Type 2 diabetes is a foreboding presence in the lives of more than half of all American adults.
Like most chronic conditions, however, its impact is not evenly distributed across the socioeconomic spectrum. Black and Hispanic/Latino Americans, for example, are up to 20% more likely to be diagnosed with diabetes than non-Hispanic white people.
Despite these very real and immediate threats, the American healthcare system has not yet developed a seamless, coordinated and truly proactive approach to helping people prevent complications from diabetes, including foot and lower-limb issues like chronic wounds, peripheral artery disease (PAD) and amputations. In fact, amputation risks are higher than ever, particularly among Black Americans, who are three to four times more likely to have a limb amputated as a result of diabetes than white Americans with the same condition.
In a recent survey, just 24% of people with diabetes feel that the healthcare system is doing enough to prevent amputations and other complications of chronic disease. The majority recognize that sick care is still dominant and that it simply isn’t adequate to meet the needs of millions living with prediabetes and diabetes.
America’s healthcare system needs a better approach to make preventive care the priority, rather than an afterthought. This new road map should combine reimbursement changes, policy updates and innovative, tailored technologies that empower patients to lean into their own health and well-being with confidence and ease. Lastly, we need our healthcare system and clinicians to focus on building person-centered relationships to meet people living with prediabetes and diabetes where they are on their journey to better health.
Aligning reimbursement with clinical guidelines
According to the latest guidelines, the American Diabetes Association (ADA) encourages podiatrists to provide close, lifelong surveillance for people with previous complications—as well as routine nail and foot care to prevent the likelihood of complications.
Some podiatrists feel that this routine care should occur every six weeks for certain high-risk people who require customization of their care plans, but Medicare will only reimburse for such services every 62 days. This misalignment leaves many complex patients at elevated risk of developing issues that could result in debilitating and costly amputations.
Retooling reimbursement policies to reward appropriate preventive care and fit with the real-world needs of people with diabetes will be crucial for supporting timely and appropriate interventions, reducing the costs and burdens associated with treating more advanced wounds and ensuring accurate documentation of the services provided to patients.
Leveraging technology to engage and monitor patients
Living with diabetes gets even harder when providers are in short supply and appointments are prohibitively expensive. Many living with Type 2 diabetes feel an economic strain from managing their condition yet understand that access to better care would help reduce their worries about both the cost and mortality of the disease.
Evidence-based technology can offer less expensive, more consistent connections with the healthcare system. From continuous glucose monitors and telehealth visits to home blood pressure cuffs and thermometry tools, digital devices can extend the reach of limited clinical resources and keep patients informed and involved in their care.
Patients are very eager to embrace the digital approach to proactive diabetes management. Data also suggest patients are eager to embrace remote monitoring devices following their providers’ advice.
Providers, payers and patients must continue to lean into the potential of smart monitoring tools by investing in their development, generating objective and trustworthy evidence for their use, integrating digital devices into reimbursement structures and developing the workflows to surface actionable insights to providers and patients in an intuitive, user-friendly way.
In addition, providers need to be very cognizant of accessibility, coverage, affordability and technological prowess when recommending a home-based technology for a patient living with diabetes. Technologies such as Glooko, for example, are highly innovative and becoming more widely used for diabetes management. Still, given massive variances in coverage by insurers, these types of technologies can actually serve to widen care gaps. As such, providers should work hand-in-hand with patients to identify right-fit technologies that are reimbursed and empower patients to be informed and active in their own care.
Focusing on the social determinants of health to meet patients where they are
None of these prior efforts will truly improve preventive care unless they are put into the context of the social determinants of health (SDOH).
Healthcare providers must invest in formalized, standardized strategies that develop comfort and familiarity by engaging with patients around these issues and integrating self-care into their everyday lives.
In addition to following the ADA’s recent guidance for enhancing the screening process for SDOH concerns, providers should consider how they interface with individuals and the community.
For example, investing in diversity within the clinic can make patients more comfortable with working with providers who understand the unique cultural and social context of their personal decision-making.
Within the community, providers can consider organic outreach activities such as working with faith-based groups to offer free PAD screenings after weekly worship, collaborating with grocery stores to offer a diabetes-friendly meal planning class or starting a walking group at the senior center. Each of these approaches can make self-care less daunting and provide social support for people living with the condition.
Without integrating this type of nonclinical care into the traditional diabetes journey, the health system will remain unable to shift away from sick care to a more forward-looking, holistic approach that is infinitely more cost-effective over time.
These processes will take time, effort and dedication from stakeholders across the care community. If we can pair upstream socioeconomic interventions with more flexible reimbursement policies and a strong emphasis on digital, consumer-friendly tools, we can start to truly move the needle on equitable, accessible, high-impact care for everyone affected by diabetes.
Gary Rothenberg, DPM, CDCES, CWS, is the director of medical affairs at Podimetrics. Dr. Rothenberg is also a practicing board-certified podiatrist and serves as an associate professor of internal medicine in the division of metabolism, endocrinology, and diabetes at the University of Michigan. He also is the director of fellowship training in lower extremity complication prevention at the University of Michigan.