Young people with severe diabetes must manage their disease hour by hour. Sometimes, preventing their glucose levels from soaring too high or dropping dangerously low requires scrutiny of blood readings on a nearly minute-to-minute basis.
Yet in this era of ubiquitous data and instant digital communication, diabetes physicians are still using visits to the clinic every three months to manage their patients with Type 1 diabetes. Formerly known as juvenile diabetes, Type 1 is the more severe form of the disease usually detected early in life and requiring lifelong daily insulin injections.
"Frankly, we see children in our clinic who are not in the best health that they could be in. And we have to do something different to improve our outcomes," endocrinologist Dr. Laura Gandrud said. "We are not where we want to be in terms of the outcomes for these children."
Work is underway at diabetes clinics and technology companies across the country to crack the problem of how best to manage diabetes, specifically Type 1, which happens when the immune system destroys the body's ability to regulate blood sugar levels.
The institutions working on the problem include Gandrud's employer, Minneapolis-based Children's Hospitals and Clinics of Minnesota, which treats three-quarters of the children with Type 1 diabetes in the metro area, according to UnitedHealth Group.
Hour-by-hour trends
The nonprofit Children's Minnesota health system is in the midst of a yearlong clinical trial with 113 children and teens to evaluate whether physicians monitoring patients' hour-by-hour glucose trends each week — instead of each quarter — can save money and keep people healthier. The trial is leading a three-year, $6 million plan to build a new care model based on lessons learned from the study.
The extra monitoring of diabetes patients' blizzard of stats can require a lot more work from physicians like Gandrud. It also adds new expenses, such as customized communications software from San Francisco-based start-up Welkin Health.
Keeping kids' and teens' glucose levels in check can cut overall spending on complications such as blindness and lower-limb amputation. The rub is that those savings come later in life, so they wouldn't necessarily flow to a children's hospital. So far, Children's Minnesota is paying for much of the project though donations from individuals and financial support from Minnetonka-based UnitedHealth Group.