Why People with Diabetes are Hit Harder by COVID-19—And How to Help Them

As we continue to learn more about COVID-19 and its long-term effects, it’s clear that those with existing conditions or more compromised immune systems will have a harder time fighting the disease, leaving patients with chronic conditions such as diabetes at increased risk. CDC data indicates that among individuals who have died from COVID-19, more than three-quarters had at least one pre-existing condition, with four in 10 patients having diabetes as an underlying condition. When accounting for people younger than 65 who died from COVID-19, approximately half had diabetes. Research suggests that people with diabetes may have weakened immune systems, leaving them less equipped to quickly recover from illnesses. Particularly when uncontrolled for a long period of time, diabetes can cause inflammation—further negatively affecting the immune system.

Pandemic aside, patients with uncontrolled diabetes are at greater risk of heart disease, stroke, kidney failure, infection, and diabetic ketoacidosis. These conditions often require emergency attention and hospitalization, resulting in significantly increased treatment costs. Of the $237 billion dollars spent in direct medical costs for diabetes in the United States each year, 30% accounts for hospital inpatient care. Moreover, only 50% of Americans achieve good glycemic control, leaving the remainder at risk for diabetes complications as A1c levels rise above 6.5. During COVID-19, in-person healthcare services are not only less accessible, but also less safe.

Poor adherence to long-term therapies is the most significant modifiable factor limiting effective chronic disease management. Studies indicate that patients with chronic diseases take only half of their medication as prescribed, resulting in serious health consequences including disease progression, ED visits and hospitalizations, and even death. Particularly during the pandemic, we know that improving medication adherence can not only help avoid human suffering, but also mitigate excess economic costs associated with increased use of healthcare services.

Improving Adherence By Focusing on a Different Metric

When discussing adherence, the industry is completely confused about what the term even means. The true definition of medication adherence is the extent to which a patient takes their medication as prescribed. Yet when payers, pharmacies, and manufacturers speak about adherence, they refer to whether or not a patient has filled or refilled their prescription. In other words, they are indicating whether or not a patient is generating revenues for pharma.

The industry has long used Medication Possession Ratio (MPR) or Proportion of Days Covered (PDC) as a standard measure, but possession does not equal ingestion. Instead, companies may want to consider a validated, decades-old public health solution called Directly Observed Therapy (DOT), a process for challenging cases in which a brief medication management appointment is held at each dose of medication.

DOT not only ensures that patients have medication, but also helps them actually take their medication properly. This process does not need to take place in-person and can be digitized—making it possible to measure adherence as the proportion of doses actually taken while surrounding the patient with AI-enabled nurses, pharmacists, and healthcare workers. Virtual programs could include direct observation to confirm ingestion and adherence, daily engagement and support, and targeted clinical interventions.

Those with diabetes and other chronic conditions such as asthma, COPD, and congestive heart failure are at much higher risk during the pandemic, with high potential for complications in those who survive a COVID-19 infection. An immediate priority must be to help these patients manage their conditions in order to slow or reverse the compounding effects of COVID-19. Medication adherence to prescribed regimens is quite literally “what the doctor ordered,” and can effectively support health plans, providers, and patients, achieving improved and desired outcomes for every stakeholder in healthcare.

  • Sebastian Seiguer

    Sebastian Seiguer is CEO of emocha Health, a digital health startup backed by Johns Hopkins. emocha solves medication adherence through a CDC-endorsed, validated model called Directly Observed Therapy (DOT), which is the only technique proven to consistently secure adherence rates greater than 90%, and address behavior issues, medication problems, and social determinants through daily interaction. As CEO, Sebastian is responsible for overall company strategy and management.


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