World Diabetes Day 2020 – Connecting the dots to improve outcomes with iPDM-GO.

For World Diabetes Day, we talk with Dr. Dagmar Kownatka on the implementation of an integrated, personalised diabetes management approach through the iPDM-Go project.

14 November of each year marks the celebration of World Diabetes Day. Created in 1991 by the International Diabetes Federation (IDF) and the World Health Organization (WHO) to raise awareness in response to rising diabetes rates worldwide, World Diabetes Day 2020 places focus on The Nurse and Diabetes, to highlight the vital role nurses play in supporting people with diabetes.

On this occasion, we interviewed Dr. Dagmar Kownatka, Head Healthcare Transformation & VBHC at Roche Diabetes Care and Project Coordinator of iPDM-Go, an EIT Health Innovation project, whose objective is to enhance the iPDM approach with innovative personalized health technology and implement outcomes-based healthcare payment.

Let’s find out what are the latest developments in the project.

1.Every year the World Diabetes Day is marked on 14 November, to raise awareness of a condition that millions of people all around the world live with every day. What is the connection between iPDM-GO and diabetes?

iPDM GO stands for “integrated Personalised Diabetes Management Goes Europe” – the concept is based on a publication from 2012 by Antonio Ceriello et al and the idea is to put the person at the centre of the care delivery process and support them with digital tools to improve outcomes, Roche Diabetes Care initiated and carried out a study (PDM ProValue) to test the concept and with iPDM Go we want to implement it into a real-life setting together with our consortium partners.

2. How does diabetes affect individuals and society as a whole?

Currently, the International Diabetes Federation estimates that worldwide over 460 million adults are living with diabetes. This number is expected to increase up to 700 million by the year 2045. This poses a huge burden on the patients but also on their caregivers and society as a whole including amongst others the increasing healthcare spending. Diabetes being a chronic disease pose a continuous challenge for people living with diabetes as they strive every day to reach their treatment targets and manage this chronic condition well. Usual care foresees them to see their healthcare professional only 4 times per year and if they are not able to keep their glucose levels in range, this can have serious consequences for the individuals as for example pronounced glucose fluctuations can lead to severe secondary complication such as cardiovascular disease or stroke. Other diabetes-related complications include kidney failure or amputations due to undersupplied vessels, and dementia and depression which are also often associated with this chronic condition put an additional burden on the patient.

3. While the costs associated with diabetes continue to rise, many people with diabetes still do not achieve their treatment goals. How is iPDM-GO addressing this?

iPDM is an interventional approach consisting of a structured disease management process, which utilizes digital tools and aims at bringing together physicians and patients for joint decision-making on the therapy goals and therapy adjustments, respectively. The PDM ProValue study showed that glycemic control as well as treatment satisfaction can be improved with iPDM for both – the patient and the treating physician. At Roche Diabetes Care we strongly believe that the concept does not only work in a study set-up but also works in daily practice by integrating it into a specific local ecosystem as a pilot.

4. The central idea of the project is to design a tool to capture the unique needs, circumstances and challenges of each person with diabetes. What is the current status of this tool?

The Danish Technical University is leading the development of the tool together with the Steno Center Copenhagen, the University of Copenhagen and the City Hospital Copenhagen. They are currently testing its usability with patients and collecting their feedback prior to further optimization.

5. The personalized treatment of diabetes is also at the core of the ongoing transformation of healthcare systems from volume-based to value-based. In your opinion, what does the future hold for us?

I see a clear shift from volume-based to value-based healthcare in different parts of the world. Some systems are more advanced, others are just starting. Generally, healthcare systems and society still need to work on many issues and barriers, i.e. all the topics around data – ownership & privacy, interoperability, cybersecurity; integration of technologies, incentivization according to the generated value instead of per number of patients treated etc. This is a big endeavor and a long journey! What we have already learned from the analyses of the University of Copenhagen assessing VBHC pilots in Sweden and in Denmark in the iPDM GO project is that there is a clear need to co-create the solutions jointly which makes it even more complicated. Every party has to “invest” something to get a “reward/value” and it must be a “win-win” for all participants of the respective ecosystem. That doesn’t make it easy. Only in a joint effort, we can address the challenge to ensure the sustainability of healthcare systems.

6. The number of people living with diabetes is expected to rise to 700 million by 2045. How can iPDM-GO play its part here?

The experiences and findings we gained in the iPDM GO project so far suggest, that the process could also be successfully used in the area of disease prevention. This would be a new and separate project of course requiring the identification of a healthcare system interested to explore and invest in this space.

7. On a more personal note, what are your lifestyle recommendations for diabetes prevention?

My personal recommendation is to move and eat healthily. Identify what is holding you back from physical activity and healthy food and then develop strategies to overcome them. I am aware that discipline is not easy but there are tricks. For example: I really love chocolate, but sugar immediately shows on my skin. Therefore, I started to increase the proportion of chocolate and reduce the amount of sugar – step by step. Today I eat chocolate with a minimum of 80% cocoa and interestingly my overall demand has decreased. My skin can cope and I do not even like large amounts of sugar in chocolate anymore. Regarding physical activity, I am lucky because I love to be active outside, but of course, there are these days I do not feel like moving. In those cases, it helps to remind myself how great it feels afterward or to make an appointment with a friend for running, cycling or just hiking, and sometimes even only my watch is sufficient to remind me to get up and move!

8. To conclude, what is your key message for this World Diabetes Day?

Go for iPDM! Because with iPDM GO we put people with diabetes and their healthcare team at the center, aiming to foster communication between them thus contributing to improved outcomes. Doing so, we see the use of digital tools as a key element in care delivery – especially in times of Covid-19.