Diabetes Registry Enables Safer, More Thorough Care for Patients

**By Nicholas Moy, MD**

MD PatientAccording to a landmark study published in 2016 in The Lancet, 422 million adults worldwide have diabetes. In the United States alone, diabetes statistics are staggering. According to the Centers for Disease Control and Prevention, in 2015:

  • More than 100 million Americans have diabetes or prediabetes, which if not treated can lead to type 2 diabetes within five years.
  • The percentage of adults with diabetes increased with age, reaching a high of 25.2 percent among those aged 65 years or older.
  • An estimated 1.5 million new cases of diabetes were diagnosed among U.S. adults, with more than half between the ages of 45 and 64.
Understanding diabetes by type

In type 1 diabetes, the body does not produce insulin. Insulin is a hormone the body needs to get glucose (sugar) from the bloodstream into cells. Type 1 is usually diagnosed in children and younger people. However, it can develop at any age. Only about 5 percent of people with diabetes have type 1. Currently, there is no known way to prevent type 1. People with it must inject or pump insulin to survive.

In type 2 diabetes, sometimes called “adult onset,” the body does not use insulin properly, which is called insulin resistance. At first, the pancreas makes extra insulin to make up for it. But, over time, it isn’t able to keep up and can’t make enough insulin to keep blood glucose at normal levels. People with type 2 can manage the disease with diet, exercise and medications. In some cases, insulin is needed for management.

Preventing type 2 diabetes

Before people develop type 2 diabetes, they almost always have prediabetes – blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as diabetes. This condition puts you at a higher risk for developing type 2 diabetes and cardiovascular disease.

While there is still no cure for diabetes, there is good news: The progression from prediabetes to type 2 diabetes is not inevitable. The National Institutes of Health clinical trial, the Diabetes Prevention Program, found that for people with prediabetes, modest lifestyle changes led to weight loss of 5 to 7 percent in participants and reduced the risk of type 2 diabetes by 58 percent in individuals at high risk.

Diabetes Registry

This is why primary care physicians with Virginia Mason, including myself, developed a Diabetes Registry, which does three important things to help ensure the right care is delivered to the right patients at the right time. First, it identifies patients with diabetes. Second, it identifies how well they are doing. And third, it pulls them back into care when needed.

Although the American Diabetes Association recommends that people with diabetes see a primary care or endocrinology provider every three to six months, life doesn’t always allow that to happen. This is why Virginia Mason’s  Diabetes Registry software is so helpful. It uses algorithms to regularly analyze electronic medical records and alert care teams about who may need follow-up, whether through an appointment or a report to their care team on recent changes, such as with blood pressure, weight loss, etc.

Virginia Mason team members, including medical assistants and nurses, then know to check in with these patients to make sure they are on track. This ensures the care they receive is aligned with their current needs.

“Recently, I was able to get several out-of-care patients in for an appointment and labs with one of our providers,” said Certified Medical Assistant Courtney Yates. “Patients are responding well to the simple reminders we’re sending them, whether they are messages though the patient portal, calls, or mailed letters. Our goal is to get 100 percent of our out-of-care patients back in care.”

Dr Nicholas MoyNicholas Moy, MD, is board certified in Internal Medicine and practices Primary Care at Virginia Mason Hospital and Seattle Medical Center. His special interests include quality improvement and geriatrics.


Artificial Pancreas Studies Bring New Found Freedom to People with Type 1 Diabetes

What if eating were a balancing act at every meal, every day?

This is the case for people with Type 1 diabetes, because they must adjust their insulin very carefully so their glucose levels don’t go too low or high. People with Type 1 diabetes must manage their disease 24 hours a day, seven days a week by vigilantly testing blood glucose levels and administering insulin multiple times a day while determining correct doses with diet and activity.

Studies Provide Hope

Benaroya Research Institute at Virginia Mason (BRI) is testing an artificial pancreas that automatically dispenses insulin based on real-time changes in blood glucose levels. The hope is that this would someday relieve adults, children and their families from the arduous 24/7 manual maintenance of their diabetes. This past year, BRI tests of the artificial pancreas showed that blood glucose levels under highly controlled conditions could be better managed through the artificial pancreas than participants likely could do on their own. Most patients with diabetes cannot achieve tight glucose control with traditional diabetes tools and spend less than half of their days at healthy glucose levels. Studies show that tight control of levels significantly reduces or delays the development of complications.

Clark Webber, a participant in the artificial pancreas clinical research trial, with Dr. Carla Greenbaum.

The artificial pancreas combines a continuous glucose monitor with an insulin pump and a computer software program. The monitor and pump are devices worn on the outside of the body and contain a tube or sensor that goes inside the body. The monitor provides real-time information on the body’s blood glucose levels and reports this to the computer software program. When the program determines insulin is needed, it sends a message to the insulin pump to provide a certain amount of insulin.

“If this device is successful, people can reduce the constant monitoring of their disease and relieve a huge mental burden,” says BRI Director of the Diabetes Research Program Carla Greenbaum, MD. “This type of system would also keep blood glucose levels much tighter, reducing diabetes complications which can be very serious. While we search for new methods to prevent and even cure diabetes, we need to provide better ways to improve the lives of people who currently have diabetes.”

Unique Software for Artificial Pancreas

While other systems are being tested at selected locations worldwide, BRI is the only center nationally testing this unique software program for the artificial pancreas. The program was developed by Richard Mauseth, MD, a longtime Pacific Northwest pediatric endocrinologist, currently at Seattle Children’s and two Boeing software engineers, Robert Kircher and Don Matheson. Their software program applies “fuzzy logic” to the glucose data to direct appropriate amounts of insulin to be delivered. Fuzzy logic is a technical term describing how a computer uses imprecise information to make a decision. It is used in a wide variety of applications ranging from airplanes and consumer products to medical diagnostic systems.

This BRI artificial pancreas study is funded by JDRF, which has designated 15 centers internationally to test various approaches to these devices. JDRF is aiming to develop a firs

t-generation artificial pancreas with the hopes of helping millions of people with diabetes.

Type 1 diabetes occurs when insulin producing cells of the pancreas are destroyed by the immune system. The discovery and use of insulin therapeutically has enabled people to survive. But the disease remains an enormous burden on individuals and their families. A successful artificial pancreas will enable better, safer and easier diabetes control and thus lessen long-term complications.

A New Level of Freedom

Clark Webber, a participant in the artificial pancreas clinical research trial wears an insulin pump on his arm and a continuous glucose monitor on his abdomen. His glucose information is related by the sensor to a computer. The hopes are that the computer software can eventually be contained in a smaller device such as a smartphone. Clark was diagnosed with Type 1 diabetes at age 12 and is now 23.

“The artificial pancreas looks to be the next big, decisive innovation in diabetes management and care,” says Clark.

“It will bring a new found level of freedom to people with diabetes,” says Dr. Greenbaum.

Visit BenaroyaResearch.org or Facebook.com/BenaroyaResearch for more information about BRI, clinical studies and autoimmune diseases.

Take Action During National Diabetes Month

November is National Diabetes Month and Nov. 14 is World Diabetes Day. Why devote the month and that day to diabetes awareness?

Reflections on World Diabetes Day — The Pacific Science Center Arches turned blue for World Diabetes Day in 2011.

Here’s a great reason: The risk of diabetes might run in your family. Don’t think of it as just something your grandparent or your neighbor’s friend has; think of it as something that could affect you in your lifetime.
Virginia Mason’s Endocrinology Section Head, Grace Lee, MD says, “Nearly 26 million people in the U.S. have diabetes. Join us as we come together as a global community to increase the awareness about diabetes.”

If diabetes runs in your family and you think you might be at risk, don’t despair. With early diagnosis and treatment, the majority of Type 2 diabetes can be prevented or delayed by focusing on certain risk factors – unhealthy diets, tobacco use, alcohol consumption and physical inactivity. The National Diabetes Education Program says making changes in how you care for your health is all about choosing a goal and working toward it:

  • Think about what is important to your health. What are you willing and able to do?
  • Decide what your goals are. What changes do you want to make? Choose one goal to work on first.
  • Decide what steps will help you reach your goal.
  • Pick one step to try this week.

Simple action steps could include making healthier food choices and being active at least 30 minutes, five days per week. Losing 5 percent to 7 percent of your body weight can greatly improve your overall health and decrease your risk for diabetes.

On the evening of November 14, Benaroya Research Institute at Virginia Mason will be one of 12 buildings and monuments in the Puget Sound area that will light blue to shine light on Seattle’s unique diabetes research collaboration and dedication to outstanding clinical care. Learn more at benaroyaresearch.org/wdd.