Managing Diabetes with Remote Patient Monitoring in 2024
Diabetes, a chronic condition characterized by abnormal blood glucose regulation, primarily occurs as Type 1 Diabetes (T1D), and Type 2 Diabetes (T2D). In T1D, the body's immune system attacks insulin-producing cells in the pancreas, leading to little or no insulin production. T2D is primarily a result of insulin resistance, where the body’s ability to use insulin effectively is inhibited.
Each instance of diabetes can lead to unsafe levels of blood sugar which, if unmanaged, can cause significant damage to bodily function, including the heart, kidneys, eyes, and nerves. Diabetes is a major risk factor for cardiovascular diseases and other serious health complications, putting further strain on the healthcare system.
According to the American Diabetes Association, individuals diagnosed with diabetes face nearly ∼$16,750 per year of healthcare costs, of which ∼$9,600 is directly attributed to the disease, contributing to the total cost of condition management and lost productivity reaching $327 billion across the U.S.
Digital Health Technologies, including connected medical devices like continuous glucose monitors and digital health platforms like Mozzaz, offer significant improvements in diabetes management. Together these solutions enable remote and continuous monitoring of glucose levels, extending care into the home and providing a wealth of data through other accompanying wellness metrics like activity, nutrition tracking and more.
This technological embrace has resulted in improved connectivity between patients and healthcare teams outside the traditional office setting, enhanced patient engagement, increased touch points between visits, and better overall blood glucose control.
Overview
Telehealth in Diabetes Management
Type 2 Diabetes Management with Digital Health and Remote Patient Monitoring
How Diabetes is Monitored Remotely
Diabetes Diagnosis and Screening
Telehealth in Diabetes Management
Diabetes imparts a significant burden on society through elevated medical costs, reduced productivity, premature mortality, and reduced overall quality of life. Approximately 29.3 million Americans are diagnosed with diabetes, 9.7 million adults have undiagnosed diabetes, and 115.9 million have pre-diabetes. Of those mentioned above, about 95% of individuals are diagnosed with type 2 diabetes, which can often be prevented or delayed with lifestyle adjustments and early detection.
Type 2 diabetes has efficacious prevention options including weight loss, diet modification, and exercise. If exercise and nutrition are insufficient in blood sugar regulation, medications or insulin therapy are straightforward treatments that may be recommended. While the above factors are also helpful for Type 1 diabetics, due to the nature of the condition type 1 diabetics must rely on exogenous insulin to manage their glucose levels.
*Where relevant we will differentiate between improving outcomes for T1D from T2D.
Some of the largest areas for improvement in both treating and preventing type 2 diabetes lie in lifestyle intervention, supporting patients through dietary and nutritional education, early disease detection/screening and improving the access to care and medication.
Mozzaz provides support and enhance all modifications mentioned above through remote patient monitoring.
Type 2 Diabetes Management with Digital Health and Remote Patient Monitoring
Improving prevention and treatment outcomes for those with Type 2 diabetes across the United States requires a multifaceted approach as the condition encompasses genetic, lifestyle, environmental, socioeconomic, and behavioral factors. Digital health tools like continuous glucose monitors (CGMs) and remote patient monitoring through virtual care platforms like Mozzaz can revolutionize Type 2 diabetes prevention and treatment.
How the Mozzaz Platform Helps Improve Diabetes Outcomes
The Mozzaz Platform helps improve diabetes outcomes by:
Enhancing Glycemic Control and Monitoring
Continuous Glucose Monitors (CGMs) offer real-time insight on blood glucose, empowering patients to monitor fluctuations and trends. Digital health platforms bridge this data to care teams, facilitating diet, exercise, and medication adjustments easier while empowering preventative and swift response to potential health issues. By keeping a closer eye on glucose levels, patients can better understand their triggers and improve their glucose regulation.
Improving Patient Engagement and Promoting Self-Management
Providing patients with easy-to-use tools like patient-facing care applications individuals are able to log physical activity, medications, and food intake/nutrition on the go. These tools provide educational resources and personalized feedback instantly and in-between visits, empowering better self-management of type 2 diabetes. Patient-facing apps help to incorporate behavioral treatment such as coaching, goal-setting and reminders to keep patients motivated and adhering to their treatment plans.
Enabling Personalized Care Plans
By incorporating rich data analytics and charting in connected digital health platforms, care team workers are empowered with personalized insights and patterns. This helps to further tailor data-driven treatment plans to individual needs and preferences. Moreso, having real-time data readily available to your care team, dynamic adjustments to medication and lifestyle suggestions can optimize treatment efficacy while reducing the risk of hyper or hypoglycemia.
Elevating Care Coordination and Communication
Enhanced monitoring, availability of data, secure chat, and video functionality through patient facing applications can help close care gaps with patients managing type 2 diabetes. Convenient communication methods encourage patients to stay in regular contact with their care team, allowing for more frequent, impactful conversations without the need for travel.
How Diabetes is Monitored Remotely
At home diabetes monitoring is enabled through cellular or Bluetooth connected glucometers. There are two different types of glucose monitors, include finger-prick tests and continuous monitoring patches. Occasionally additional data points can be collected through RPM devices like smart watches or activity trackers.
The type of health data available from these devices can be found described below:
Glucose Monitors:
A digital glucometer is an electronic, portable device that can measure the glucose in blood through various methods. Standard Blood Glucose Monitoring (BGM) uses a test strip and a drop of blood, whereas continuous glucose monitors (CGMs) use sensors to measure interstitial fluid. These glucose monitoring devices are user-friendly and feature connectivity options for remote monitoring and data sharing with healthcare providers.
Smart Watch:
A smartwatch is an optional accessory to bolster any digital health program, providing a variety of health metrics through the wrist-worn electronic device. These smartwatches are designed to seamlessly integrate with smartphones and other digital platforms, allowing users to track their health metrics, receive real-time feedback, and share activity data with healthcare providers through platforms like Mozzaz.
Some common health metrics gleanable can be found below:
Heart Rate Monitoring: Continuous and on-demand measurement of heart rate, often using optical sensors that detect blood flow through the skin.
Blood Oxygen Saturation (SpO2) Monitoring: Measurement of blood oxygen levels to monitor respiratory health and detect potential issues like sleep apnea.
Electrocardiogram (ECG): Ability to record the heart’s electrical activity, providing insights into heart rhythm and detecting anomalies such as atrial fibrillation.
Sleep Tracking: Monitoring of sleep patterns, including duration, quality, and different sleep stages (light, deep, REM sleep).
Activity and Fitness Tracking: Tracking of physical activities such as steps taken, distance traveled, calories burned, and specific workouts (running, cycling, swimming, etc.).
Stress Monitoring: Assessment of stress levels using heart rate variability (HRV) and other indicators to provide insights into overall well-being.
Body Temperature Monitoring: Measurement of skin temperature to provide insights into body temperature trends and potential health issues.
Additional information can also be attained through in-app and SMS-based tools such as:
Medication Adherence Tracking: SMS reminders or in-app success messaging
Built-In Nutrition Tracking: Patient-facing mobile applications for tracking nutrition.
Push Surveys: Collecting subjective data like mood, pain and more through push surveys.
Diabetes Diagnosis and Screening
The American Diabetes Association (ADA) advises regular diabetes screenings for most adults beginning at age 35, with earlier screening if individuals are overweight or have additional risk factors. Screening guidelines aim to identify individuals at risk early, regardless of physical fitness levels, to prevent complications and promote overall health equity. Type 2 diabetes is easier to manage in the pre-diabetes phase, so such screening is essential in stemming the overall condition burden.
There are several different validated blood tests for diagnosing diabetes and pre-diabetes:
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This method of glucose measurement looks at your average blood sugar over the past two to three months. The results are broken down into the below ranges.
Normal: A1C of less than 5.7%
Prediabetes: 5.7% to 6.4%
Diabetes: 6.5% or greater
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This method of testing checks your fasting blood glucose levels. In this case, the readings are taken after at least 8 hours after cessation of eating or drinking (aside from water). FGP testing is generally done first thing in the morning before breakfast when you are already in a fasted state from sleeping. The results are shown in milligrams per deciliter (mg/dL), this same measurement is provided with continuous glucose monitors.
Normal: less than 100 mg/dL
Prediabetes: 100 mg/dL to 125 mg/dL
Diabetes: 126 mg/dL or higher
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The OGTT is a two-hour method of testing determining your blood glucose levels before and after you drink a specific sweet beverage. The results inform physicians of how your body processes sugar and again provides measurement in mg/dL. The results are broken down as seen in the table below:
Normal: less than 140 mg/dL
Prediabetes: 140 to 199 mg/dL
Diabetes: 200 mg/dL or higher
CMS Reimbursement for Diabetes Management
Reimbursement for remote monitoring of diabetes is most often covered by the following CPT codes, with some specific categories for monitoring the results of continuous glucose monitoring.
Remote Physiologic Monitoring Codes
99453: Remote monitoring of physiologic parameters (e.g., weight, blood pressure, pulse oximetry, etc) initial; setup and patient education on use of equipment. Average national reimbursement rate of $19.32
99454: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s)or programmed alert(s) transmission, each 30 days. Average national reimbursement rate of $50.15
99457: Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes. Average national reimbursement rate of $48.80
99458: Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes. Average national reimbursement rate of $39.65
95249: Personal CGM – Setup and Training - $65.24
Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; patient-provided equipment, sensor placement, hook-up, calibration of monitor, patient training, and printout of recording.
95250: Professional CGM - $147.46
Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; physician or other qualified health care professional (office) provided equipment, sensor placement, hook-up, calibration of monitor, patient training, removal of sensor, and printout of recording.95251: CGM Interpretation - $34.29
Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation and report.
Together, these reimbursement options align to create an environment where care providers are incentivized in establishing digital health offerings to those diabetic patients they serve.
Why Choose Mozzaz for Diabetes RPM
Digital health platforms like Mozzaz, combined with connected medical devices, can significantly enhance diabetes management by offering continuous and personalized care. These technologies support dietary and nutritional education, improve early detection, and provide better access to care and medication. By leveraging technology, we can stay connected with patients and support them in their daily lives, helping them make informed decisions and improve their overall health.