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Experts say healthcare executives should bear several factors in mind when dealing with diabetes and some of the issues surrounding the condition.

Here are five areas diabetes patients care about.

While a host of newer medications can abet weight loss-often a primary concern for people with diabetes, of course-a number of them also are quite expensive. That hampers patient compliance if they’re required to pay out-of-pocket, or have high co-pays, says Sheri Colberg, PhD, FACSM, professor Emerita, Exercise Science, research professor (self-supported), Old Dominion University in Norfolk, Virginia.

Glucose Monitor Advances Could Vastly Improve Diabetes Management

One in four people taking prescription drugs report difficulty affording their medication, while recent Kaiser Family Foundation 

 bipartisan support for government action to lower prescription drug costs. In 2016, per capita retail prescription drug spending burgeoned at a slow rate (0.6%)-particularly compared to the previous two years when new specialty drugs entered the market. Looking ahead, the CMS projections suggest growth in per capita drug spending will be moderate through 2026.

2. The role of technology in diabetes care 

Self-care of chronic conditions is a major area where virtual health can be leveraged to help patients remain medically stable, according to Kaveh Safavi, MD, JD, head of Accenture’s global health practice. Adults with diabetes can use sophisticated mobile technology to effectively manage their lifestyles and conditions, reducing the need for in-person encounters.

Sophisticated analytics can track, trend, and assess patient- and medical device-provided data, such as blood glucose levels, Safavi says. The same technology can prompt and suggest a personalized self-management plan-and that plan can evolve as the patient’s health status changes.

Digital health solutions to manage diabetes 

 from simply tracking blood sugar values to far more comprehensive capabilities such as supporting clinical decisions, enabling behavioral changes and proactively managing the condition.

With the increasing use of smartphones and Internet, there’s an opportunity to use digital tools for training people with diabetes to self-manage their disease. A number of 

 are available to help patients to improve their diabetes care.

3. Rebates can help raise level of adherence

Since insulin is rebated at around 70%, passing rebates to patients at the point of sale will make a big difference in their ability to adhere to medication treatment regimens and keep them out of the hospital where the bulk of their costs occur, according to Jesse Bushman, senior director, Health Policy and Advocacy at the 

Plans can put insulin on a “preventive medicines” list so that it is not subject to a deductible. This helps those in HDHPs maintain medication adherence early in the year and stay out of the hospital, says Bushman.

 in recent years-from $231 to $736 a year per patient between 2002 and 2013. The increase reflects rising prices for a milliliter of insulin, which climbed 197% from $4.34 per to $12.92 during the same period. Meanwhile, the amount spent by each patient on other diabetes medications fell 16%, from $600 to $502.

Based on a nationally representative survey, the mean price of insulin increased from $4.34 per milliliter in 2002 to $12.92 in 2013. The estimated expenditure per patient for insulin in the United States in 2013 was greater than all other antihyperglycemic medications combined. Another factor contributing to the rise in expenditures on insulin was increased treatment intensity.

Patients like to have choice in the devices they use (continuous glucose monitors [CGMs], pumps, artificial pancreas systems), says Bushman. These devices-regardless of manufacturer-are driving significant improvements in the glucose control of those who use them. To encourage the largest number possible to use the devices, it’s important to provide choice in the available device-adding to the importance of broad coverage of items like CGMs and pumps, he adds.

Choice is also important in both the adoption of pump technology and continued wear. 

 demonstrates the variability of pump use by brand and by age range. The insulin pumps of younger patient populations vary more widely among brands. The younger populations may also opt for some of the features available in other brands, such as waterproof or tubeless options, or those available in a sleek touch-screen interface.

Diabetics More Likely to Suffer from This Condition Than Non-Diabetics

The T1D Exchange Registry also collected evidence from members of its community which stated the importance of choice. On a recent Question of the Day, 99% of respondents stated that features and usability factors were either somewhat important (4%), important (15%) or very important (80%) to pump choice.

It’s possible for people with type 1 diabetes to have an insulin resistant state similar to those with type 2, essentially giving them “

.” In almost all cases, lifestyle management improvements can help with managing blood glucose levels and insulin resistance for this reason, says Colberg.

In the early stages, it appears that both prediabetes and type 2 diabetes are somewhat reversible with lifestyle management and weight loss. However, if people return to their former lifestyles, both conditions return-meaning that they are more likely just under control rather than reversed.

Studies of patients with type 1 diabetes and a family history of type 2 diabetes have supported the notion that this combination might promote both microvascular and macrovascular complications of type 1 diabetes.

Chuck Green has covered healthcare for more than 10 years.

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Patients with diabetes care a lot about everything from price to choice-and you should too.

Five Diabetes Factors Health Execs Should Care About

For some, diabetes management can rock the bottom line.

The American Diabetes Association (Association) 

 earlier this year estimating that the total costs of diagnosed diabetes have risen to $327 billion in 2017 from $245 billion in 2012, when the cost was last examined. It represents a 26% increase over a five-year period.

The study, Economic Costs of Diabetes in the U.S. in 2017, was commissioned by the Association and addresses the increased financial burden, health resources used, and lost productivity associated with diabetes in 2017. The study includes a detailed breakdown of costs along gender, racial and ethnic lines, as well as a breakdown of costs on a state-by-state basis.

The total estimated cost of diagnosed diabetes in 2017 includes $237 billion in direct medical costs and $90 billion in reduced productivity.

Prescription medications are among the largest components of medical expenditures care, representing 30% of the total medical cost.

Those with diagnosed diabetes incur average medical expenditures of $16,752 per year, of which about $9,601 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes.

However, diabetes patients and their families can do a number of things to help reduce the costs related to the condition, according to experts.

Poor Engagement Takes High Toll on Diabetes Patients, Healthcare Costs

“Online retailers may offer brand name medications or supplies at lower prices, which might be viable alternatives for those with limited or no insurance,” says Ann Albright, PhD, director of the Division of Diabetes Translation at the CDC. “It’s important to know that the organization is reputable when buying online.” A tip document published by the FDA can help consumers make that determination.

Consumers also should consider pharmacy assistance programs, often offered by pharmaceutical companies, nonprofits, or state governments to help those otherwise unable to afford medications,” says Albright. Patients are also encouraged to work closely with their healthcare providers to select the medications that meet their treatment needs and targets, but perhaps less expensively, she notes.

Of course, individuals can also save money by improving their overall health, primarily through various lifestyle measures, like a low-carb diet, stress management movement, and if required, nutritional supplements, says diabetes expert Hanna BoÃ«thius.

“That way, the diabetes diagnosis of that person also improves, and can potentially lower the amount of medication, as well as medical attention needed,” she adds. Some type 2 diabetes patients can even stop taking medication altogether, although they should do so in conjunction with their physician. “People living with type 1 diabetes can certainly never stop insulin altogether, but the amount used can be less through a healthier lifestyle.”

Shopping and meal preparation are another area where people with diabetes can reduce expenses, adds Albright. “When shopping, look for deals in the perimeter of the store, where healthy, unprocessed foods are located.” Shop for healthy items on sale and use coupons to buy fruits, vegetables, dried beans, fish, and other lean meats, she notes. “You can also plan meals ahead of time so you know what you’re shopping for and prepare a list.”

Other methods include buying healthy foods in bulk and preparing or freezing them so they can easily be pulled as needed for quick meals, says Albright. “For instance, fruits and vegetables can be washed, cut and frozen to use throughout the week and beyond. Also try to buy fruits and vegetables in season, which are often less expensive, and use them in a variety of meals.”

What’s more, type 1 and type 2 diabetics can seek out items on sale and use coupons. “But be sure they’re (coupons) for healthy foods, fish and meat, and low-cost things like beans and lentils. Not refried, but in the can.” She stressed using, if possible, dried beans in the bags, since canned ones often contain a great deal of hidden sodium. Buying dried beans in the bags are a healthier and more economical option, she continues. Frozen vegetables are a good option as well; though it’s important to avoid those packaged with sauce.

It’s no secret that diabetes costs the healthcare system billions every year. Here are some tips to help keep those costs in check.

The Cost of Diabetes Care-And How to Help Patients Lower It

Studies suggest that individuals with diabetes are twice as likely as non-diabetics to have depression.

Not only that, the chances of becoming depressed increase as diabetes complications worsen, according to 

That’s seemingly made all the more troubling given a 

, showing the risk of mortality among those with diabetes grew if they also had depression, anxiety, or both.

Major depressive disorder impacts 6.7% of U.S. adults at least 18 years of age and is more likely to be diagnosed in U.S. adults with diabetes, according to a study in the 

Journal of The American Medical Association

The underlying issues behind the association of depression are unidentified, according to the study. It’s speculated that depression could be stress related or the culmination of the metabolic impact of diabetes on the brain. Studies suggest that people with diabetes-along with a history of depression-are more likely to develop diabetic complications than those who aren’t depressed.

It can be trickier for individuals with depression to effectively tackle their diabetes, explains Sarah Markowitz, PhD, a psychologist in Ithaca, New York. Those with both conditions are much less likely to engage all the self-care required to help control diabetes, such as diet, testing blood sugar, and exercising, she says. “That’s hard for anyone, and if you’re also depressed, it’s really difficult. The two conditions interact and often compound each other, which creates a challenging cycle.”

Physicians can help by fostering an open line of communication with patients, says Dimitry Davydow, MD, a psychiatrist and medical director for Franciscan Behavioral Health at the University of Washington School of Medicine in Seattle. “If they’re having problems with diabetes and think they might be depressed, they should be encouraged to talk to their doctor,” Davydow says.

The discussion should include empowering patients to harness greater control over their own care, with physicians proffering support rather than exerting “the fear or shame approach,” Markowitz says. “A lot of people-especially if they’re depressed-already feel bad that they’re not doing a good job controlling their diabetes. If their providers use the approach ‘you should be doing better with this,’ it can exacerbate rather than improve matters,” she says.

“When people get down on themselves and discouraged, it’s hard for them to change and feel motivated toward doing well and being in control of diabetes, Markowitz sa.ys

Of course, it helps matters when patients assume more control of their health. Consequently, researchers and healthcare providers are designing decision aids, according to a February 28, 2017, 

. Providers can also walk patients through various options, helping to translate difficult to understand medical jargon and statistics.

Patients also are offered complete access to their medical records, while physicians are being trained to help guide them during the decision-making process, according to the 

 article. Those participate in healthcare decisions with their physicians are less likely to regret the choices they make and more likely to stick to the treatment regimens they select.

There’s also a matter of everything patients probably have on their mind already, which physicians can help them deal with by working closely with other providers, such as a dietitian, diabetic educator, psychologist, and social worker, according to Markowitz. “Patients have to go from one practitioner to another on different days; that’s a burden, especially among those with fewer resources,” Markowitz says. “Things can fall through the cracks without that team-based approach.”

Another important consideration: having these two conditions together isn’t confined to adults. Studies show the prevalence of depressive disorders in the pediatric population suggest higher rates of depression, anxiety and distress among children and young adults with type 1 diabetes than the general population, according to a 

. Similar depression rates have been demonstrated among adolescents with type 2 diabetes or in populations including both type 1 diabetes and type 2 diabetes

No matter who’s impacted, the two diseases are extremely costly, with estimated direct and indirect costs of $245 billion and $210.5 billion, respectively, according to US Pharmacist.com.

It can be tricky for individuals with this condition to effectively tackle their diabetes. Here’s how healthcare executives can help.

Diabetics More Likely to Suffer from This Condition Than Non-Diabetics 

Adhering to a healthy regimen- including regularly taking their medications-can be difficult for diabetes patients, according to experts.

, which appeared recently in a  Cardiometabolic Health Congress 

, showed that poor adherence statistics ranged from 25% to 91%, with a mean of 37.8%.

Some might be hampered by behavioral issues, remarked David Marrero, PhD, director of the UA Center for Border Health Disparities at the University of Arizona Health Sciences. “If all I had to do was tell people they shouldn’t eat so much, we wouldn’t have an obesity problem. Diabetics have to say to themselves: ‘if I do that, this happens, and what will be the outcome over here?’” says Marrero. “A lot of calculations are involved, and not everyone’s good at that.”

Another impediment could be illness, like diabetes distress; a reaction to the burden of therapy, he says. “Therapy’s not a single behavior; it’s multilayered and complex. You have to think about things like diet and exercise, so it can be challenging for a lot of people.”

Physicians can help patients deal with various challenges by regularly questioning them in the clinic about their level of adherence, says Sethu Reddy, MD, chair of Medicine, CMU College of Medicine, in Mt. Pleasant and Saginaw, Michigan, and former chief of adult diabetes at the Joslin Diabetes Center in Harvard, Massachusetts. In fact, based on the assumption patients don’t regularly take their medications, Reddy provides what he called a safe, forgiving office environment. “If I come out sounding very accusatory and negative, it could be counterproductive.”

By the same token, most patients don’t want to see their doctor angry and might be tempted to tell them what they want to hear instead of the truth, he said. But it’s better to be honest, so a physician and patient can come up with ways to improve adherence, Reddy says.

For example, he encourages some patients to keep extra pills in places such as their office, so if they forgot to take them at home and are due for a dose, it’s there in their office.

Physician/patient communication works optimally when they devise solutions together, a process known as shared decision making, says Reddy. “The old approach is that a doctor gives a patient a prescription and that’s it.” Today, doctors talk to patients about their condition and ask them if they’re able to take a certain medication every day, he says. Patients have to be involved in the decision making and “buy in” to the need for the medication so that they’re engaged and more likely to follow instructions, according to Ready.

Conversations help physicians pinpoint stressors, such as economic issues, that might persuade them against taking certain medications because they can’t afford them, says Marrero. “You need analytics to determine what challenges a patient’s facing and decide whether it’s a correctable problem.”

Modern technology, like smartphones, also can help improve adherence, by providing those diabetes patients who need it a reminder to take their meds, according to Reddy.

The availability of smartphone health apps has expanded quickly, with a recent 

 showing 160 medication adherence-specific health apps.

Mail order pharmacies are another way to help ease a patient’s ability to adhere, he says. “Patients would have a guaranteed supply with no excuse of running out of meds.”

Some pharmacies provide a patient’s monthly medications in convenient blister packs, Reddy adds.

Of course, there are those patients who might need something more drastic to compel them to be more adherent-like a friend or relative with diabetes recently experiencing a diabetes related-complication, Reddy says. “Some don’t take their medications because they’re not having any symptoms; but once someone they know does-or if they develop tingling/burning in their feet-their concern for their diabetes increases and one becomes more adherent to taking their medications,” he says.

With that being said, some patients simply are more predisposed than others to adhere, according to Reddy. “Patients have different personalities; some don’t conform; others are more obsessive about religiously following orders,” he says.

Perhaps more will get the message, given how much nonadherence can put at stake financially.

, estimated nonadherence causes nearly 125,000 deaths, 10% of hospitalizations and costs the healthcare system between $100 billion to $289 billion yearly.

Patients must first get over these hurdles to achieve healthy outcomes. Here's how you can help.

This Component is Key to Diabetes Self-Management

Statistics show that as many as one in five adults lacks the skills to actively engage in their own care. The healthcare industry must help individuals learn more about their health to better prepare them to participate in their own treatment.

That’s according to Mike Wolf, associate vice chair for research in the department of Medicine and Geriatrics at Northwestern University’s Feinberg School of Medicine. Additionally, healthcare should ease the complexity inherent in its operations that largely inhibits individuals from assuming a deeper role in addressing their medical needs, he says.

 on patient engagement published in an issue of 

, many patients lack health literacy-or a true understanding of their medical conditions. On top of that, the U.S. healthcare system often has seemed indifferent to patients’ desires and needs while many practitioners fail to provide the information that patients need to make the best decisions about their own care and treatment, according to the article.

“It can be difficult in our brief encounter system, but patients appreciate questions from their providers about what's difficult about the current treatment, what questions they have, and how satisfied they are with the way things are going,” says Jeffrey Gonzalez, PhD, associate professor of Medicine and Epidemiology & Population Health at Albert Einstein College of Medicine in New York.

 Insights Council, which included U.S. healthcare executives, clinician leaders, and clinicians at organizations directly involved in healthcare delivery, more than 69% of respondents report that their organizations use patient engagement initiatives to increase patients’ meaningful participation in care

The Smart Technology That Will Boost Diabetes Care

Many survey respondents indicated the need to engage patients beyond the exam room with frequent, creative interactions that needn’t always include their physicians. Executives and clinical leaders said the chief medical officer is best equipped to lead such an initiative, while clinicians said staff physicians should do so.

Whatever the case, Wolf says that practitioners must take into account ordinary challenges individuals typically encounter. “After a doctor’s visit, patients may go home and enter their own world, which may distract focus from their diabetes or hypertension,” he says, which can water down their degree of engagement, leading to less than ideal self-management. “They may not achieve critical goals in managing or understanding their chronic condition, leading them to believe things like their medicine,” he says.

Then there’s the impact of patient engagement on cost. Patients with heart conditions, benign uterine conditions, benign prostatic hyperplasia, hip pain, knee pain, or back pain who received enhanced decision-making support by trained health coaches over the phone, by mail, and via the Internet ultimately had overall medical expenses 5.3% lower than those receiving only the usual support, according to a 

 They also had 12.5% fewer hospital admissions and 20.9% fewer preference-sensitive heart surgeries.

Gonzalez, who is also co-director of the New York Regional Center for Diabetes Translation Research at Albert Einstein College, says that ineffective patient engagement also can lead to individuals failing to do things like adhering to their prescription regimen. “I spend a lot of my research efforts on studying the problem of treatment nonadherence and am very familiar with overwhelming patient evidence that treatments often fail to help-or even cause harm-because they weren’t implemented the way they were intended to be.”

Prescriptions aren’t filled; medications aren’t correctly taken; lifestyle changes aren’t made, he continued. “This leads to unnecessary and significant costs for the healthcare system and patients.”

About half of patients with chronic diseases don’t take their medication as prescribed, according to the May 14, 2017 

. Nonadherence also is associated with significant societal costs. Upward of $300 billion of avoidable healthcare costs have been attributed to medication nonadherence annually in the U.S., comprising up to 10% of total healthcare costs.

“When we encounter individuals less engaged in their care, it should tell us there are significant barriers to the patient's ability to engage in this plan, such as poverty, lack of sufficient understanding of the health threat to these goals, or competing demands on their time and effort,” Gonzalez says.

Here’s how healthcare can do more to help patients learn more about their health to better prepare them to participate in their own treatment.

Poor Engagement Takes High Toll on Diabetes Patients, Healthcare Costs 

The latest continuous glucose monitors (CGMs) are more portable and powerful than first-generation models. They’re also easier to use and the science behind them is exponentially more accurate, says Michael LeMay, MD, an endocrinologist at Hartford Hospital in Hartford, Connecticut.
“I expect they’ll continue to get better,” he says.

CGMs, which constantly measure glucose levels for diabetic patients, may include special features such as:

• An alarm that can sound when an individual’s glucose level goes too low or high;
• The ability to record (based on user input) meals, physical activity, and medicines;
• The ability to show a person’s glucose levels without requiring a fingerstick;

The ability to download data to a computer or smart device so trends can be more easily read;The ability to immediately transport information to the smartphone of another, perhaps a parent, partner, or caregiver.

Several studies have promising results regarding how patients can benefit when using CGMs.

According to a September 15, 2017 JDRF-funded 

, of diabetic mothers, the use of a CGM during pregnancy results in healthier moms and babies. The study showed that using a CGM during and prior to pregnancy improves health outcomes, because women who used a CGM spent 100 extra minutes per day with blood sugars in a healthy range. That results in their babies being less likely to have hypoglycemia postpartum

Thirty-nine percent of patients with type 1 diabetes are using CGMs, yet healthcare providers see a steady upward trend in the adoption of the devices, according a survey of 339 patients and healthcare providers that appeared in 

 in March 2018. In fact, providers who took the survey estimate that 77% of their patients will be using CGM five years from now.

Practitioners believe CGM usage in patients with type 2 diabetes will soar in the next five years. Currently, they estimate 11% of these patients are using CGMs; in five years, they expect that will increase to 46%.

Schafer Boeder, MD, division of endocrinology, at the University of California, San Diego, La Jolla, however, says that only about 15% to 20% of patients with type 1 diabetes-and a much smaller percentage of patients with type 2 diabetes-in the U.S., are believed to be using a CGM.

“Cost is a major barrier, though lack of familiarity by both patients and providers is also an issue,” Boeder says.

Unwavering Costs Fuel Need For New Diabetes Treatment Paradigm

Although LeMay encourages patients to use the device, issues like insurance coverage prohibit some from doing so. “I’ll give a patient a sample sensor, which they get used to and love, but when they try to put in a prescription for it, they find it’s too expensive,” he says. “Sometimes, insurance companies lag behind.”

But the pipeline hasn’t been lagging. It includes high-tech CGM devices, such as smartphone-connected CGMs, wearable and smartphone-connected CGMs, and a “smart” diabetes management solution (also called an artificial/bionic pancreas), are expected to culminate in a higher adoption of CGMs among endocrinologists and patients.

The major innovation many people are waiting for-especially in the type 1 arena-is the fully closed-loop artificial pancreas, which requires a highly accurate and reliable CGM system, says Schaefer. Whether standalone, or as part of a closed-loop system, he expects CGM use among patients requiring multiple daily doses of insulin to increase steadily.

The FDA recently approved the Eversense Continuous Glucose Monitoring (CGM) system for patients 18 years or older. The device is the first FDA-approved CGM system to include a fully implantable sensor to detect glucose levels, which can be worn for up to 90 days. The sensor is implanted just under the skin during an outpatient procedure. In July, the company that developed the CGM reported that it expects it to ship in the next few weeks.

In the meantime, the use of CGM in the hospital setting-even for those not on CGM as outpatients-is an area of active research, Boeder says. If CGMs can reduce inpatient hypoglycemia events, decrease complications, shorten hospital stays, and/or reduce readmissions, it may become a standard technology in the hospital.

Glucose monitoring technology could become the go-to management strategy in a few years. Here’s where we are and where we are going.