1) Do your primary care physicians know that there are studies that have proven that diabetes can be prevented? Do you know what the range in efficacy is for interventions like lifestyle or metformin? Do you know how large these studies were and when they were conducted and how long patient follow up occurred?
a. Primary care physicians are going to have to own diabetes and diabetes prevention, and we have the opportunity to help educate them on these subjects. No one else is doing it.
i. Did you know that there are only about 5,000 endocrinologists in the US, and 1,500 of them do not provide clinical care? Also, 1/3 of them are over the age of 60, nearing retirement, and the ranks are not being refilled (see http://www.endo-society.org/media/press/2008/Endocrinology-Workforce-Shortage-Represents.cfm). Finally, most of these endocrinologists are NOT primarily focused on or interested in diabetes care, most are biased towards hormonal disorders.
ii. Did you know that 90% of all diabetics are managed by PCPs? Did you know that 99.5% of all pre-diabetics are managed by PCPs?
b. Thus, my point: the diabetes epidemic is growing uncontested. There is no reliable “channel” for prevention or even management of diabetes outside of primary care. Primary care must OWN primary prevention of this disease state.
c. And to that point, there is no other physician group whose primary purpose is the assessment of risk and the prevention of disease. We offer the first in a line of “advanced risk assessment” tools that primary care physicians can use to identify those individuals most vulnerable to chronic disease states. We offer them a path towards early intervention, helping to arrest the progression of disease while there is still time – while there is still an option to do so effectively. We can help them to pre-empt this disease.
d. We need to help educate these physicians on the data, the studies that demonstrate that prevention of diabetes is achievable, and what can be done to make it happen.
2) Did you know that there is NO PRIMARY PREVENTION GUIDELINE for type 2 diabetes? With no guideline, what are primary care physicians referencing to determine “what to do” with a high-risk patient?
a. This is a complex answer that we must reduce to a “simple standard” for diabetes prevention. The simple standard for high-risk individuals should include 4 evidence-based therapies:
i. Aggressively engage patients to improve lifestyle choices:
1. Improving diet
2. Improving nutrition
3. Increasing exercise
ii. If diagnosed with hypertension, aggressively manage blood pressure to 140/90 and consider 130/80 if additional risk factors are present
iii. If diagnosed with dyslipidemia, aggressively manage LDL to <130 mg/dL, HDL to >40, and non-HDL cholesterol to <160 mg/dL
iv. Consider ASA therapy if cardiovascular risk factors warrant its use
b. Importantly, treatments for blood pressure, cholesterol, and hypercoaguability are recommended by national guidelines if a patient presents with hypertension, dyslipidemia, or recognized cardiovascular risk factors, respectively.
c. Thus, the opportunity that PreDx DRS offers is to identify those patients who are highly vulnerable to diabetes and associated cardiovascular disease (patients with HIGH PreDx Scores) and to ensure that each patient is treated aggressively with lifestyle intervention and indicated therapies in order to help reduce the risk for diabetes and cardiovascular events.
d. Remember that, nationally, less than 10% of diabetics are treated to evidence-based guidelines with indicated therapies. Thus, we must assume that it is no better among pre-diabetics, and we should not assume that all patients at risk according to PreDx are receiving appropriate, indicated medications like lifestyle interventions, antihypertensives, or statins.
e. PreDx DRS is an “alarm bell” that should help physicians to “STOP, REASSESS, and OPTIMIZE”. Every high PreDx Score needs a fresh assessment to determine if, in light of the new PreDx DRS MOD/HIGH-HIGH result, the patient warrants any of the therapies listed above for hypertension or dyslipidemia – or – just as importantly – if they need to be managed more aggressively towards target levels for BP or lipids.
3) Remember the basic messaging:
a. Diabetes is preventable, but 80-90% of patients seen by an IM are eligible for prevention based on common risk factors, and they are overwhelmed with this population.
b. We must identify those individuals who are most likely to convert to diabetes, and focus our preventive efforts and therapies.
c. PreDx DRS leverages technology that didn’t exist 10 years ago, allowing us to establish “pattern recognition” for progressing diabetes.
d. With this new information, physicians can identify patients with up to a 1,600% increased risk of developing diabetes within 5 years.
e. The biomarkers represent inflammation, glucose metabolism, and adipocyte function, and provide results that are superior to every other method of risk assessment except OGTT (we are equivalent to OGTT, the gold standard that is rarely used in primary care).
f. PreDx DRS also captures cardiovascular risk, as patients with HIGH scores are also significantly more likely to experience heart attack or other cardiovascular events within 5 years.
g. By establishing diabetes risk, and risk of associated cardiovascular events, we believe that PreDx DRS is identifying the 10% of patients that drive 70% of future medical costs.
h. We are enabling early intervention with lifestyle changes and appropriate pharmaceuticals, which have both been proven to reduce the incidence of diabetes in large, prospective studies.
i. Ultimately, we are helping to shape personalized medicine in a way that helps prevent the country’s most common disease.
a. Primary care physicians are going to have to own diabetes and diabetes prevention, and we have the opportunity to help educate them on these subjects. No one else is doing it.
i. Did you know that there are only about 5,000 endocrinologists in the US, and 1,500 of them do not provide clinical care? Also, 1/3 of them are over the age of 60, nearing retirement, and the ranks are not being refilled (see http://www.endo-society.org/media/press/2008/Endocrinology-Workforce-Shortage-Represents.cfm). Finally, most of these endocrinologists are NOT primarily focused on or interested in diabetes care, most are biased towards hormonal disorders.
ii. Did you know that 90% of all diabetics are managed by PCPs? Did you know that 99.5% of all pre-diabetics are managed by PCPs?
b. Thus, my point: the diabetes epidemic is growing uncontested. There is no reliable “channel” for prevention or even management of diabetes outside of primary care. Primary care must OWN primary prevention of this disease state.
c. And to that point, there is no other physician group whose primary purpose is the assessment of risk and the prevention of disease. We offer the first in a line of “advanced risk assessment” tools that primary care physicians can use to identify those individuals most vulnerable to chronic disease states. We offer them a path towards early intervention, helping to arrest the progression of disease while there is still time – while there is still an option to do so effectively. We can help them to pre-empt this disease.
d. We need to help educate these physicians on the data, the studies that demonstrate that prevention of diabetes is achievable, and what can be done to make it happen.
2) Did you know that there is NO PRIMARY PREVENTION GUIDELINE for type 2 diabetes? With no guideline, what are primary care physicians referencing to determine “what to do” with a high-risk patient?
a. This is a complex answer that we must reduce to a “simple standard” for diabetes prevention. The simple standard for high-risk individuals should include 4 evidence-based therapies:
i. Aggressively engage patients to improve lifestyle choices:
1. Improving diet
2. Improving nutrition
3. Increasing exercise
ii. If diagnosed with hypertension, aggressively manage blood pressure to 140/90 and consider 130/80 if additional risk factors are present
iii. If diagnosed with dyslipidemia, aggressively manage LDL to <130 mg/dL, HDL to >40, and non-HDL cholesterol to <160 mg/dL
iv. Consider ASA therapy if cardiovascular risk factors warrant its use
b. Importantly, treatments for blood pressure, cholesterol, and hypercoaguability are recommended by national guidelines if a patient presents with hypertension, dyslipidemia, or recognized cardiovascular risk factors, respectively.
c. Thus, the opportunity that PreDx DRS offers is to identify those patients who are highly vulnerable to diabetes and associated cardiovascular disease (patients with HIGH PreDx Scores) and to ensure that each patient is treated aggressively with lifestyle intervention and indicated therapies in order to help reduce the risk for diabetes and cardiovascular events.
d. Remember that, nationally, less than 10% of diabetics are treated to evidence-based guidelines with indicated therapies. Thus, we must assume that it is no better among pre-diabetics, and we should not assume that all patients at risk according to PreDx are receiving appropriate, indicated medications like lifestyle interventions, antihypertensives, or statins.
e. PreDx DRS is an “alarm bell” that should help physicians to “STOP, REASSESS, and OPTIMIZE”. Every high PreDx Score needs a fresh assessment to determine if, in light of the new PreDx DRS MOD/HIGH-HIGH result, the patient warrants any of the therapies listed above for hypertension or dyslipidemia – or – just as importantly – if they need to be managed more aggressively towards target levels for BP or lipids.
3) Remember the basic messaging:
a. Diabetes is preventable, but 80-90% of patients seen by an IM are eligible for prevention based on common risk factors, and they are overwhelmed with this population.
b. We must identify those individuals who are most likely to convert to diabetes, and focus our preventive efforts and therapies.
c. PreDx DRS leverages technology that didn’t exist 10 years ago, allowing us to establish “pattern recognition” for progressing diabetes.
d. With this new information, physicians can identify patients with up to a 1,600% increased risk of developing diabetes within 5 years.
e. The biomarkers represent inflammation, glucose metabolism, and adipocyte function, and provide results that are superior to every other method of risk assessment except OGTT (we are equivalent to OGTT, the gold standard that is rarely used in primary care).
f. PreDx DRS also captures cardiovascular risk, as patients with HIGH scores are also significantly more likely to experience heart attack or other cardiovascular events within 5 years.
g. By establishing diabetes risk, and risk of associated cardiovascular events, we believe that PreDx DRS is identifying the 10% of patients that drive 70% of future medical costs.
h. We are enabling early intervention with lifestyle changes and appropriate pharmaceuticals, which have both been proven to reduce the incidence of diabetes in large, prospective studies.
i. Ultimately, we are helping to shape personalized medicine in a way that helps prevent the country’s most common disease.
