Diabetes Experts Shape New Guidelines and Introduce Novel Approaches in Precision Medicine to Optimize Care for Complex Disease
Specialists in the Diabetes Program at Brigham and Women’s Hospital (BWH) are informing new guidelines and leading studies in personalized treatment approaches to improve care for patients with diabetes, especially older patients with complex conditions.
“With the rapid increase of the prevalence of diabetes, including Type 1 diabetes, in the older adult population, there is a global effort to reevaluate how we care for these patients,” said Marie E. McDonnell, MD, Director of the Diabetes Program.
Dr. McDonnell is participating in an international committee that is developing recommendations for the Endocrine Society’s Clinical Practice Guidelines for Managing Diabetes in the Older Adult, which is expected to be published by early 2017. The guidelines will address several important issues in older adults with diabetes, including:
Selecting appropriate diabetes medications for older patients with declining renal function or renal insufficiency;
Education for care providers and patients on the use of insulin in a growing number of older adults with Type 1 diabetes, who are at risk for hypoglycemia unawareness;
Newer diabetes agents and their role in achieving and maintaining glycemic control in older adults with diabetes.
Optimizing Medications for Diabetes Patients
Endocrinologists at BWH also are working to determine the most precise medication for subgroups of older patients with diabetes through funded research. Alexander Turchin, MD, and Donald Simonson, MD, are collaborating on a Patient-Centered Outcomes Research Institute (PCORI) grant to identify patient characteristics from a BWH database of 20 randomized trials with almost 7,000 patients to ascertain which treatment is likely to work best in a specific patient population
The diabetes research team also is conducting an investigator-initiated clinical trial (Safety and Efficacy of Saxagliptin for Glycemic Control in Non-Critically Ill Hospitalized Patient) studying the use of a low-risk diabetes drug in hospitalized patients up to 80 years-of-age with diabetes, who are typically only given insulin therapy. The ongoing study, led by site principal investigator Rajesh K. Garg, MD, is evaluating the effect of saxagliptin, a DPP4 inhibitor, on glycemic control in non-critically ill hospitalized patients with Type 2 diabetes.
Diabetes Self Management Education Programs
BWH’s Diabetes Self Management Education Programs, which have received American Diabetes Association Recognition, perform an annual review of data, including percentage of patients achieving goals. The Diabetes Program recently launched a new active disease management initiative for high-risk patients, including patients who frequently visit hospital emergency departments or have repeat hospitalizations due to poor diabetes control. Dr. McDonnell has shown that providing access to rapid follow up care from the emergency department to patients with diabetes can reduce hospitalizations in the next year by nearly 50 percent (Diabetes.63:A1-A102,23-OR. June 2014).
As part of this initiative, a diabetes educator, physician, and other team members work with the patient to achieve a set target. Enrolled patients receive education and support via office visits, virtual visits, telephone calls, and other communication for three months to provide intensive education.
“As the diabetes population landscape continues to shift and change, we continue to search for better ways to manage this condition in older patients with complex needs and a high risk of complications,” said Dr. McDonnell.