Cardio Metabolic Health Congress – Official Blog

Diabetes Management in the Digital Age

With increasing smartphone and digital device usage, there is a growing opportunity for technological tools to be incorporated into diabetes self-management (DSME). Although studies are limited thus far, scientific advancements in diabetes care have reduced long-term complications by improving glucose control, and simplifying disease management. Poor glucose control can lead to long-term diabetes, micro- and macro-vascular complications, and other health issues: all of which generate higher morbidity and mortality rates. The CDC reports that 100 million U.S. adults live with diabetes or prediabetes: a number expected to rise to 592 million by 2035.

Only about 20% of diabetic individuals are under professional care, according to an article from BioMed Central, and 77% of people with diabetes live in low- to mid-income countries with a lack of resources for adequate diabetes self-management training: an essential component of preventing long-term complications. There is both an opportunity and need for the development of cost-effective tools to support DSME in order to improve overall diabetes outcomes, particularly in developing countries. The increase of smartphone and digital device users has influenced the rise of mobile app technology, designed to help patients manage their diabetes. Applications that monitor food intake, physical activity, medication adherence, blood glucose levels and insulin doses are designed to assist patients with daily management of their condition. Other helpful tools such as diabetes education platforms as well as relaxation and meditation apps are also becoming increasingly available.

Diabetes self-management training is tailored to people with or at risk for diabetes, and allows them to gain the knowledge and skills necessary to successfully manage the condition. This includes information on healthy eating, self-monitoring of blood sugar levels (SMBG), medication adherence, and other risk-reduction behaviors. Not only has DSME proven effective in lowering A1c and blood pressure levels, it is also cost-effective. DSME training support is becoming more widely available to patients through online education materials provided by government organizations, professional organizations such as the American Diabetes Association, and nonprofits.

As weight management is crucial to the prevention of long-term diabetes complications, conducted studies have revealed a marked increase in weight loss results with the use of monitoring apps. Nutrition trackers and other healthy eating applications—such as Healthy Out, Foodily, and CarbControl—offer features to assist with meal planning and weight management. Extensive nutritional information, calorie and food trackers, and personalized diet plans can help modify behaviors while controlling blood glucose levels: all from a smartphone device. Readily available physical activity tracking applications, including MyFitnessPal and Endomondo, allow users to monitor activity levels, count calories, and set targeted goals for weight management.

Specifically designed blood glucose monitoring applications and insulin dose calculators are additional technological advancements that assist with daily self-management. Patients prescribed multiple daily insulin injections are recommended to check blood glucose levels at least three times a day, which can prove bothersome due to bulky devices, frequent blood drawing, and manual result logging. Apps such as EasyDose, Insulin RX, and Glucose aim to simplify the process of SMBG levels and calculate accurate insulin doses while increasing patient compliance rate.

Medication non-adherence is another recurring issue with diabetes patients, resulting in poor glycemic control and increased risk of long-term complications. MyMedSchedule, MedSimple, and other applications developed to solve this problem are simple and cost-effective, reminding patients to take medication, and thus improve overall glycemic results.

These new developments in DMSE technology have additionally increased the amount of data available to healthcare professionals, giving them enhanced access to reliable information, and allowing them to effectively support patient care. The expansions in diabetes technology provide exciting opportunities in health care for both patients and physicians seeking more effective care management. While robust data on the benefits of these health-related apps is still lacking, small-scale studies have demonstrated better glucose control, improved SMBG outcomes, and enhanced medication adherence. The future of digital diabetes management is promising; further studies on the benefits of digital technology with larger randomized control trials are underway, and the development of technological applications and digital devices continues.

Updated Guidelines for Blood Pressure

For many years, hypertension was defined as a blood pressure reading of 140 over 90 mm Hg or higher. Recently updated guidelines from the American Heart Association, however, now classify a BP of 130 over 80 mm Hg or higher as hypertension. As a result, many patients previously considered healthy—with normal or slightly elevated BP readings—now rank in the hypertension stage 1 category.

The updated guidelines are based on the 2017 Systolic Blood Pressure Intervention Trial, which indicated reduced chances of heart attacks, heart failure, and stroke over a three-year period: when targeting a systolic pressure of 120 mm Hg or lower. VA Boston Healthcare System endocrinologist Dr. Paul Conlin explains the lowered classification in Harvard Men’s Health Watch as a preventive measure to help people address high blood pressure and its correlated problems earlier.

Redefined classification categories and guidelines, new treatment suggestions, and pharmacologic recommendations from the AHA’s report are outlined below:

Updated Classification Categories

Beyond the change in definition, the updated hypertension guidelines have also eliminated the prehypertension category: previously defined as a systolic BP reading of 120 to 139 mm Hg or diastolic reading of between 80 to 89 mm Hg. These readings now fall into the categories of elevated blood pressure or Stage 1 hypertension, while Stage 2 hypertension begins at 140/90 mm Hg. Any reading higher than 140 over 90 is currently classified as hypertensive crisis.

New Treatment Guidelines

The AHA’s updated guidelines outline new treatment recommendations for patients with high blood pressure, including lifestyle changes and pharmacologic care. While the DASH diet is still referenced, the report recommends reducing sodium consumption and increasing potassium intake to lower BP. Patients with kidney disease, or those taking certain medications, should avoid excess potassium. Additional lifestyle changes include incorporating 90 to 150 minutes of aerobic or dynamic resistance training per week, and/or 3 sessions of isometric resistance training. Moreover, patients who consume alcohol should limit their intake to 1-2 drinks daily for men, and 1 daily drink for women.

For patients with normal BP, treatment is comprised of yearly evaluations and a focus on healthy lifestyle choices. It is suggested that patients with elevated BP (previously normal BP) implement lifestyle changes and reassess in 3-6 months. Stage 1 hypertension patients should be evaluated for 10-year risk of heart disease and stroke using the ASVCD calculator. If risk is less than 10%, patients should begin to integrate healthy lifestyle recommendations, with a reassessment in 3-6 months. If the risk is greater than 10%–or the patient has known clinical cardiovascular disease, diabetes mellitus, or chronic kidney disease—he/she should be prescribed a BP-lowering medication, coupled with lifestyle change recommendations. These patients should be reexamined in 1 month to ensure efficacy of the medication until control is achieved. Treatment for Stage 2 hypertension patients is similar, with the addition of another BP-lowering medication of a different class.

Pharmacologic Recommendations

New guideline recommendations focus on more aggressive pharmacological treatment of hypertension patients. While a BP-lowering medication is only recommended for those with an ASCVD risk of 10% or greater at stage 1, stage 2 treatment now includes 2 BP-lowering medications.

The updated guide also features recommendations for at-risk populations with higher morbidity and mortality rates associated with hypertension, such as African-American and Hispanic adults. In order to achieve a BP of less than 130/80 mm Hg in these groups, 2 or more BP-lowering medications are suggested.

Currently, the AHA reports that nearly half of American adults have high blood pressure; nearly half of those cases are uncontrolled. With the implementation of the new blood pressure guidelines, patients will receive treatment at earlier stages of hypertension, thus reducing their risk of heart disease, stroke, and other life-threatening illnesses.