“Year’s end is neither an end nor a beginning but a going on.” – Hal Borland

This past year proved to be an exciting time in the advancement of diabetes care. New technology and new research are on the forefront of improving aspects of living with and even preventing diabetes. Take for instance the development of the artificial pancreas, the holy grail of diabetes innovation, which first came to market this past year.

While important advancements have been made, there is still much to accomplish and much more adoption that needs to occur, particularly in the inpatient setting.  With the new year, we have an opportunity to look at what lies ahead as we continue to keep “going on” to advance glycemic management.

Here are the three biggest trends Monarch sees in 2018:

Diabetes Care in the Hospital Will Take Center Stage

The trends in diabetes have not been in our favor as highlighted in our recent blog post. Diabetes is a growing problem. Eighty-six million Americans have pre-diabetes and another 30 million have diabetes, and approximately 1.5 million individuals are newly diagnosed with diabetes each year. The costs of direct medical care for diabetes is on the rise, and many hospitals are not equipped to optimally care for these patients. Fewer endocrinologists are working in the inpatient setting, many facilities lack glycemic management standardization, and most institutions still rely on challenging and imprecise care practices to manage hyperglycemia.

With a growing prevalence of patients presenting with hyperglycemia and clear evidence supporting normoglycemia leading to better patient outcomes, we see this changing. Hospitals are starting to optimize their glycemic management programs, and we believe even more will adopt best practices to care for these patients this year.

A major contributing factor to increased adoption will likely come from recent legislation passed to enhance diabetes care. The National Clinical Care Commission Act was signed in November of 2017 to facilitate improved access to high quality care for patients with diabetes and other insulin-related diseases.  The legislation, which was championed by the American Association of Clinical Endocrinologists (AACE), establishes a commission charged with identifying gaps in activities in federal diabetes programs and providing recommendations to improve diabetes care in the U.S.

While the final report from this commission is due three years after the first meeting, the bill marks a step in establishing clear guidelines and regulatory programs that will influence overall diabetes care management, including inpatient glycemia. It represents an increased emphasis on diabetes care, and should serve as a call to action for organizations to optimize their glycemic management programs and get ahead of the impending regulatory moves.

Glycemic Management Will be Tied to Value-Based Care Economic Drivers

Just as new legislation will likely drive improved glycemic management, so too will the changing payment structures. Value-based care payment models have already taken hold in the healthcare industry, and those payment structures are on their way to becoming the norm. The industry will continue to slowly transition from fee-for-service payments towards value-based care models, and hospitals will need to continue to focus on lowering costs and optimizing outcomes.

As part of this transition, we believe glycemic management outcomes will become tied to value-based economic drivers. This past December a new consensus statement paved the way for standardizing consistency and provided a basis for value-based reimbursement approaches. The consensus recognized glycemic management outcomes other than just hemoglobin A1c (HbA1c) that should be measured to fully capture the efficacy of diabetes therapies and treatments. HbA1c, which has long been considered the primary metric, does not capture short-term variations in blood glucose or episodes of hypoglycemia and hyperglycemia that can have a significant negative impact on a patient’s health. The consensus concluded that hypoglycemia, time in normal range, hyperglycemia and diabetic ketoacidosis (DKA) are also clinically meaningful, and they established clear definitions for each metric.

While the consensus statement was not directly connected to inpatient glycemic management, it is expected that it will bring more patient safety and payer-related scrutiny to glucose management and glucose metrics of in-hospital patients. Hospitals are going to need to establish initiatives that measure and improve these priority outcomes to perform well in future value- based programs, and a platform like EndoTool can help in providing value.

Interoperability Will Improve Glycemic Management

To help make this transition to value-based care, capturing data and analyzing metrics are necessary. One barrier to collecting this data is the lack of interoperability between devices, software, and electronic medical records (EMRs). Interoperability was a major focus for hospitals in 2017, and will continue to be a target in 2018.

For inpatient glycemic management, the first step in interoperability is integrating the electronic glucose management systems and point of care (POC) blood glucose testing devices with the system’s EMR. The systems need to be able to talk to one another to remove double data entry and improve clinical workflow. The removal of extra steps in the workflow reduces input errors and enables the bedside caregiver to spend more time with the patient instead of being in front of a screen. Many of Monarch’s clients have already fully integrated EndoTool with their EMR and POC testing device, and we believe more will in 2018.

The next step in future data integration will be with continuous glucose monitoring (CGM) products. With vast innovation in the outpatient diabetes care, many individuals living with diabetes have CGM devices to help manage their glucose, and they may find it surprising when they cannot use the same systems when they enter the hospital. While CGM is in use at some facilities, widespread adoption has been limited by costs and insufficient outcome data. More hospitals will likely adopt CGM, and this information will also need to be integrated with the EMR for a more complete picture of a patient’s care.

Ultimately, the data needs to be shared to make it easier to interpret real-time information and diagnostic reports. With shareable data, clinicians can make patient-centered care decisions, and hospitals can measure performance and make improvements to enhance care and reduce costs.

2017 may have brought significant enhancements in glycemic management, but Monarch is excited for the year ahead. Together we can continue on the path of improving inpatient glycemic management and advancing patient care.