Improved diagnostics mean earlier, more effective screening.
Diabetes continues to be a growing problem in the United States – and not just among aging boomers. Citing a study published in late December in Diabetes Care, the Centers for Disease Control and Prevention (CDC) reported that the number of people under 20 with diabetes in the United States is likely to increase in the coming decades. In fact, by 2060, the country may be home to as many as 220,000 young people with diabetes type 2 – a 700% increase in less than 40 years. Type 1 diabetes is also expected to increase, but only by as much as 65% during this period. Point-of-care testing will be critical in identifying the growing number of people who may be affected.
The diabetes epidemic is expected to impact races and ethnicities disproportionately, placing Black, Hispanic/Latino, Asian, Pacific Islander and American Indian/Alaska Native youth communities at greatest risk. Whether this trend is the result of an increasing prevalence of childhood obesity, maternal diabetes (which increases the risk of diabetes in children) or a combination of factors, the takeaway is clear: In just under four decades, a substantial number of middle-aged Americans could be diabetic, placing them at risk for a myriad of health complications, including death, and leading to escalating healthcare costs for the country.
Health complications
Although advances in diagnostics have enabled physicians to better screen their patients for diabetes – and thereby more effectively address the disease state – the potential for health complications remains. Common health problems associated with diabetes include heart disease, chronic kidney disease and nerve damage, as well as problems with feet, oral health, vision and hearing, according to the CDC.
People with diabetes are twice as likely to have heart disease (considered to be the leading cause of death for both men and women in the United States) or stroke than those without diabetes, the CDC reports. The longer one has diabetes, the more likely they are to have heart disease, placing the growing number of diabetics at a much higher risk. Diabetic patients most commonly develop coronary artery disease, caused by the buildup of plaque in the coronary artery walls. As plaque builds, the arteries narrow and harden, decreasing blood flow. Decreased blood flow to the heart can cause a heart attack, while decreased blood flow to the brain may result in stroke. Arteries may harden in other parts of the body as well, such as the legs and feet. Referred to as peripheral artery disease (PAD), this is an early sign that a patient with diabetes has developed cardiovascular disease.
In addition, people with diabetes are at risk for other health problems that can lead to heart disease, including high blood pressure, high LDL cholesterol and high triglycerides.
Another complication associated with diabetes – chronic kidney disease (CKD) – often doesn’t present itself until it’s very advanced and patients require dialysis. One in three adults with diabetes has CKD, which ultimately can lead to death, according to the CDC. Regular blood and urine tests are essential to monitor kidney health in diabetics.
High blood sugar also can lead to nerve damage – or diabetic neuropathy – that impacts different parts of the body. As with chronic kidney disease, symptoms of nerve damage often develop slowly. The four main types include peripheral nerve damage, which affects hands, feet, legs and arms; autonomic nerve damage, which affects the heart, bladder, stomach, intestines, sex organs and/or eyes; proximal nerve damage, which targets the thighs, hips, buttocks and/or legs; and focal nerve damage, which can affect single nerves in the hands, head, torso or legs.
High blood sugar also weakens white blood cells, making it harder for the body to fight infections that may occur in the mouth. Patients with diabetes may develop dry mouth due to a lack of saliva, inflamed and bleeding gums, and infections in the mouth that take a long time to heal. In other cases, diabetes can lead to nerve damage associated with hearing loss. People with diabetes are also at higher risk of vision loss and blindness. As high blood sugar damages blood vessels in the retina, diabetic retinopathy develops, leading to blurry vision, floaters, trouble seeing colors and vision loss.
Improved diagnostics
The earlier physicians can detect diseases, the easier it may be to treat them. Evolving diagnostic testing makes it possible for physicians to do just that. “More than 8.5 million people in the United States are living with diabetes and don’t know it,” according to Abbott, which is committed to removing barriers to care while providing greater access to the latest medical technologies and health resources for people with diabetes. “This problem has been exacerbated by the pandemic, which disrupted medical care and annual health appointments for many people.”
Expanding access to testing can help people understand if they have diabetes or are at risk for developing it. “One of the benefits to rapid point-of-care testing for HbA1c is that it eliminates the need for people to fast beforehand, compared to a glucose test,” says Abbott. The company’s Afinion™ HbA1c Dx test provides a tool that physicians with a moderate complexity lab can use to screen for diabetes and prediabetes, enabling them to have a conversation with the patient in the same visit. (In addition to many office laboratories, hospitals, health systems, IDNs and even some community health centers have a moderate complexity lab.)
To screen a patient, a healthcare worker collects a small amount of blood from a fingerstick in the test cartridge, which is then placed into the analyzer. Within three minutes, the Afinion HbA1c Dx test measures HbA1c and delivers the result. In addition, the barcode on each test cartridge includes lot-specific calibration information, eliminating the need for any separate calibration steps.
When a patient’s HbA1c level indicates they have prediabetes or diabetes, their doctor can speak with them while the patient is still present. “As millions of people continue to live with diabetes or prediabetes and are unaware, the Afinion HbA1c Dx is a strong tool that can help more people be diagnosed early, counseled and linked to treatment to reverse this trend,” says Abbott.
Preventing vision loss
When high blood sugar damages blood vessels in the retina, it can result in diabetic retinopathy. The Welch Allyn RetinaVue Care Delivery Model – designed specifically for point-of-care settings, such as primary care offices – allows physicians to provide increased access to diabetic retinopathy exams in a variety of care settings, across a broad patient population, and better treat the growing number of patients diagnosed with diabetes each year.
Welch Allyn’s first-generation retinal camera – the RetinaVue 100 Imager – was introduced in 2016. Since then, the imager and care delivery model has evolved, making diabetic retinal exams accessible across several point-of-care settings, including primary care clinics, payers, mobile healthcare providers and retail locations. “This growth is due in part to large organizations, like payers, driving compliance with providers for diabetic retinal exams – a key solution to achieving value-based care metrics,” says Baxter, which acquired the Welch Allyn brand as part of the Hillrom acquisition in late 2021.
The company’s newest addition to its care delivery model, the Welch Allyn RetinaVue 700 Imager, provides automated retina imaging, including auto-alignment, auto-focus and auto-capture. Image capture takes less than five minutes and generally does not require chemical dilation.
RetinaVue Network Software is hosted on the secure Microsoft Azure platform and transmits encrypted retinal images to ophthalmologists for review and diagnosis, as well as for generating reports. HIPAA-compliant, SOC-2 Type II certified and FDA-cleared, the RetinaVue Network software manages image transmission, documentation and workflows with EMR systems. It also gives healthcare providers population health data on their tele-retinal program by clinic and patient. Image analysis and reporting is conducted by a nationwide team of state-licensed, board-certified ophthalmologists and retina specialists at RetinaVue, P.C., the first tele-ophthalmology provider to earn The Joint Commission’s Gold Seal of Approval, says Baxter. Alternatively, healthcare providers can send images to their preferred local eye specialists.
Distributor sales reps should educate their customers who provide primary care-based services that, with early diagnosis and treatment, vision loss from diabetic retinopathy is 95% preventable. Annual diabetic retinal exams are a key element of early detection. Timely and easier-to-access diabetic retinal exams help patients and their healthcare providers identify disease early so it can be managed and treated by eye care professionals to preserve vision. What’s needed is a turnkey solution to enable diabetic retinal exams at the point of care.
The importance of diabetic retinal exams cannot be overstated, which is why Medicare Advantage Star Ratings and CMS Quality Payment Program measures include the NCQA® HEDIS® quality measure (NQF #0055). Intercepting patients during routine primary care office visits with the RetinaVue care delivery model can help providers achieve up to 90% documented compliance with diabetic retinal exams in 12 months.
The RetinaVue Care Delivery Model is applicable across several segments, including retail, payers, mobile, large and small primary care practices, community health centers and non-profits and community organizations. Baxter reports it has seen adoption of the solution because its value proposition is multi-faceted for commercial stakeholders who are focused on value-based care measures and financial performance and closing care gaps, as well as clinical stakeholders focused on patient outcomes, clinician satisfaction and lower overall cost of care.