Erik Oshel’s first visit with a primary care provider last October was his first in several years. It was memorable – for the wrong reasons.
Oshel, 44, a machine operator with an Englewood-based medical device manufacturer, knew he was overdue for a medical checkup. He admits he was “afraid to step on the scale” – he tipped in at 240 pounds, about 25 more than he wanted – and had a host of other confusing symptoms, including memory issues, fatigue, frequent urination and constant thirst.
During the clinic visit at UCHealth Internal Medicine – Anschutz Medical Campus, Dr. Linda Overholser ordered a full blood screen. The results revealed a shocking number. Oshel’s blood glucose level was over 300, more than double the normal level. He had Type 2 diabetes, a disease that impairs the body’s ability to produce insulin, the hormone that metabolizes blood sugar.
Overholser quickly consulted a UCHealth endocrinologist, who prescribed the medication metformin to control his blood sugar. Soon after, Oshel had to begin taking insulin injections.
A silver lining: catching Type 2 diabetes
The news from the checkup wasn’t all bad. For one thing, Oshel had caught his Type 2 diabetes and begun treatment. Unchecked, the disease can produce a host of other severe medical complications, including kidney and cardiovascular disease, eye damage, foot issues and more. The diagnosis also helped to explain those confusing problems he’d noticed.
“I’d never put all of those symptoms together,” he said. “I was lucky to get diagnosed when I did.”
But Overholser gave his care another boost. She referred him to the Diabetes Home and Remote Care Program at UCHealth. The new program uses technology to help patients like Oshel manage their Type 2 diabetes. Combined with his own efforts to manage his diabetes through weight loss and healthier eating, the program has helped Oshel make a remarkable recovery from last October’s low point.
The Diabetes Home and Remote Care program launched last October as an innovative collaboration between the UCHealth Endocrinology Clinic – Anschutz Medical Campus and the UCHealth Virtual Health Center, which provides a variety of remote patient care and services. The idea: identify Type 2 diabetic patients at greatest risk of poor outcomes – as determined by their HbA1C levels, a measure of blood glucose levels over three months – and monitor their blood sugar control from afar to head off health problems before they worsen.
Blood sugars via Bluetooth
Patients who agree to join the program work with Virtual Health Center techs to set up an app for their smartphone that wirelessly pairs with their glucometer, the device that measures their blood glucose levels. Ann Marie Murray, clinical coordinator for the remote monitoring program, and her team provide technical support for patients throughout their enrollment. Murray also ensures that patients who do not have a Bluetooth-enabled glucometer are able to receive one.
Once they are set up, patients take their blood glucose levels twice a day, then wirelessly transmit the readings back to the Virtual Health Center, where techs monitor the data. When they notice a worrisome blood sugar spike, they contact the patient to identify the problem, such as a high-carbohydrate meal, missed medications or other issues.
In addition, patients work with Amy Vance, a certified diabetes care and education specialist, on tailored plans for key lifestyle changes, such as making healthy meal choices and increasing their exercise. The monitoring also helps patients’ physicians quickly make necessary medication adjustments.
A targeted program: Remote monitoring for diabetes
Amy Hassell, a critical care nurse and director of Patient Services for the Virtual Health Center, said patients with HbA1C levels of 8% or greater – 5.7% is considered normal – are at greatest risk of complications from their Type 2 diabetes and therefore can benefit most from consistent monitoring of their blood glucose levels.
“We’re able to provide better outcomes when we have these continuous touchpoints rather than seeing patients once every three months, then making a change and having to wait another three months to see if that change had an impact,” Hassell said. “We can see that change within 24 to 48 hours. We’re able to really compress care when we have these key data points.” She added that the program allows patients to quickly communicate any health issues they encounter.
Thus far, the evidence bears her out. As of late June, patients who enrolled in the voluntary program stayed with it an average of 135 days. During that time, their HbA1C levels declined, on average, by nearly a quarter, from 10.3% to 7.7%. The decline is greater than the evidence shows for any single glucose-control medication alone, noted Christine Jones, senior project manager at the UCHealth CARE Innovation Center.
Diabetes program gets thumbs up, thus far
The program has drawn favorable reviews from both patients and providers, Jones added. In surveys, patients said the benefits included the ability to quickly adjust their medications, high-quality coaching, and easy, frequent communication with members of the remote monitoring team. With the support of endocrinologist Dr. David Saxon, providers have also generally acknowledged the benefits the program offers their patients, Jones said.
“They are excited that their patients have more routine touchpoints for their diabetes care and are impressed with the initial results,” she said.
The monitoring program continues to move forward. It’s added UCHealth Internal Medicine – Lowry as a referral source, and post-transplant patients are also receiving the care.
Hassell said the Virtual Health Center is now working on integrating the app with continuous glucose monitors, which could alert techs any time patients have an abnormal blood glucose value. Another area of interest is using the app to “push” coaching and education to patients’ phones, she said. Work is also underway to develop a methodology to compare the total cost of care for diabetes patients enrolled in the remote monitoring program to those who receive standard care, Hassell added.
Monitoring, coaching and self-help equal diabetes management success
Erik Oshel’s experience in the program has helped to paint its still-early success story. During his three-and-a-half months of remote monitoring, his HbA1C levels declined dramatically, from a dangerous 11% to a safe 5.7%, Jones said.
Oshel credited diabetes coach Vance, a registered dietitian, with guidance that helped him make the changes necessary to manage his condition and improve his health.
“It was wonderful to have a coach to answer questions and walk me through taking injections, changing my diet and building better eating habits,” Oshel said.
He followed through, starting with eliminating the three or four cans of sugary soda he consumed daily as a caffeine substitute for coffee.
“I was due for a change,” Oshel said. “I didn’t really struggle with it once I made the decision to do it.”
It was harder to cut down on the carbohydrates in his diet, including breaded fast foods, French fries, and especially pasta, he said. He started with small steps, as Vance had advised, the first being changing the lunches he made for work. Sandwiches, chips and crackers gave way to fruits, vegetables, cottage cheese and yogurt.
He communicated regularly with Vance early on, including the occasional call if the Virtual Health Center detected an uptick in his blood glucose levels. But their communications gradually tapered off as he gained confidence that he could control his condition on his own. For now, he’s been able to discontinue his insulin injections.
Many life changes after a diabetes diagnosis
His life has changed in many other ways since that October clinic visit. As of late June, he’d trimmed his weight by more than 20 pounds and was exercising regularly.
“You see the changes in the mirror, and it feels good,” he said. “It helps you to keep doing the things that you’ve been doing to get better.”
The memory issues and brain fog that plagued him last year are also a thing of the past. That’s made his job a lot easier.
“I remember things from one day to the next,” Oshel said. “Now I know why I had that problem.”
As for the remote monitoring program, he said that he was initially skeptical about why he had to turn over his medical information. But his reluctance faded once he understood the rationale behind the initiative.
“I saw they were trying to help me,” Oshel said. “I decided to let it play out and see what happens. I can’t say enough good things about the program now. It gave me confidence and helped me out. When my blood sugar spiked, I had somebody there to talk to and reflect on what happened at that particular time.”