Optimizing Health Care Value in Diabetes

By David Y. Gaitonde, MD.  Dr. Gaitonde is an Endocrinologist at SCL Health Medical Group

Improving health care value to people with diabetes in Montana should be a top goal of every health care organization in the region.  It is not simply enough to reduce the costs of health care; though for obvious reasons that is critically important in a time when medications and physician visits are increasingly more expensive.  The treatments prescribed by providers need to make a meaningful difference in patients’ lives.

Arguably, what matters most to patients is feeling better and living longer. If medical treatments do not help people live longer or improve their quality of life, then cheaper health care is simply cheap health care.

Persons with diabetes have a lower life expectancy and a greater risk of death from heart disease and stroke. In 2017 the Center for Disease Control (CDC) listed diabetes as the seventh leading cause of death in the United States. The CDC also found that deaths related to diabetes were on the increase. This increase in diabetes-related deaths was one reason why overall life expectancy for the United States population dropped in 2017 (https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_09-508.pdf ).

Today there are several diabetes medications that reduce cardiovascular events like heart attack, stroke, and death from heart disease. The medications are expensive, however, and not without side effects.  More importantly, not every person with diabetes in Montana will experience the same cardiovascular benefit that was seen in the studies that brought the drug to market. This discrepancy in benefit can be explained by a concept known as external validity. External validity says that the results of a single study cannot be broadly and universally applied to every person with a disease simply because they have the same disease as participants in the trial. There are important differences between the person being seen in the exam room and the participant enrolled in a medical study. Better health care value requires that diabetes providers fully understand whether the results of a trial involving 10,000 patients are relevant to the one patient sitting in front of them. 

Critically appraising medical literature is complex and time-consuming.  But a thorough understanding of the benefits, limitations, and shortcomings of clinical trials can save patients money and ensure that they are more likely to experience the desired, intended benefit rather than a well-known side effect. The ability to translate the benefit and risk of a medication from large trial to an individual patient is complex, and unfortunately not always done with accurate and simple language.

Abraham Lincoln was well-known for being able to communicate complex legal and Constitutional terminology into language that both farmer and fellow lawyer could easily grasp. In her book, Leadership in Turbulent Times, Doris Kearns Goodwin wrote that “the key to Lincoln’s success was his uncanny ability to break down the most complex case or issue “’into its simplest elements.’”

Diabetes health care value is truly valuable when medical professionals engage patients in personal, compassionate, and honest conversation that integrates medication cost into achieving realistic and meaningful outcomes that are relevant to the patient’s individual diabetes disease. 

 

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