Nearly two-thirds of patients living with Type 2 diabetes feel that having better access to care would ease their fears about dying from complications of the disease, according to a new survey.
The survey from virtual care management company Podimetrics analyzed the challenges and care experiences for more than 4,000 patients diagnosed with Type 2 diabetes. More than half of patients (53%) fear that complications from their condition will ultimately result in their death, the survey found.
Patients revealed a general sense of falling through the cracks of healthcare, including lack of access to preventive care, a general sense of distrust in healthcare and a feeling that their racial identity affected the quality of the care they received.
“We can manage what we measure, and we need to have a better understanding of the challenges so that we can know how to make changes to affect change,” Jon Bloom, M.D., CEO of Podimetrics, said in an interview with Fierce Healthcare. “We've understood the epidemic of amputations in Black Americans through reporting. What really struck me here is that the burden for Hispanic American respondents was quite significant if you look at mental health because it's more than just diabetes’ effects on the body.”
It has long been established that Black Americans are 60% more likely than their non-Hispanic white counterparts to be diagnosed with diabetes, according to data from the Department of Health and Human Services, and four times more likely to lose a limb to the disease, the American Diabetes Association reports. Hispanic and LatinX populations have a 50% chance of developing Type 2 diabetes, versus 40% of other U.S. adults. Native populations are twice as likely as white populations to lose a limb to diabetes.
These populations also tend to develop the disease earlier in life.
Of the Hispanic survey respondents, 67% reported mental health challenges related to diabetes, versus 50% across all demographics. When it came to fear of death due to the disease, 53% of the general population expressed fear that the disease would cause their death; for Hispanic populations, that number was 65%.
A quarter of all respondents reported needing emergency care for a diabetic complication, versus 40% of Hispanic respondents. Out of that 40% that needed emergency services, 74% said it was a life-threatening situation, compared to 62% of the general population.
“How are they feeling about their disease? I see the destruction of the disease firsthand but not how patients feel about it,” Bloom said. “There’s a lot of worry that's here: 32% didn't trust the healthcare system to keep them healthy. I saw that trend quite a bit. There's this trust element where they wanted to get the right care and they didn't feel they had good access to it.”
The Centers for Disease Control and Prevention (CDC) has predicted that 1 in 3 American adults will have diabetes by 2050. Currently, 37 million live with the disease. Patients living with the disease make up 135,000 of the 200,000 total amputations that happen each year.
According to the American Diabetes Association, 85% of diabetes-related amputations are preventable.
Bloom first encountered what has been called “The Black American Amputation Epidemic” as an anesthesiologist where he saw “civil war-era medicine.”
Podimetrics’s FDA-approved SmartMat assesses patients’ feet 20 seconds a day to pinpoint “hot spots” before the condition progresses to diabetic foot ulcers, the number one cause of lower extremity amputations.
Podimetric's SmartMat reports on average 1.4 "hot spots" per patient annually. When one shows up on a daily scan, Podimetrics informs the patient's clinician so care teams can intervene before an ulcer develops. In 97% of cases, the SmartMat discovered "hot spots" five weeks earlier, leading to a 73% decrease in amputations.
“How could it have gotten this bad?” Bloom asked. “You can see diabetic foot ulcers coming weeks before they happen. How is it we're still doing, ‘If it’s a disease, cut it off medicine’ where simple preventative care and technology can get into the home and find out the moment things are happening instead of spot checks in the clinician's office? It's an unacceptable amount of amputations that still occur because we're still not able to get the right preventative care to the patient who needs it most.”
Bloom said Podimetrics' model is a true preventive platform: "It can really only exist in systems where you're trying to match payments and outcomes."
Podimetrics's survey found that 32% of patients didn’t trust the health system to keep them healthy. Half reported mental health challenges due to the disease, and 45% reported serious financial burden as a result of caring for diabetes.
It was estimated by the CDC in 2017 that lost productivity to the disease totaled $90 billion. Bloom calls this a double burden on the patient.
Of the Podimetrics respondents, 19% said they receive poorer healthcare than in other states, 60% said that was due to affordability and 36% said it was because of racial issues. One in 6 patients said seeing their doctor was difficult.
“We got to do more on our side, both as policymakers to ensure that we get good access to care, as the payer to ensure patients get the right testing, for example, to know how's the blood flow in these limbs for these patients that are affected and at high risk, and for the providers to have a better education on how to care for patients with gaps in social determinants of health,” Bloom said.
Podimetrics found that 95% of patients who are recommended to use health tracking services or remote monitoring usually follow their doctor’s advice.
The high cost of treatment was a top reason for patients' non-adherence, according to Podimetrics, along with the service not being covered by insurance. Patients also cited challenges with a device being too difficult to use as another reason for not following treatment plans.
Of all demographics, 56% said they are more inclined to use an insurance-provided service or device. Yet, 65% of Black Americans and 69% of Hispanic respondents said they would use the same device.
Patient education plays a critical role in helping them manage their condition and adhere to treatment plans, Bloom said.
“We have a role here, but labeling it as behavior change without offering resources puts it squarely on patients,” Bloom said. “There's a lot of health literacy gaps. Patients do not have a full understanding of this disease. We can arm them with more information in a way that they can bring that information into their lives."
In September, Podimetrics partnered with the American Diabetes Association in its pronouncement of the Amputation Prevention Alliance. The initiative pledges to address the rates of disproportionately high amputations in certain populations by advancing policy changes, improving clinician awareness of non-amputation interventions and empowering patients to advocate for their health needs.