Daily Archives: 29 April 2024

The approach of remote care enhanced therapy adherence and engagement among patients with type 2 diabetes

Leave a Reply

A recent study by researchers from Mass General Brigham has shown that a remote team dedicated to identifying, educating, and prescribing therapy can significantly enhance adherence to guideline-directed medical therapy (GDMT) in patients with type 2 diabetes who are also at high risk for cardiovascular and kidney complications. The study found that patients who received education concurrently with medication management had a higher uptake of medications and started treatment earlier than those who were educated about two months before beginning medication management. These findings were presented at the 2024 American College of Cardiology’s Annual Scientific Session and published in Circulation.

Dr. Alexander J. Blood, MD, MSc, the corresponding author who presented these findings, emphasized the effectiveness of simultaneous education and treatment. Dr Blood, who is an attending physician in the Division of Cardiovascular Medicine and the Heart and Vascular Center at Brigham and Women’s Hospital—part of the founding network of the Mass General Brigham healthcare system—advocated for initiating treatment promptly when a patient shows readiness to invest in their health, suggesting that providers should capitalize on the patient’s immediate interest.

Type 2 diabetes is a prevalent condition in the United States that heightens the risk of severe cardiovascular and kidney events. Despite the potential benefits of medications like SGLT2 inhibitors and GLP-1 receptor agonists in improving outcomes for these patients, widespread adoption remains limited. Clinical trials and societal recommendations have not sufficiently translated into broad clinical practice.

The study involved a parallel, randomized, open-label clinical trial funded by the Novo Nordisk Foundation. It enrolled 200 adult patients with type 2 diabetes at elevated risk for cardiac and kidney issues at Mass General Brigham. Participants were randomly assigned to either an “education-first” group, which received two months of dedicated educational content through patient-centric videos on disease management and medication before starting treatment, or a “simultaneous” group, which received the same academic resources concurrently with treatment initiation.

Both groups were managed using a research and clinical care management platform developed by the Accelerator for Clinical Transformation at Brigham and Women’s Hospital and Mass General Brigham. This platform supported coordinated care delivery involving patient navigators, pharmacists, nurse practitioners, and physicians, thus facilitating comprehensive patient engagement and streamlined communication. This system is integral to Mass General Brigham’s efforts to transform healthcare delivery. It allows patients to access services and monitor their health from home, which is particularly vital when hospitals are often over capacity.

Over a six-month follow-up period or one-month post-medication initiation, if longer, results showed notable benefits like weight loss and reduced blood glucose levels in both groups. However, the simultaneous education group demonstrated superior medication retention rates, with 60 per cent adherence compared to 44 per cent in the education-first group. Interestingly, the education-first group’s engagement with the educational platform was lower than initially expected.

The findings challenge the assumption that a pre-treatment education period alone can resolve medication adherence issues and highlight the potential of remote, team-based care delivery. This approach appears promising for facilitating the adoption of new therapies, reducing disparities in care quality, and improving health outcomes across diverse patient groups. The flexibility of remote treatment models can broaden access to care, particularly benefiting underserved communities and individuals with demanding schedules. Additionally, including a patient navigation team enhances ongoing communication between patients and providers, ensuring personalized support essential for sustained engagement in healthcare.

Dr. Benjamin M. Scirica, MD, MPH, the principal investigator of the DRIVE study and director of the Accelerator for Clinical Transformation, expressed strong belief in the impact of remote care programs that utilize non-licensed navigators, clinical pharmacists and team-based care in conjunction with a dedicated care delivery platform. He emphasized that such programs improve operational efficiencies and communication and significantly contribute to enhancing access, elevating patient outcomes, reducing physician burden, and promoting the appropriate use of guideline-recommended medications.

More information: Alexander J. Blood et al, Randomized Evaluation of a Remote Management Program to Improve Guideline-directed Medical Therapy: The Diabetes Remote Intervention to Improve Use of Evidence-based Medications (DRIVE) Trial, Circulation. DOI: 10.1161/CIRCULATIONAHA.124.069494

Journal information: Circulation Provided by Brigham and Women’s Hospital

The Mediterranean Diet: Beneficial for Your Well-being and Wallet

Leave a Reply

The Mediterranean diet, renowned for its health benefits, is a dietary approach that has piqued the interest of many. However, the misconception of it being expensive often discourages budget-conscious individuals from considering it.

Research from the University of South Australia has uncovered a fascinating aspect of the Mediterranean diet: it promotes health and offers significant economic benefits. Compared to a typical Western diet, adopting the Mediterranean diet could potentially save a family of four an average of $28 per week, translating to a substantial $1456 annually.

This research evaluated the nutritional content and cost of three dietary models: the conventional Australian Western diet, the Mediterranean diet, and the dietary approach recommended by the Australian Guide to Healthy Eating (AGHE). The Mediterranean and AGHE diets satisfied the criteria for recommended food groups, macronutrient ratios, and essential micronutrients for maintaining good health. In contrast, the typical Australian diet lacked several nutrients such as fibre, zinc, potassium, calcium, magnesium, vitamin E, and vitamin B6. It exceeded the advisable salt intake by twofold.

The cost analysis revealed that the Mediterranean diet required an expenditure of $78 weekly for an individual, $135 for two, $211 for three, and $285 for a family of four.

Ella Bracci, a researcher and PhD candidate at UniSA, has drawn attention to the implications of the study. She has underscored the Mediterranean diet as a viable and healthful choice for households on a budget, emphasizing the role of diet as a modifiable risk factor for chronic diseases. Bracci has also highlighted the alarming prevalence of unhealthy eating habits in Australia, contributing to the rising rates of type 2 diabetes, cardiovascular diseases, obesity, and osteoporosis.

The challenge in Australia has been the perceived expense associated with adopting diets like the Mediterranean, which emphasizes fruits, vegetables, whole grains, nuts, extra virgin olive oil, seeds, and seafood. Bracci’s research counters this perception, demonstrating the Mediterranean diet as an economically viable means to prioritize health and financial well-being.

The Australian Guide to Healthy Eating outlines a balanced diet encompassing five food groups. Despite these guidelines, only 8% of Australians meet the recommended vegetable intake, with many consuming a significant portion of their daily calories from high-salt, high-sugar, and high-fat foods.

Associate Professor Karen Murphy from UniSA remarked on the affordability of healthy eating, suggesting that maintaining a balanced diet could be more cost-effective than some might think, contrary to the financial toll unhealthy eating can have on the body. She advocated for the Australian Healthy Eating Guidelines and the Mediterranean diet, noting the latter’s lower cost.

Murphy provided practical advice on reducing grocery expenses, such as taking advantage of sales, buying seasonal produce, and opting for generic brands. She highlighted the significant cumulative savings – nearly $1500 annually – that can be achieved by choosing the Mediterranean diet, underscoring the potential impact on households’ budgets during challenging financial times.

More information: Ella L. Bracci et al, Developing a Mediterranean Healthy Food Basket and an Updated Australian Healthy Food Basket Modelled on the Australian Guide to Healthy Eating, Nutrients. DOI: 10.3390/nu15071692

Journal information: Nutrients Provided by University of South Australia