Close Concerns, San Francisco, California.
Joslin Diabetes Medical Center, Harvard Medical School, Boston, Massachusetts.
Diabetes Technol Ther. 2020 Jan;22(1):1-9. doi: 10.1089/dia.2019.0273. Epub 2019 Oct 3.
Recent years have brought about an explosion in the number of companies offering connected diabetes care products, defined as digital diabetes management systems based around (1) smartphone apps, (2) devices with built-in connectivity, and (3) remote human and automated coaching and support. These nascent models aim to provide more continuous and on-demand care, aligning with the 24/7 demands of chronic disease. It has been enabled by multiple factors, including the rising use of connected devices and apps to help people manage their chronic conditions, growing appreciation for the importance of outcomes beyond A1c, and the lofty and growing cost of health care. Despite the potential of these programs to improve the outcomes and well-being of people with diabetes and reduce the burdens on health care providers and systems, awareness and use of these programs and approaches remain low in the medical community. In this article, we present a snapshot of this dynamic field, including a taxonomy of various connected diabetes care products available to employers, health plans, health systems, and people with diabetes in the United States, and we identify meaningful distinctions among them: (1) health conditions managed, (2) peer support interactions, (3) prescribing providers on the care team, (4) provision of connected medical devices and/or continuous glucose monitors, (5) degree of treatment personalization, and (6) clinical and real-world evidence. We also discuss broad trends in connected diabetes care. Given the urgency and scale of the diabetes epidemic, it is vital that a range of medical and clinical communities find meaningful ways to scale individualized, timely care under reimbursement models that better align incentives for various stakeholders, particularly health care providers themselves. This would not only address deficiencies in care but could also make diabetes care more attractive to future clinicians.
近年来,提供互联糖尿病护理产品的公司数量呈爆炸式增长,这些产品被定义为基于(1)智能手机应用程序、(2)具有内置连接功能的设备以及(3)远程人工和自动化指导和支持的数字糖尿病管理系统。这些新兴模式旨在提供更连续和按需的护理,以满足慢性病的 24/7 需求。这得益于多个因素,包括越来越多地使用互联设备和应用程序来帮助人们管理其慢性病,对超越 A1c 的结果的重要性的认识不断提高,以及医疗保健成本的高昂和不断增长。尽管这些计划有可能改善糖尿病患者的结果和幸福感,并减轻医疗保健提供者和系统的负担,但医疗界对这些计划和方法的认识和使用仍然很低。在本文中,我们介绍了这个充满活力的领域的一个快照,包括美国雇主、健康计划、医疗保健系统和糖尿病患者可获得的各种互联糖尿病护理产品的分类法,并确定了它们之间的有意义区别:(1)管理的健康状况,(2)同伴支持互动,(3)护理团队中的处方提供者,(4)提供互联医疗设备和/或连续血糖监测仪,(5)治疗个性化程度,以及(6)临床和真实世界证据。我们还讨论了互联糖尿病护理的广泛趋势。考虑到糖尿病流行的紧迫性和规模,各种医疗和临床社区都必须找到有意义的方法,在报销模式下扩大个性化、及时的护理,使各利益相关者(特别是医疗保健提供者本身)的激励措施更好地保持一致。这不仅可以解决护理方面的不足,还可以使糖尿病护理对未来的临床医生更具吸引力。