Digital Health Solutions Optimize Hypertension and Diabetes Treatment and Self-Care

Diabetes, particularly type 2, and hypertension (high blood pressure) are two of the most common chronic conditions today. In the U.S. the Centers for Disease Control and Prevention (CDC) report that 1 in 9 Americans have diabetes¹ and 1 in 3 Americans have hypertension.² Diabetes and hypertension are each a major risk factor for heart disease, which remains the leading cause of death in America.

According to CDC statistics:

• About 7 of every 10 people having their first heart attack have high blood pressure³
• About 8 of every 10 people having their first stroke have high blood pressure³
• People with diabetes are twice as likely to have heart disease or a stroke as people without diabetes and at an earlier age⁴

Hypertension and Diabetes Equals Dangerous Duo

These conditions often occur together with hypertension typically occurring prior to the diagnosis of type 2 diabetes. Statistics show that 60% of Americans with diabetes also have hypertension.² Together, diabetes and hypertension is an even more dangerous duo. Beyond heart disease, the combination of diabetes and hypertension increases the risk of kidney, eye, and nerve disease; all of which can severely impact quality of life and lead to increased health care costs.

Yet both diabetes and hypertension can be “silent”, meaning that people may not notice any symptoms of the condition before they’ve experienced a medical crisis, or they may have had the condition for several years prior to diagnosis.

Medical Treatment and Self-Management Similarities

There are similarities between the two disease states beyond their potential complications. Both typically require taking medication to achieve and maintain optimal control. Medical treatment regimens, particularly over the years, can become complex with the use of multiple medications. Careful and regular titration of medications is an essential part of good quality care.

Implementing a pattern of healthy food choices and eating habits, adequate physical activity, stress management, and sufficient quality of sleep can significantly improve management of both diabetes and hypertension. Fortunately, the recommendations for self-management behaviors are generally aligned for the two conditions. This can make teaching self-care knowledge and skills a bit easier for clinicians managing both diseases; however, keeping both conditions under control requires significant effort by the person as well as support from healthcare providers.  

Role of Digital Health Solutions in Diabetes and Hypertension

When people self-monitor their glucose and blood pressure, the volume of data they create builds up quickly. An increasing number of digital health solutions offer people a way to track, understand, and report their patient-generated health data (PGHD). Some digital health solutions also have the potential to provide people with diabetes and/or hypertension with either in-app or virtual human-based coaching to offer feedback to improve self-management. In combination these actions may assist in limiting costly acute complications such as severe hypoglycemia or hypertensive crisis and complications from having one or both diseases for many years. For people with diabetes, reaching their blood pressure targets comes with big benefits: reduction in risk of heart disease by as much as 50% and risk of kidney, eye, and nerve disease by about 33%.⁵

Healthcare providers can benefit from the implementation of digital health solutions as well. When providers receive timely, analyzed PGHD from a digital health solution, they can have more beneficial touchpoints to engage the people they care for whether by phone, email, in-person, or online. More rapid medication titration for both hypertension and diabetes is a major benefit of digital health solutions. Timely and adequate medication titration can lead to improved clinical outcomes and can decrease acute and/or costly situations. Recent data from a study by Banegas, et al., indicates that home blood pressure measurements were a stronger predictor of all-cause and cardiovascular mortality than clinic measurements.⁶

Payer Benefits of Digital Health Solutions

For healthcare payers, digital health solutions offer scalable, low cost solutions to reach people within the population they care for or cover. The best digital health tools provide members with contextual, customized in-app or on-demand coaching about self-care with appropriate prompts to contact their healthcare providers if and when need be. Further, they offer both users and health care providers data analysis and clinical decision support. Systems that also assist clinicians with implementing population health management strategies allow payers to more easily identify people at risk and problem areas in need of intervention.

Available Mobile Apps for Diabetes and Hypertension

Many mobile apps are available to help users track their glucose or blood pressure data, however, only a small subset of these apps allow the tracking of both. Of these, some provide simple feedback about whether a data point is in or out of target. They may integrate with a glucose meter or home blood pressure cuff for easy data transfer. They may also generate reports summarizing the data for the health care team.

The most effective mobile medical apps to manage both conditions go much further by providing contextual, customized in-app coaching about self-care along with timely, appropriate prompts for the user to contact their healthcare provider. They will also offer data analysis and clinical decision support to the healthcare provider to engage the person to more quickly and efficiently manage their dual conditions.

Conclusion

For people with diabetes, reaching their blood pressure targets comes with big benefits: reduction in risk of heart disease by as much as 50% and risk of kidney, eye, and nerve disease by about 33%.⁵ Digital health solutions that integrate the management of both conditions offer the greatest value for affected individuals, their healthcare providers, and payers to achieve improved care and outcomes and contain healthcare costs.  

References

1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed May 22, 2018.
2. Centers for Disease Control and Prevention. High Blood Pressure. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services.  https://www.cdc.gov/bloodpressure/index.htm. Accessed May 22, 2018.
3. Centers for Disease Control and Prevention. High Blood Pressure Facts. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services. https://www.cdc.gov/bloodpressure/facts.htm. Accessed May 22, 2018.
4. Centers for Disease Control and Prevention. At A Glance 2016 Diabetes. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services. https://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2016/diabetes-aag.pdf. Accessed May 22, 2018.
5. Centers for Disease Control and Prevention. Putting the Brakes on Diabetes Domplications. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services. https://www.cdc.gov/features/preventing-diabetes-complications/index.html. Accessed May 22, 2018.
6. Banegas, JR, et al.: Relationship between Clinic and Ambulatory Blood-Pressure Measurements and Mortality. N Engl J Med 2018; 378:1509-1520.