Prevalence of Self-Reported Obesity

A Patient-Centered PaTH to Addressing Diabetes: Impact of health policies on health outcomes and disparities

PI: Jennifer L. Kraschnewski, MD, MPH

Our current research study, “A Patient-Centered PaTH to Addressing Diabetes: Impact of health policies on health outcomes and disparities” is funded by the Patient-Centered Outcomes Research Institute (PCORI). PCORI is an independent, nonprofit organization that seeks to address questions and concerns most relevant to patients, while including them, their caregivers, clinicians and other stakeholders in the research process. We are thrilled to be working alongside our stakeholder body, comprising of patient partners, clinicians, and community stakeholders representing regional and national organizations within diabetes and obesity. By engaging our talented roster in key research activities, this synergistic partnership ensures researchers are studying questions patients and other stakeholders care most about and strengthens our research through their perspective and experience.

To give you some background on our PaTH to Health: Diabetes study, let’s take a brief look at the literature. You may be aware that overweight and obesity are a big issue in the US. In fact, it’s our number one health concern. Addressing obesity through lifestyle interventions (i.e. healthy eating and increased physical activity) decreases the risk of developing type 2 diabetes, a disease which affects over 29 million people (9.3% of the US population). You may also be aware that diabetes is associated with serious complications, including heart disease, blindness, renal failure and lower extremity amputation. Although complications are preventable with proper medical and lifestyle management, including weight loss, nearly half of patients with diabetes do not have adequate glycemic control.

Recent policy changes and health insurance expansion have resulted in coverage for obesity counseling by Centers for Medicare and Medicaid to improve weight loss for adults either with or at high risk of type 2 diabetes. Beneficiaries whom are obesity are eligible for up to 20 face-to-face visits for weight counseling in the primary care setting. However, whether or not this new benefit has actually helped patients lose weight and better control their diabetes is unknown.

This is where we come in. In our PaTH to Health: Diabetes study, we are looking at Electronic Health Record (EHR) (see video below) and claims data across 3 states to see if obesity counseling has improved weight and diabetes outcomes. For patients with or at risk of developing type 2 diabetes, are they receiving obesity counseling? If so, is it leading to weight loss and better blood sugar control? These are questions we hope to answer by analyzing the data. We are utilizing the PaTH network, which is an integrated research collaboration between Maryland, Pennsylvania, and Utah, to pull EHR data on over 2 million patients with or at risk of type 2 diabetes. Additionally, we are collecting Patient-Reported Outcomes (PRO’s) from each partnering institution, including physical activity levels, fruit and vegetable consumption, social support, and other variables of interest that will help us understand more about diabetes and associated risks.

Image source: Prevalence of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2017:
https://www.cdc.gov/obesity/data/prevalence-maps.html

Data source: Diagnosed vs. Undiagnosed Diabetes in the US:
http://www.diabetes.org/assets/pdfs/basics/cdc-statistics-report-2017.pdf

Diagnosed vs. Undiagnosed Diabetes in the US

Diagnosed Diabetes: 23 million (Blue)
Undiagnosed Diabetes: 7.2 million (Red)