Comorbidities Associated with Diabetes

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EP: 1.Comorbidities Associated with Diabetes

EP: 2.Diabetes in the Presence of Cardiovascular Disease

EP: 3.Risk Factors Associated with Diabetes

EP: 4.Early Intervention in the Management of Diabetes

EP: 5.Insurance Considerations in Diabetes Management

EP: 6.Treatment Strategies for Hyperglycemia

EP: 7.Managing Blood Pressure in Patients With Diabetes

EP: 8.The Utilization of Combination Therapy in Patients with Diabetes

EP: 9.A1C Management Strategies

EP: 10.A Strategic Approach to Controlling Diabetes

EP: 11.Drivers of Cost in the Management of Diabetes

EP: 12.Identifying Cardiovascular Risk in Patients with Diabetes

EP: 13.Incentivizing Comprehensive Care Approaches within the Management of Diabetes

EP: 14.Role of Insurance Companies in Treating Patients with Diabetes

Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE: Welcome to this American Journal of Managed Care stakeholder summit: Preventing Clinical Inertia in Early Treatment Management of Type 2 Diabetes. My name is Yehuda Handelsman. I’m the medical director and principal investigator of The Metabolic Institute of America [in Tarzana, California]. I’m also chair of the scientific advisory board of [the] Diabetes Cardiorenal & Metabolism Institute. Today, I’m joining a couple of colleagues. [First,] Dr Jennifer Green.

Jennifer B. Green, MD: I’m an endocrinologist and professor of medicine at Duke University [in Durham, North Carolina].

Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE: And on my left, Dr Eugene Wright.

Eugene E. Wright Jr, MD: I’m a medical director for performance improvement at the Charlotte Area Health Education Center [in North Carolina] and a consulting associate in the Department of Medicine at Duke University.

Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE: And Dr Jaime Murillo.

Jaime Murillo, MD: I’m a senior vice president and chief medical officer at OptumLabs, which is the research and development arm of the UnitedHealth Group.

Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE: It’s very nice to discuss [how] medical stuff relates to insurance with a doctor. It gives [us] a different perspective because we would like to get a perspective from every direction on the conditions that are out there. Especially [for individuals] like us, sometimes [we] are so [far] ahead of the data and ahead of what’s going on, we need somebody to bring us back to Earth, and that will be part of the discussion. Maybe, Jaime, you could do a reality check for us as to how we go forward. But we want to discuss diabetes and its comorbidities: what’s going on with diabetes and why the condition has become such a household name. I did my fellowship in a diabetes endocrinology special fellowship, and it was a boring profession at the time with very few tools, [so] I decided not to do diabetes endocrinology [and] just to do general internal medicine. It lasted for a couple of years, and now that everything is changing, we’d like to understand the comorbidities and how we can change them. And perhaps we should partner with insurance companies to help us and help the patient going forward.

When we’re looking at diabetes, one of the biggest issues is hyperglycemia, but it’s a complication. It’s [one of] the comorbidities, and lately, we are all talking about this cardiorenal metabolism [that] can come from different directions. I’d like for you to look at the condition. What is the prevalence of complications? What are the more dire complications we see? Later on, we’ll discuss how to approach it. Jennifer, maybe you want to start?

Jennifer B. Green, MD: We need to think very broadly when we consider and determine a treatment plan to either prevent or manage diabetes-related complications. Traditionally, we really focused more on what was called microvascular complications: retinopathy, neuropathy, and nephropathy. But I think we all have come to appreciate the fact that [patients] with diabetes also are at very significant risk for cardiovascular complications, and frankly, I’m not sure we should call kidney disease a microvascular complication any longer because it’s really much bigger and more important than that. And these have become incredibly important in deciding how we’re best going to treat our patients. Remember, when a [patient] is diagnosed with type 2 diabetes, they often have established microvascular if not macrovascular complications, so we need to be vigilant and ensure that we are screening appropriately from the outset of the disease.

Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE: Gene, anything to add? When you were in practice managing patients, what was the thing that you wanted to pay attention to in [patients] with diabetes?

Eugene E. Wright Jr, MD: What I’ve evolved and learned is to communicate with my colleagues as well as my patients, and that [managing] diabetes is more than just [managing] sugar. The reason we [manage] diabetes is to prevent or significantly delay all these bad things: these complications we know are ahead of them. It’s a different approach. It’s trying to prevent a disease and an illness in its earliest stages.

Transcript edited for clarity.