The New Paradigm of Diabetes Care
Abstract
Background: Achieving targets in diabetes care is still an elusive dream since < 54% reach HgA1c<7%. Is there a better paradigm? CGMS has proven its excellent data and analytics value.The Virtual Pancreas System (VPS) has proven its therapeutic value, by reaching Targets in >% 80, to achieve the triple aim of optimum HgA1c/glucose variability, zero hypoglycemia or weight gain,it is now cloud-based, reachable by any mobile or internet as a VPS/metabolic simulator. The value index is how much money ($) is spent on improving HgA1c 1% in three months
Methods and Design: We compared, using the value index, in 10 matched patients the standard paradigm (SP) and the new CGMS/VPS paradigm. We projected savings on total diabetes care for 10 million people with diabetes. We present data for both paradigms and consider the better option.
Results: CGMS/VPS lowered HgA1c by the absolute value of 2.4% and the relative value of 2.7% when compared to standard paradigm(SP), which is better than many newer standard medications (DPP-4 lowers HgA1c by an average of 0.5%, SLGT2: 0.8-1, Dulaglutide: 1.08). With CGMS/VPS the glucose in targets was 82%, FBS was 123, PPG 154, hypoglycemia 0.8%, and weight -5 lbs, the value index was $236 per quarter.In standard care, the glucose in the target was 66%, FBS 148, PPG 186, and weight +6 lbs, and the value index was $1400 per quarter.
Conclusion: CGMS/VPS is a superior new paradigm.Here is how I envision the new brave world of diabetes care in the future: 1) each patient registers through their medical home, to the cloud-based VPS with secure password, with CGMS daily data transmission 2) Patients and providers receive instant feedback to act. 3)diabetologists supervise the process, consult and advice when necessary. 4) The goal of optimum diabetes care is reached with optimal HgA1C, optimal weight, and no hypoglycemia with quarterly CGMS. 5) This new paradigm will cut the burden of the diabetic epidemic scourge by 30 Billion/year; we could prove it by initiating real-life large multi-center studies. This should be the new paradigm: promising and achievable.
Disclosure S. Sakkal: None.
- © 2018 by the American Diabetes Association.
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