Diabetes

This physician gets a leg up on diabetes prevention referral

As an internist and private practice owner in San Francisco, Mark Savant, MD, knows that technology is essential to advancing medicine and helping patients. He just needed to find the right organization to help. It was an introduction from one of his patients to a Silicon Valley-based preventive chronic care company that would change the way Dr. Savant identified and enrolled patients with prediabetes into a diabetes prevention program (DPP).

The AMA’s Diabetes Prevention Guide supports physicians and health care organizations in defining and implementing evidence-based diabetes prevention strategies. This comprehensive and customized approach helps clinical practices and health care organizations identify patients with prediabetes and manage the risk of developing type 2 diabetes, including referring patients at risk to a National DPP lifestyle change program based on their individual needs.

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During its initial pilot phase, this 22-session diabetes prevention program is delivered to patients in their own neighborhood at no charge during the pilot. The program, facilitated by certified coaches, focuses on small and sustainable lifestyle changes aimed at reversing prediabetes. Patients attend sessions once a week for four months, followed by biweekly meetings, and then monthly sessions.

In February, Dr. Savant started working with First Mile Care, a spinoff of the AMA-launched Silicon Valley innovation enterprise Health2047 Inc. First Mile Care has an ambitious plan: to create a digitally connected network of diabetes-prevention coaches across the nation’s 42,000 ZIP Codes and prevent up to 50 million cases of prediabetes by making the clinically proven DPP conveniently available to all 84 million Americans living with prediabetes.

To refer patients to the DPP, Dr. Savant’s team contacts First Mile Care directly. The team will then reach out to the patients to attend classes, which are held within a 10-minute drive of patients’ homes. A coach with local knowledge of neighborhood resources leads classes and fosters community-based, peer-to-peer connections.

Since the partnership began, First Mile Care reached out to 100% of Dr. Savant’s at-risk patients, enrolled 60 patients in the first 90 days, and maintained a retention rate of more than 80%. Operating as an extension of Dr. Savant’s practice, the First Mile Care program enabled him to deliver hyperlocal patient support and lifestyle change management in a way that was not previously available.

“It’s time that’s the real challenge for primary care physicians,” Dr. Savant said. “It’s just having the time to talk to people.”

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Culture’s role

Dr. Savant finds that his cultural background—his father’s family is French and his mother’s family is Chinese and Indian—is an asset in his diabetes-prevention referral efforts.

“With some cultural sensitivity and culinary interest there can be a significant impact made in people’s lives that doesn’t require writing metformin or writing any of the diabetic medications,” Dr. Savant said.

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“All the things I was telling people not to do were the things that were just opposite of what I knew from both of my cultural histories in terms of food, and it just didn’t seem right as I saw people getting heavier with more incidence of diabetes,” he added.

Patient power

When referring a patient to a DPP, it is important to provide a thorough explanation as to why this is needed.

“First off, I tell them they don’t have diabetes, but that their lab work and vital signs are telling us that they’re pointing in that direction,” he said. “If we don’t do anything, this is a path you’re heading down.”

While many patients already know about type 2 diabetes because of family history, many think it is set in stone. But Dr. Savant tells patients they have the ability to change where their health path is headed.

“It’s not a foregone conclusion. There are choices that can be made here,” he said. The talk aims to give “people not only the power—but give them the confidence—to be able to do that.”