Get the highlights from Day 3 of the American Diabetes Association's (ADA) 82nd Scientific Sessions.
Find some of the highlights from Day 3 of the American Diabetes Association’s 82nd Scientific Sessions.
Technology Education in Underserved Populations—Education Factors
Technology plays a significant role in diabetes care. But limited access to technology education and the technology itself can disadvantage some of our patients. In a session titled “Technology Education in Underserved Populations—Education Factors,” experts go around the world and shared their perspectives on the barriers to education and underserved populations and proposed solutions as to how we can improve access to technology.
Diabetes Technology—Panacea Meets Reality
The session began with Dr. Anne Peters, Director of the USC Clinical Diabetes Programs at the University of Southern California. Doctor Peters began by evaluating the factors that impact outcomes for patients with diabetes. Some of these factors include a higher A1C, social determinants of health, and the stressors of everyday life.
According to Dr. Peters, one of the biggest barriers to technology in these communities is the language barrier, which can leave patients feeling overwhelmed and frustrated. For companies operating over the phone, even with interpreter options, oftentimes, patients still get transferred to English-speaking associates, or the options available after the initial call options are in English.
While barriers like these continue to exist, emerging companies such as Blue Circle Health are helping to make health equity a reality, according to Dr. Peters. This program was funded by a $45 million grant from the Helmsley Charitable Trust to fund a nonprofit type one diabetes center for under-resourced individuals in order to offer free care.
Dr. Peters concluded by saying that while there is no panacea for the treatment of diabetes, devices coupled with education and follow-up can improve outcomes. Providers must continue to work hard to develop culturally sensitive, comprehensive diabetes care to overcome health disparities.
Keeping Up with Technology Teaching the Underserved
This next session, led by Dr. Vivian Ayuk from Sorogi, Inc., took a look at the evolving realm of diabetes technology and the barriers to educating underserved communities.
The development of continuous glucose monitoring devices, insulin pumps, tools for telehealth, and more have vastly improved how many patients were you able to care for, especially during the COVID-19 pandemic.
There are several characteristics of underserved communities that act as barriers to education. Some of these barriers include
- Limited access to health care providers and services
- Lack of familiarity with the health care delivery system
- Fear and distrust and accessing government programs
- Lack of digital and/or health literacy
Some of the ways we can overcome these barriers are to assess providers' knowledge of the different devices and apps used by patients, provide targeted training and ongoing support care teams, develop a plan and update workflow as needed, and conduct assessments for teaching sessions to determine patients’ comfort level with technology and willingness to engage with new tools, and by sharing success stories.
More research is needed to create a more effective tool for the underserved populations and education and support programs must be developed based on the challenges and needs of those communities. Improving access to diabetes care and education specialists as well as positioning patients to optimize the use of technology and diabetes management can help improve care and can continuing education and support critical for long term success.
The Role of The Diabetes Care and Education Specialist Barriers and Solutions to Access Diabetes Technology for Under-Resourced Populations
In another session led by Dr. Jasmine Gonzalvo from the College of Pharmacy at Purdue University, Dr. Gonzalvo aimed to identify common barriers in disparities in diabetes technology access and explore the role of the Diabetes Care and Education Specialist in accessing diabetes technology for under-resourced populations.
Patients encounter a variety of individual and interpersonal barriers to technology access. There are two types of disparities in the use of diabetes technology: socioeconomic, racial, and ethnic disparities; and geographic disparities. To overcome these obstacles, a broader implementation of diabetes technology practices in primary care is essential.
The Diabetes Care and Education Specialist (DCES) can help implement technology through the following steps:
- Identify the right type of technology which of your patients is the right patient and what is the right time to collaborate
- Incorporate shared decision making and care team integration
- Configure the right technology utilizing user preferences, a treatment plan, and ongoing support
Through a specialist, a provider can recommend particular diabetes technology and relevant applications based on supportive evidence and provide comprehensive education via preferred language to optimize benefits from the use of technology for all individuals affected by diabetes. The DCES teams in primary care provide person-centered care and services to enrich the patient experience to improve patient understanding and support primary care physicians to optimize clinical care.
Incorporating New Weight Management Strategies for Obesity into Type 2 Diabetes Care—Medical Management & Surgery
While weight loss and long-term weight management are often key objectives of T2D treatment, to achieve these objectives healthcare providers and their patients must navigate through a varied, complex treatment landscape, which includes not only new weight loss medications but also bariatric surgery options. Weight loss strategies have been an important topic at the 2022 ADA conference. The session on day 3 titled “Incorporating New Weight Management Strategies for Obesity into Type 2 Diabetes Care—Medical Management and Surgery” hosted by Dr. Silvana Pannain of the University of Chicago, mapped out recent advances in medication and surgical solutions to T2D treatment.
Medical Weight Management for Type 2 Diabetes Treatment
Dr. Dina Griauzde, assistant professor at the University of Michigan, began the presentation by highlighting the clear connection between obesity and T2D. Weight loss of >10% improves T2D, reduces liver fat, improves the quality of life, and reduces CV events. But Dr. Griauzde noted there is no one-size-fits-all diet, as each patient will have their own unique preferences and challenges. For that reason, medication can be a valuable tool for weight loss.
Dr. Griauzde explained the weight management medications currently FDA-approved for long-term use and their corresponding weight loss percentage at 1 year.
- Orlistat, 3.8% weight loss
- Liraglutide, 4.8% weight loss
- Bupropion/naltrexone, 5.4% weight loss
- Phenterimine/topiramate, 8.6% weight loss
- Semaglutide, 12.4% weight loss
While the efficiency tends to be lower in patients with T2D, according to the STEP 2 trial, 45% of T2D patients taking semaglutide achieved ≥10% weight loss after 68 weeks, with a -1.6 HbA1c change.
Bariatric Surgery & Diabetes
Dr. Kristina H. Lewis, associate professor at Wake Forest University School of Medicine, was the next to present and began by highlighting the weight-loss efficacy of bariatric surgery compared to other weight-loss strategies.
- Bariatric surgery, 20->30% weight loss
- Anti-obesity medications, 5-15% weight loss
- Lifestyle-based treatment, 5-7% weight loss
For patients with T2D, surgery achieved a median decrease in HbA1c of 2%, compared to a decrease of 0.5% for medication/lifestyle-based treatment. Dr. Lewis then discussed the various types of bariatric surgery for T2D patients and their weight loss efficacy.
- Roux en Y Gastric Bypass (RYGB), maximum weight loss of 30-35%
- Sleeve Gastrectomy (SG), maximum weight loss of 25-30%
- Adjustable Gastric Banding (AGB), maximum weight loss of 20-25%
- Biliopancreatic diversion with Duodenal Switch (BPD/DS), maximum weight loss of 35-45%
Several studies compared SG and RYGB outcomes in T2D patients and found no significant difference between the two surgeries, though Dr. Lewis pointed out that these studies only looked at a relatively small sample size, and more research is needed. While BPD/DS only accounts for ~1% of weight loss procedures due to a higher risk of complications, Dr. Lewis explained the risk of complications from most laparoscopic bariatric surgeries is very low and is comparable to routine surgeries.
Despite the high efficacy and low risk of complications, only 0.6% of the eligible population in the U.S. are treated with bariatric surgery, according to a 2014 study.
Integrating Medical & Surgical Weight Loss Options in Clinical Practice
Jackie Boucher, President of Children’s Heartlink, presented strategies and tools primary care physicians can use to openly discuss weight-loss treatment options with their patients. According to Boucher, reasons primary care physicians fail to recommend bariatric surgery or weight loss medication include:
- The concern of complications & side effects
- Lack of comfort & knowledge of medications
- Patient’s minimal insurance coverage
- Negative track record of prior weight loss medications
- Lack of time during a routine visit
- Uncertainty on how to have the conversation with their patients
To help encourage the conversation, Boucher recommends using the 5As framework:
- Ask permission
- Assess their story
- Advise on management
- Agree on goals
- Assist with drivers & barriers
Understanding & Communicating Current Weight Loss Strategies for T2D Patients
Weight loss is the first step to achieving T2D treatment goals. By understanding the current therapy landscape, HCPs can tailor treatment plans to their specific patients, and openly discuss the risks and benefits of all weight-loss strategies. As explained in this session, new medications such as semaglutide and surgical strategies such as SG and RYGB procedures have given HCPs tools to effectively manage, if not eliminate, T2D.