Diabetes management: Proactive approaches for better health, lower costs

Diabetes is a pervasive, costly and complicated condition, especially among older employees and retirees.

It is one of the top drivers of rising health care costs, accounting for $327 billion a year in direct and indirect costs.1 More than 30 million Americans have diabetes – that’s 9.4% of the population, and its only becoming more common.2 3 4 More than 12 million of them are 65 or older, meaning that one in four seniors has diabetes.5

“Diabetes is a huge cost for employers,” said Tanya Lugliani Stewart, MD, MBA, chief clinical transformation officer at UnitedHealthcare. “And the cost of diabetes is on the rise.”

Strategies to help control diabetes 

Given the prevalence of diabetes and its impact on employer costs and member health, UnitedHealthcare is exploring new strategies to take a proactive approach to managing the condition, including using digital engagement, 1-on-1 coaching and incentivizing behavior change. 

These efforts are meant to improve outcomes among more than 1.1 million UnitedHealthcare® members who are at least 50 years old and have diabetes.6

Diabetes often can be managed through medication, diet, exercise, and sometimes it requires insulin. It’s important for diabetics to self-monitor blood glucose levels to take action when their blood sugar is too high or too low. Although traditional management techniques —such as screening and education —have helped many manage diabetes, there are significant opportunities to improve treatment and care. 

Employers can play a role in helping their employees take a more dynamic approach in managing diabetes by identifying key opportunities for them to improve their health and intervening with appropriate, timely solutions. One approach is to ensure health plans include a focus on diabetes that takes a proactive, personalized, whole-person approach, including individualized coaching, technology and patient data.

Today, more than ever, there are tools to help people with diabetes better control their disease. Meal and fitness trackers, smart-phone connected glucose monitors and online coaching are a few ways employees are better equipped to tackle diabetes management head on. To further advance diabetes management for employers, UnitedHealthcare has launched a pilot study that is exploring new strategies to manage diabetes, including continuous glucose monitoring (CGM) technology that can support those with poorly controlled diabetes with more accurate information.

“There are a lot of things we need to understand,” said Mike Christy, senior vice president with UnitedHealth Group R&D. “What does it take to get people to participate? Will insights result in behavior change and improve outcomes? These are the goals of our research.”

Can continuous glucose monitoring (CGM) improve diabetes management?

The most common way to monitor blood glucose is through test strips, especially for people 50 years old and older. However, these occasional test strips do not adequately demonstrate the relationship between medication, eating, exercise and blood glucose levels that can enable better management.

The pilot, in part, is assessing whether CGMs could be an effective alternative management technique. The pilot program uses an FDA-approved system that tracks glucose levels every 5 to 15 minutes, day and night, and detects trends and patterns that can help find ways to better manage the condition.7

The technology consists of a sensor —usually worn on the abdomen —that reads glucose levels just beneath the skin. A transmitter sends the data to a smartphone, which processes and displays updated data in minutes.

“We believe that CGM can help members with poorly controlled diabetes to better manage their condition,” Stewart said.“Today, Medicare has specific criteria for CGM coverage. We are evaluating whether coverage expansion makes sense to help the people we serve live healthier lives by improving control of their diabetes and feeling empowered in the process.” 

The early results from the pilot are encouraging:

  • Participants with high A1c levels (A1c measures the average blood glucose level over 2 – 3months) averaged a more than 1% drop within the first 90 days, a meaningful clinical improvement
  • Opportunities were identified to modify medication regimens —such as medication dosing and time of day —for 77% of enrollees to help them better manage their conditions.8

The pilot program is part of UnitedHealthcare’s focus on integrating human support with data from real-time sources — such as digital health technology —and historical sources, like claims data, to help improve and personalize how people navigate the health care system. The latest technologies, such as CGMs and activity trackers, can be most effective when integrated with a holistic care plan.

The hope is that these tools, combined with other strategies such as personalized coaching and incentivized behavior, will empower people with chronic conditions—such as uncontrolled diabetes —to better manage their health, and will result in fewer drugs, lower costs and better outcomes. Click here for more on diabetes and for questions on what UnitedHealthcare is doing to help manage this condition.

For non-beneficiary facing materials only: Not for distribution to retirees or beneficiaries.

 

1 Johnson SR. Rising insulin prices drive higher diabetes care spending. Modern healthcare, Jan. 22, 2019. https://www.modernhealthcare.com/article/20190122/NEWS/190129990/rising-insulin-prices-drive-higher-diabetes-care-spending

2 American Diabetes Association. Statistics about Diabetes. http://www.diabetes.org/diabetes-basics/statistics/

3 Centers for Disease Control. National Diabetes Statistics Report, 2017. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

4 Lin J, et al. Projection of the future diabetes burden in the United States through 2060. Popul Health Metr (2018);16: 9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003101/.

5 American Diabetes Association. Statistics about Diabetes. http://www.diabetes.org/diabetes-basics/statistics/

5 Centers for Disease Control. National Diabetes Statistics Report, 2017.

6 Proprietary information of UnitedHealth Group

7 WebMD. How Does a Continuous Glucose Monitor Work? https://www.webmd.com/diabetes/guide/continuous-glucose-monitoring#1

8 Interview with Mike Christy, 7/10/19.