Home-based health model could improve outcomes for adults in US with diabetes
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Key takeaways:
- Life expectancy in the U.S. has declined below most other high-income countries since 2020.
- Shifting to a home-based health model could help bring high-quality care to more of the U.S. population.
ORLANDO — The U.S. health care community must focus on getting diabetes therapies, technology and tools into the hands of all people with diabetes, especially those with low incomes and living in rural communities, according to a speaker.
Robert M. Califf, MD, commissioner of the FDA, discussed how life expectancy and other health outcomes in the U.S. are declining despite recent advances in medications and technology during a keynote talk at the American Diabetes Association Scientific Sessions. He described diabetes as the “tip of the spear,” with approximately 26 million adults in the U.S. living with diagnosed or undiagnosed type 2 diabetes and 8 million adults living with type 1 diabetes. Califf called upon the diabetes community to focus on inequities and develop ways to provide all people with diabetes with high-quality care.
“We are not succeeding in implementation of the things we know,” Califf said during the presentation. “We need to bring these things together so that we harness technology, particularly digital technology and AI, to benefit the people we care about.”
Declines in health outcomes
Several trends are leading to the U.S. falling behind other high-income nations in key health outcomes, according to Califf. He discussed how the prevalence of diabetes and obesity is rising in the U.S. and life expectancy has declined since 2020.
Califf also examined disparities in regard to key health outcomes. According to data from CDC WONDER, people living in rural communities have a 69% higher rate of diabetes mortality than those living in large urban communities and Black people have an 84% higher risk for diabetes mortality than white people. Califf said income level is also tied to diabetes incidence rates, a concern as some of the costliest medications in the U.S. are for diabetes.
There are several actions the health care community can take to reverse these trends, according to Califf. He discussed an FDA proposal to change the Nutrition Facts label on food packaging. The proposal includes moving the label to the front of food packaging to help people quickly identify healthy foods, highlighting high levels of saturated fat, sodium or added sugars in red and redefining the “FDA healthy” claim to align with dietary guidelines and nutrition science.
Disparities in therapies
Califf said a lot of progress has been made with diabetes medication and technology advances, including SGLT2 inhibitors, GLP-1 receptor agonists and continuous glucose monitoring. Despite these advances, Califf acknowledged the newest medications and technology remain out of reach for many people with diabetes due to high costs, lack of insurance coverage, drug shortages, clinical inertia and other factors. Additionally, many people in the U.S. lack access to an endocrinologist. In 2021, there was one endocrinologist practicing in the U.S. for every 4,657 people with diabetes. The populations most affected are those living in rural communities, racial-ethnic minority groups and Indigenous people.
Digital health tools are also falling short of improving diabetes outcomes, according to Califf. He discussed how the FDA sought comments from diabetes stakeholders on digital health tools such as CGM and electronic medical records and found there were a lack of studies on their impact on diabetes, there are problems with integration in a real-world setting and access is limited, particularly in rural communities.
“There’s a great tendency for these [technologies] to be taken up by people with PhDs and people living in urban areas,” Califf said. “Most of our people were left out and haven’t caught on. This is a thing that we really need to work on and figure out how to get effective technologies and innovations to people in rural areas and the underserved.”
Home-based health
To combat these problems, Califf presented a paradigm change to a national system. The system would include active surveillance to monitor patients, use real-world evidence to support regulatory decisions, have data collected during routine care that can be included in a larger system and use a shared system to inform all stakeholders in health care.
Implementing such a system involves transforming health care. Califf discussed an FDA Center for Devices and Radiological Health proposal of a prototype home model of health care. The goal of the model is to develop innovative medical-grade technology to deliver and expand access to first-class health care at the home. The model would be developed in collaboration with an architectural firm, patient groups, health care providers and the medical device industry.
“We hope this will help the industry gravitate to something like the cockpit of an airplane, which is reliable, and people can depend on and not be besieged by information from different places that they can’t put into context,” Califf said.
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Califf RM. Keynote Address. Presented at: American Diabetes Association Scientific Sessions; June 21-24, 2024; Orlando.
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