patients and HCPs

– Diabetes research

– Collaboration

• Let us all join forces to change diabetes in Iowa

Questions?

LET’S CHANGE DIABETES TOGETHER

Contact Dr. Anuj Bhargava at abhargava@iowadiabetes.com

For access to Diabetes Portals/University, contact partner@iowadiabetes.com