Carbohydrates Kill: A Conversation with Tim Noakes

Tim NoakesTimothy Noakes is Chair of Exercise and Sports Science at the University of Cape Town, South Africa — and he will be speaking at Diabetes Innovation 2013. He has Type 2 diabetes and has made a very public about-face in nutrition recommendations. His book on running — a perrennial best-seller — had recommended a high-carbohydrate diet, but Noakes, an ultramarathoner, realized the diet was harming him, and also realized that he had developed T2D. He credits Jeff Volek — another Diabetes Innovation speaker — and others with bringing him to realize that for himself and for other people with diabetes a high-carbohydrate diet is a dangerous thing.

As far as I am concerned it is clear cut, the evidence in my view is that the more insulin resistant you are, in other words the more you are likely to have diabetes, or if you have diabetes there is no question, you do not need carbohydrates in the diet and the less carbohydrates you eat the healthier you will be. To me there is no debate; the problem is that in my view the drivers of the high carbohydrates diets are political and economic. They are not medical and scientific and unfortunately the solution of this problem is a political one — it’s not a medical solution.

Please have a listen to our wide-ranging conversation, touching on diabetes, diet, and the politics and economics of the food supply.

Listen in to our conversation (press play); read the transcript below.

Tim Noakes, Chair of Exercise and Sports Science, University of Cape Town, Diabetes Innovation Interview 08 2013 [Read more...]

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Population Health in a Post-Fee-For-Service World, with Grace Terrell at Cornerstone Health Care

Grace TerrellAre you ready to escape the “tyranny” of the 15-minute office visit?

Grace Terrell is the CEO of Cornerstone Health Care, a 250-physician, multi-site, multispecialty group practice in the Piedmont Triad region of North Carolina; it’s an Accountable Care Organization, and it is in value-based contracts with 100% of its commercial payors. Spread out over 85 different practice sites in a largely rural area, it sees 250,000 patients annually. All of these factors come together in a way that allows Cornerstone to practice population health, and to address chronic disease in a holistic manner that is not usually done in a traditional fee-for-service practice.

In discussing cost and quality, Dr. Terrell focused on diabetes:

One of the things, obviously, that is one of the biggest challenges in population health has to do with diabetes and its enormous impact that it has on quality for life for patients and its increasing prevalence, particularly as the population is aging.There’s not a contract out there that we have that doesn’t focus on diabetes as the first and foremost population health issue to tackle within the context of both the cost as well as looking at quality parameters.So a lot of the focus that we have seen has been evaluating what sort of ways we can put things in place to really address that part of our patient population.

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Give the people what they want: Alan Glaseroff’s radical approach to patient empowerment

Alan Glaseroff MDIf you were to show up in Alan Glaseroff’s office as a person with diabetes and, let’s say, numerous complications, putting you into that group of 5% of Americans whose care consumes 50% of the national health care spend, he would ask you: What bothers you the most? in order to start developing a patient-centered plan of care. The visit would likely end with a discussion of the question: If things go well, what do things look like a year from now? What are your goals?

By focusing on the patient’s goals, and developing a multi-pronged approach to helping patients achieve those goals, Glaseroff and his team are able to introduce behavior change that will improve a patient’s health, and help patients achieve better-than-avergage adherence to new, healthy behaviors, and a significant reduction in the burdens of disease. Glaseroff says:

[To quote] Don Berwick . . .  “People need to become citizens in the improvement of their own work.” . . . I think self-management is the similar idea that patients need to become citizens in the improvement of their own health — [as] subjects rather than objects  . . . . [This can allow] you [to] design very specific workflows for patients that much better meet their needs than telling people what to do — which is usually the model of medicine practiced in the context of chronic illness.

Join Alan Glaseroff at Diabetes Innovation 2013, and hear more about his patient-centered approach to primary care and chronic disease management.

Have a listen to our interview (press play); read the transcript after the jump.

Alan Glaseroff MD (Stanford Coordinated Care) Diabetes Innovation Interview 08 2013

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Wellaho CEO Naser Partovi Presents a Prescribable App

PartoviThere are thousands of wellness apps in the app store. When we asked Naser Partovi what sets Wellaho apart from the crowd, allowing it to help individuals manage chronic conditions, he had a three-part answer:

1.  It’s a prescribable app, connecting patient and clinician, sending individually-configured alerts to the clinician as appropriate.

2.  It’s been validated through numerous clinical trials.

3.  It’s personalized medicine — the app is configured to reflect an individual’s history and experience (e.g., diagnosed with diabetes 10 years ago, not taking insulin).

For conditions subject to the preventable readmission rule, Wellaho customers are the hospitals that would be on the hook financially for a readmission: the hospital is the party most interested in preventing the readmission because it will not be able to bill for the readmission if it is for a condition on the Medicare list (currently COPD, pneumonia and acute myocardial infarction). For other conditions, the customer is the insurance company covering an individual with a chronic condition.

Join Naser Partovi at Diabetes Innovation 2013, and hear more about Wellaho — and a new soon-to-be unveiled product as well.

Have a listen to our interview (press play); read the transcript after the jump.

Naser Partovi (Wellaho) Diabetes Innovation Interview 08 2013

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Dexter Shurney MD promotes a 360-degree approach to lifestyle change to manage chronic disease

Dexter ShurneyWorksite clinics providing intensive lifestyle interventions are good business for some forward-thinking employers. They lead to measurable improvement in the health status of employees with chronic conditions, and — in the case of Cummins, Inc., according to CMO for Global Health & Wellness, Dr. Dexter Shurney — some of the key interventions tend to pay for themselves within six months.

The health status improvement also tends to not be limited to the chronic disease that is the subject of the intervention. Diabetes interventions lead to improvements in diabetes (some people with diabetes going off insulin entirely), but also to improvements in controlling hypertension, cholesterol and other conditions.

Come hear Dr. Shurney discuss his experiences in implementing these interventions at Diabetes Innovation 2013.

Dr. Shurney used the metaphor of a vegetable garden in our conversation: If you have a healthy plant, it’s because: “The roots are healthy. The stem is healthy. The leaves are healthy and it bears good fruit.” Changing the overall environment, through the heavy lifting done in the primary care medical homes at the Cummins worksite clinics, yields improvement across multiple conditions.

(Listen to our conversation, and read a transcript, after the jump.) [Read more…]

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A teenager takes control: Hadley George

hadley georgePlenty of people with diabetes struggle with the daily rituals involved in keeping themselves healthy.

Not everyone — and certainly not all fourteen-year-old girls with Type 1 diabetes — have the wherewithal to recognize the burnout, decide to take action, and begin to build a local community group of peers with diabetes.

That’s exactly what Hadley George did.

When I asked her what she’s looking forward to about Diabetes Innovation 2013, she answered:

This is not an experience that kids of my age normally get. I’m only fifteen years old and I get to do this, so I am very blessed. I hope that people hear my story and maybe will start something like this in their town. And I also hope that it will give hopes for people who have children with Type 1 that it’s not the end of the world and that great things can come out of it. Because I would say that, I am very — I know this sounds weird, but I am very glad that I have Type 1, because it’s really given me a different outlook on life. And although in November and December, I wasn’t really thinking this, now I have gotten so many new friends and it’s just really changed my life for the better.

Listen in on our conversation now, and come hear Hadley discuss community building at Diabetes Innovation 2013.

Read the full transcript after the jump.

Hadley George Diabetes Innovation Interview 08 2013

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College Diabetes Network CEO Christina Roth Networks with Diabetes Innovation

christina rothCollege Diabetes Network (CDN) founder and CEO Christina Roth has diabetes. When she was a college student she found that she didn’t have an adequate support system, so she built one for herself, and created the infrastructure for students on other college campuses to do the same.

Fast forward to the present, and she is at the helm of a growing not-for-profit organization dedicated to providing the tools necessary to empower persons with diabetes who happen to be college students — going through what is often a challenging time for anyone, not just someone living with a chronic condition requiring monitoring and self-care — to share experiences, share tips (medical advice is moderated by medical professionals) and more, using the existing infrastructure of public social media sites, as well as the CDN website and blog. The organization now offers resources for parents of college-age children with diabetes as well.

In building this ecosystem of support, Christina has focused in part on providing curated advice from medical professionals in a manner that can be accessed easily by college students, but the secret sauce is the peer support network that CDN is building out on line and in the real world (chapters established on over thirty campuses across the US and Canada in just four years, starting when Christina was an undergrad).

Have a listen to our conversation, which clocks in at about fifteen minutes.  Come hear Christina talk about CDN at Diabetes Innovation 2013.

Read the transcript after the jump.

Christina Roth Diabetes Innovation Interview 08 2013

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DI speaks with Rushika Fernandopulle, CEO of Iora Health: Managing chronic disease with primary care on steroids

Rushika F I recently spoke with Rushika Fernandopulle, co-founder and CEO of Iora Health, a company based in Cambridge, MA which is building “an entirely new model of primary care.” He will be a panelist at Diabetes Innovation 2013.

In order to improve the health care system, Rushika says we can’t fiddle around the edges. Instead we must take bold steps and start from scratch, beginning with three key elements: (1) Payment redesign, (2) Delivery system redesign, and (3) Health IT systems redesign.

Iora Health has started from scratch and has reinvented primary care for the populations it manages on behalf of large self-insured employers. Rushika acknowledges that he can’t do it alone (even though his company got a nice infusion of capital earlier this year), and wants Iora Health’s model to be emulated by others even as the company expands its reach within its existing geographic markets. The secret sauce is an intensive primary care service staffed with health coaches in addition to the usual suspects. The primary care service costs participating employers about twice as much as typical primary care services, but the results are anything but typical. In fact, they result in a net health care cost savings in the 15% range.

(Listen to our conversation, and read a transcript, after the jump.) [Read more…]

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Diabetes Innovation Gets to “Ask Manny” Hernandez a Few Questions

Manny HernandezI spoke with Manny Hernandez (@askmanny) about the diabetes online communities he founded at TuDiabetes (Engligh) and EsTuDiabetes (Spanish) — which include tens of thousands of people with diabetes and their family members — as well as his experience attending Diabetes Innovation last year, and his thoughts on communications regarding diabetes.

Manny was a keynote speaker at last year’s conference and will take part in a social media panel discussion this year.

I asked him whether social media can play a role in effecting clinical improvements in diabetes management, and he pointed to the Big Blue Test, an initiative of his Diabetes Hands Foundation. He’s presented data from this project at the American Diabetes Association annual meeting: Folks who participate by posting their blood glucose readings before and after 15-20 minutes of exercise, and engaging in online conversation, see long-term benefits in terms of better management of their conditions. (The before-and-after glucose readings showed a 20% drop on average.) Over 40,000 PWD have participated to date. Look for a social media campaign this fall to promote participation in the Big Blue Test in the month leading up to World Diabetes Day.

(Listen to our conversation, and read a transcript, after the jump.) [Read more…]

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Viridian Health CEO Brenda Schmidt talks multi-modal disease management with DI

BrendaSchmidt_1We caught up with Viridian Health CEO Brenda Schmidt after the American Diabetes Association meeting in Chicago where Viridian and Omada Health announced a partnership to launch “the first multimodal lifestyle offering to address the national diabetes epidemic.”

Viridian is scaling its national diabetes program through lifestyle coaches and technology, partnering with Omada Health to provide a social support structure in a virtual environment that mimics the National Diabetes Prevention Program. The power of the partnership lies in the ability to offer individuals choices about how they receive their services: through bricks and mortar sites, or virtually.

(Listen to our conversation after the jump.) [Read more…]

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