Changing Diabetes in Iowa Technology, Education, Research and Collaboration

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1 Changing Diabetes in Iowa Technology, Education, Research and Collaboration Anuj Bhargava MD, MBA, CDE, FACP, FACE CEO & Medical Director

2 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

3 300,000 Iowans with Diabetes 810,000 Iowans with prediabetes (35.2%) ~$ 2 Billion in direct medical expenses ~ 545,000 with Diabetes (2030) ~1 million with Diabetes (2050)

remember the advice -Can t afford his meds Diabetes for 15 years Neuropathy

4 Meet Mike At the Doctor. Back at Home. Mike continues his struggles -No good way of tracking sugars -Doesn t remember the advice -Can t afford his meds Diabetes for 15 years Neuropathy Uncontrolled Sugars Doctor doesn t have labs Mike can t remember questions he wanted to ask. Where can Mike go to get help?

5 HOW CAN WE PROVIDE EXCEPTIONAL CARE TO MIKE AND 300K+ PATIENTS NOW AND A MILLION PATIENTS IN 2050?

6 Research Clinical Collaboration Care Education Technology

7 Changing Diabetes in Iowa TECHNOLOGY Collaboration Research Education Technology

8 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

9 165,000 Health Apps in % Of Smart Phone Owners Have Downloaded a Health App Diabetes Apps Can Track: Blood Glucose Nutrition Medications Exercise

10 Glucose Logs Sugar Sense

11 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

review patient data online Ability to track carbs from food

12 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

13 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

Diabetes Management Programs: Reduce Costs of Meter and Supplies Provide health coaches, meters, test strips, and other diabetic supplies for set fee $19.

14 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

15 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

16 Continuous Glucose Monitoring Examples Abbott Freestyle Libre Medtronic Guardian Dexcom G5 & G6

17 Sensors: Dexcom vs Libre Dexcom 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

18 Medication Management Round Health

19 Medisafe Medication dose reminders Interaction warnings Refill reminders MedFriend: share adherence with family and friends Apple Health Records integration 4.5 million registered users

20 MangoHealth Track medications, fluid intake, blood sugars, and more Dose reminders Medication information and education Redeem points for gift cards and other prizes

21 Nutrition Management

22 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

23 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

24 Track Steps, Distance, Sleep Heart rate tracking Food tracking Integrate with many other health apps Activity Trackers

25 APPLICATION OVERLOAD

27 How can We Help Mike? Mission: Improve the health and lives of people affected by diabetes. 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

28 Iowa Diabetes Portal Modules mysugars mynumbers mymeds mycare myactivity

29 mysugars Sugar Log

30 mysugars Sugar Graph

31 mysugars - Analytics

32 Meter uploads via Tidepool No longer allow just manual entry Save time by uploading automatically Get all the benefits of historical data and analysis

33 Abbott FreeStyle Lite Abbott Freestyle Freedom Lite Abbott Precision Xtra Bayer Contour Next Bayer Contour Next Link OneTouch UltraMini OneTouch Ultra 2 Trividia True Metrix

34 mymeds

35 mymeds

36 mynumbers

37 mycare

38 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, ed, faxed or pulled up on a mobile device Aims to save doctor offices 3-5 minutes per patient per visit!

43 myactivity - Fitness Trackers

44 myactivity - Fitness Trackers

45 Patient Health Data Connection

46 Patient Health Data Connection

47 Patient Health Data Connection

48 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!

49 Medicare, Pharmacies, and Labs Top 3 pharmacies Top 2 Labs Connection for 53 million Medicare beneficiaries Access to Part A, B, and D

50 EMR Connections in Iowa Mason City, Dubuque, Dyersville Sioux City, Clinton, New Hampton and more!

51 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

52 Changing Diabetes in Iowa DIABETES EDUCATION Collaboration Research Technology Education

53 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

54 Iowa Diabetes Educators Survey 2018 Challenges 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

55 Building A Bridge Between Professionals and Patients

56 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!

57 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

59 Invite Patient

69 Who Would Benefit From the Iowa Diabetes Portal? Diabetes Educators Dietitians Pharmacists Nurses Care Coordinators Other healthcare professionals

70 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 for access

71 Health Professionals Standards of Care CV Complications Low Testosterone Diabetes Medications Obesity Available Lectures Patients Carb Counting Diabetes Apps & Websites Insulin Pumps & CGMs Blood Sugar Monitoring Hyper/Hypoglycemia And more! And more! Contact for access

72 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

73 Changing Diabetes in Iowa DIABETES RESEARCH Collaboration Research Technology Education

74 Indirect Benefits of Research Access cutting-edge treatments Help new treatments get to market Make the future for those with diabetes better

75 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

76 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

77 Iowa Diabetes Research

78 Our Experience , % 4.7 Diabetes research trials Patients enrolled in research trials Average A1c change Patient satisfaction score (out of 5)

79 Iowa Diabetes Current Studies Diabetes Type 1 Type 2 Pumps and Sensors Pediatric Kidney Disease Testosterone Replacement Iowadiabetes.com

80 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

81 Changing Diabetes in Iowa COLLABORATION Collaboration Research Education Technology

85 Project Dulce San Diego

87 Changing Diabetes in Iowa A 2025 Vision Transform diabetes management and improve outcomes for Iowans by creating a best practice standard of care model through a state-wide collaboration. Establish Iowa as the global leader in diabetes care.

88 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

89 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

90 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

91 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!

92 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

93 LET S CHANGE DIABETES TOGETHER Questions? Contact Dr. Anuj Bhargava at abhargava@iowadiabetes.com For access to Diabetes Portals/University, contact partner@iowadiabetes.com

Smartphone Apps for Diabetes Management

Smartphone Apps for Diabetes Management By David Kerr, MD; Charis Hoppe; and Ceara AxelrodMarch 2017 There s an app for pretty much everything these days reading magazines (Diabetes Forecast has its own!),