Up-to-date disease management news and analysis

Disease Management Update
Volume V, No. 38
February 5, 2009

Dear Healthcare Intelligence Network Client,

Recent reports indicate that diabetes and Alzheimer's disease are linked, as diabetics face an increased risk of developing Alzheimer's. In this week's Disease Management Update, researchers find a possible new Alzheimer's application for insulin and discover that diabetics with high glucose levels often experience lower cognitive functioning.

Your colleague in the business of healthcare,
Laura Greene
Editor, Disease Management Update

Please pass this along to any of your colleagues or, better yet, have them sign up to receive their own copy at http://www.hin.com/freenews2.html where you can also learn about our other complimentary news services.

Table of Contents

  1. Insulin Possible New Treatment for Alzheimer’s
  2. Disease Management Q&A: Marketing the Diabetes Medical Home
  3. HealthSounds: Financial Benefit of the Medical Home
  4. Higher Average Sugar Levels Linked to Lower Cognitive Functioning
  5. Survey of the Month: Health & Wellness Incentives Utilization
  6. Obesity & Weight Management: Weighing in on the Growing Epidemic

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1. Insulin Possible New Treatment for Alzheimer’s

Insulin may slow or prevent the damage and memory loss caused by toxic proteins in Alzheimer’s disease by shielding memory-forming synapses from harm. In a study of neurons taken from the hippocampus, scientists at Northwestern University treated cells with insulin and the insulin-sensitizing drug rosiglitazone, which has been used to treat type 2 diabetes. The researchers discovered that damage to neurons exposed to amyloid beta-derived diffusible ligands (ADDLs) was blocked by insulin, which kept ADDLs from attaching to the cells. They also found that protection by low levels of insulin was enhanced by rosiglitazone. The protective mechanism of insulin works through a series of steps by ultimately reducing the actual number of ADDL binding sites, which in turn results in a marked reduction of ADDL attachment to synapses.

“Therapeutics designed to increase insulin sensitivity in the brain could provide new avenues for treating Alzheimer’s disease,” said senior author William L. Klein, a professor of neurobiology and physiology in the Weinberg College of Arts and Sciences and a researcher in Northwestern’s Cognitive Neurology and Alzheimer’s Disease Center. “Sensitivity to insulin can decline with aging, which presents a novel risk factor for Alzheimer’s disease. Our results demonstrate that bolstering insulin signaling can protect neurons from harm.”

“Recognizing that Alzheimer’s disease is a type of brain diabetes points the way to novel discoveries that may finally result in disease-modifying treatments for this devastating disease,” adds Sergio T. Ferreira, another member of the research team and a professor of biochemistry in Rio de Janeiro.

To learn more about this research, please visit:

2. Disease Management Q&A: Marketing the Diabetes Medical Home

Each week, healthcare professionals respond to a reader's query on an industry issue. This week's expert is Roberta Burgess, a nurse case manager with Community Care Plan of North Carolina with Heritage Hospital in Tarboro, North Carolina. Community Care's medical home project dramatically reduced healthcare utilization by patients with diabetes.

Question: What type of marketing message entices diabetics to check out the medical home model?

Response: (Roberta Burgess) Health fairs in the community have been effective for us because we have so many rural communities in North Carolina. Many times, when the hospitals have a health fair and they sponsor it through the church, if it has a diabetic focus and they’re talking about medical homes or conferences, they bring them to their community. That seems to work and gets them more interested. When they focus, when they take the market and bring it to the community through what they’re familiar with, that works best.

Just about every piece of information that we send out, even our printed information that comes from the state, refers to their medical home, not just for diabetes but for their care. Choose your medical home for this and this. Remember your medical home. You have a medical home so they’re hearing it more and more.

For more details on cost savings generated by diabetes medical homes, please visit:

We want to hear from you! Submit your question for Disease Management Q&A to info@hin.com.

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3. HealthSounds Podcast: Financial Benefit of the Medical Home

There are so many benefits to implementing the medical home model, that they more than justify the initial investment needed, says Dr. Charles DeShazer, market medical officer at Humana. These benefits range from a decrease in fragmentation of care to an increase in quality care processes to even allowing physicians to manage their time more efficiently. Dr. DeShazer also discusses the importance of patient involvement, overcoming patient resistance and measuring the success of your medical home.

To listen to this complimentary HIN podcast, please visit:

4. Higher Average Sugar Levels Linked to Lower Cognitive Functioning

The ongoing Memory in Diabetes (MIND) study, a sub-study of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, found that higher levels of hemoglobin A1C levels (a measure of the average blood glucose levels over a 2-3 month period) are significantly associated with poorer performance on three cognitive tasks, which require memory, speed and the ability to manage multiple tasks at the same time. A higher A1C level was also associated with a lower score on a test of global cognitive function

Previous studies have shown that people with diabetes are 1.5 times more likely to experience cognitive decline and dementia than people without diabetes. The MIND results suggest diabetes may be associated with mild cognitive impairment.

“Even a mild impairment in cognitive function is of concern for people with type 2 diabetes,” said lead researcher Dr. Tali Cukierman-Yaffe, of the Gertner Institute for Epidemiology & Health Policy Research, Endocrinology Institute at Sheba Medical Center & Sackler School of Medicine at Tel-Aviv University in Israel. However, these results are cross-sectional so it is not yet known whether higher levels of blood sugar increase the risk for cognitive impairment or whether impairment decreases the ability to control blood sugar levels. This will be answered in the ongoing ACCORD-MIND study, in which study patients are followed over time and are tested three times during the trial. One aim of this ACCORD-MIND follow-up is to test the hypothesis that lowering A1C could result in improved cognitive function.

To learn more about this research, please visit:

5. Survey of the Month: Health & Wellness Incentives Utilization

As more healthcare purchasers and payors use rewards and incentives to drive participation and engagement in health and wellness programs, the industry has noted recent dramatic shifts in incentives use, preferred reward types and the activities for which incentives are offered. Please share your organization's experiences with health incentives and rewards by completing HIN's Survey of the Month. You'll receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.

To participate in this survey and receive its results, please visit:

6. Obesity & Weight Management: Weighing in on the Growing Epidemic

Increasingly, healthcare organizations are creating initiatives aimed at the 67 million obese and 85 million overweight Americans. Read how nearly 300 healthcare professionals told HIN how they are managing — and working to prevent — this growing problem.

To download this complimentary white paper, please visit:
Contact HIN:
Editor: Laura M. Greene, lgreene@hin.com;
Sales & Marketing Coordinator: Deirdre McGuinness, dmcguinness@hin.com;
Publisher: Melanie Matthews, mmatthews@hin.com

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