Authored by Megan Harper, Diabetes and Nutrition Educator at apree health
Diabetes represents a substantial economic burden in the United States. According to the Economic Report, total annual cost of diabetes in 2022 was $412.9 billion and people diagnosed with diabetes account for one of every four dollars spent on healthcare in the U.S. (1) What can we do in health care to help reduce this burden? Engage with Diabetes Self-Management Education and Support (DSMES).
DSMES has shown to reduce hospital admissions and readmissions, as well as estimated lifetime health care costs related to a lower risk for complications. A retrospective study examining medical records of over 33,000 patients found average annual health care costs were 39% lower for patients who received DSMES compared to those who had no visits. A systematic review found individuals with type 2 diabetes who received DSMES had a 0.55% reduction in their hemoglobin A1c (A1C) compared to individuals who did not receive DSMES. (2)
There are many DSMES programs available, but what makes the apree health Advanced Primary Care (APC) model different?
- Having the certified diabetes care and education specialist (CDCES) integrated in the primary care setting allows for more direct contact with the primary care provider which leads to more seamless coordination and collaboration.
- Direct contact with the primary care provider helps push through therapeutic inertia to add on or adjust medications, like insulin, quickly. In addition, the APC model prioritizes health outcomes over reimbursement, so we are able to offer more 1:1 appointments and foster ongoing care to create more personalized health recommendations.
- Traditional DSMES programs set up with fee for service models are limited to how many hours of care can be received and are limited to mainly group education sessions.
- apree health is set up for both, allowing for peer support and individual support.
- The apree APC model has an integrated, multidisciplinary care team which includes a Whole Health Coach and Behavioral Health Clinician to help support lifestyle changes and coping with the stress of managing diabetes.
At apree,our average reduction in A1C for those individuals who completed their DSMES care plan is 1.1% (compared to national average of 0.55%). We work to make small, yet sustainable changes that are attainable, but create a snowball effect with time. We have regular check-in appointments to assess progress and continue to make changes to support overall health goals. In addition, we regularly use technology like continuous glucose monitors to get a deeper insight into a person’s blood sugar throughout the entire day. Our overall goal is to give people with diabetes the knowledge, skills, and confidence to accept responsibility for their self-management resulting in better clinical and quality of life outcomes, increased productivity, and reduced total cost of care. (3)
Success with the apree model:
Rebecca*, a new member, came to an apree health care center to establish care. Three years ago, she was diagnosed with diabetes and started on short and long-acting insulin along with Metformin (a oral medication). She expressed frustration with the lack of support she had previously received regarding diabetes management. The apree health primary care provider supplied the patient with 2 samples of the Libe continuous glucose monitor (CGM) and put in a referral to the certified diabetes care and education specialist (CDCES). The CDCES educated Rebecca how to best use the CGM and interpret the data, while simultaneously educating her on diet and lifestyle changes. With time, Rebecca was able to discontinue her long-acting insulin and her A1c has dropped from 8.9-6.5% (this is the first time her A1c has been under 7% since initial diagnosis 3 years ago), plus she is feeling more confident in her own abilities to manage blood sugars.
Since our diabetes and nutrition program consists of Registered Dietitians, we are also able to offer patients medical nutrition therapy which harnesses the power of nutrition to treat and manage a variety of health conditions. Members referred for elevated cholesterol experienced an average of 50 point reduction in triglycerides, 40 point reduction in total cholesterol, and a 35 point reduction in LDL cholesterol. In addition, members referred for pre-diabetes have seen an average A1C reduction from 5.9, to 5.6% (out of the pre-diabetes range), a 58 point reduction in triglycerides, and a 4.5% weight loss.
Through empathetic listening and more touchpoints focusing on small changes, we are able to build relationships with patients to improve their health outcomes and ultimately help to lower their total cost of care.
*Name changed for privacy
- Parker ED, Lin J, Mahoney T, et al. Economic Costs of Diabetes in the U.S. in 2022. Diabetes Care. 2024;47(1):26-43. doi:10.2337/dci23-0085
- Margaret A. Powers, Joan K. Bardsley, Marjorie Cypress, Martha M. Funnell, Dixie Harms, Amy Hess-Fischl, Beulette Hooks, Diana Isaacs, Ellen D. Mandel, Melinda D. Maryniuk, Anna Norton, Joanne Rinker, Linda M. Siminerio, Sacha Uelmen; Diabetes Self-management Education and Support in Adults With Type 2 Diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Care 1 July 2020; 43 (7): 1636–1649
- American Diabetes Association. (2018). Economic costs of diabetes in the US in 2017. Diabetes care, 41(5), 917-928. https://doi.org/10.2337/dci18-0007
