Insights

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

Catherine Brown
June 7, 2018

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 Therapeutics 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 ther­a­peu­tics offer peo­ple a way to track, under­stand, and report their patient-gen­er­at­ed health data (PGHD). Some dig­i­tal ther­a­peu­tics 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 ther­a­peu­tics as well. When providers receive time­ly, ana­lyzed PGHD from a dig­i­tal ther­a­peu­tic, 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 ther­a­peu­tics. 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 Therapeutics

For health­care pay­ers, dig­i­tal ther­a­peu­tics 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 ther­a­peu­tics 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.