Disease Management Update
Volume IV, No. 26
October 18, 2007

Dear Healthcare Intelligence Network Client,

On average, one in four American adults suffer from some diagnosable mental disorder in a given year. This week's Disease Management Update takes a look at Alzheimer's and Huntington's diseases as scientists take a few steps closer to potential treatments for the diseases. Visit HIN's Blog to see what the Alzheimer's Association is doing to move towards an end to this disease.

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

If this is a forwarded copy of Disease Management Update and you like what you see, you can register to receive your own copy of this complimentary service. Sign up at: http://www.hin.com/dmdesktop/diseasemanagement.html

Table of Contents

  1. Insulin: Does a Body — and Mind — Good
  2. Disease Management Q&A: Behavior Modification for Specific Diseases
  3. HealthSounds Podcast: Identifying Diabetes Patients & Avoiding Complications
  4. MIND Study Finds Potential Treatment for Huntington's Disease
  5. Survey of the Month: Healthcare Trends in 2008
  6. Changing Lives with Lifestyle Management

1. Insulin: Does a Body — and Mind — Good

Insulin may be as important for the mind as it is for the body. Research has raised the possibility that Alzheimer's memory loss could be due to a third form of diabetes.

Scientists at Northwestern University have discovered why brain insulin signaling — crucial for memory formation — would stop working in patients with Alzheimer's disease. They have shown that a toxic protein found in the brains of these individuals removes insulin receptors from nerve cells, rendering those neurons insulin resistant. The study sheds light on the emerging dea of Alzheimer's being a “Type 3” diabetes.

The new findings could help researchers determine which aspects of existing drugs now used to treat diabetic patients may protect neurons from amyloid ß-derived diffusible ligands (ADDLs) and improve insulin signaling in individuals with Alzheimer's.

To learn more about the findings of this study, please visit:

2. Disease Management Q&A: Behavior Modification for Specific Diseases

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Richard Citrin, vice president of EAP Solutions*, Sean Sullivan, president and CEO, Institute for Health and Productivity Management on theories, application and results of behavior modification and patient engagement strategies, and Greg Lehman, president and CEO of Inspiris.*

Question: In the organizations that have been working on behavior modification, which diseases have you focused on and what was the criteria used in choosing these diseases?

Response: (Richard Citrin) For Corphealth* there are two: depression and behavioral health disease management. But in our health coaching program, we don’t focus on a specific disease. We’re trying to identify sets of health behaviors that members engage in. This might be chronic disease management, which includes their interactions with the healthcare system and how well they communicate with their physician. For example, we look at health and lifestyle behaviors they engage in as well as stress emotions. We tend to focus on the bigger picture as opposed to looking at a specific disease process.

(Sean Sullivan) We’re finding, in talking to employers, that we need to organize things into a slightly larger picture for them. For example, if you think about pre-diabetics and diabetic risks, there are many connections to cardiovascular risks, hypertension, hyperlipidemia, and of course to obesity, which is now the national rage. We are trying to organize that whole cluster into what we call “metabolic health” so we can think in larger terms about a diversity of factors that ultimately add up to healthy metabolism.

(Greg Lehman) Many organizations are focusing on two categories of disease states: those that are low in frequency but high in costs, like end-stage renal disease, and those that are higher in frequency and moderate cost disease states, such as heart disease, diabetes and asthma. Many companies in the market are focused on the latter. The list of common conditions can include heart disease, diabetes, chronic obstructive pulmonary disease, asthma, stroke, migraine, low back pain or other musculoskeletal problems. The market is evolving, and we’re being asked to add more competencies based on the prevalence of conditions identified not only from claims analysis but also as a result of stratification from the health risk assessments.

*Note: At the time of this discussion, Citrin was vice president of health and productivity at Corphealth Inc. and Lehman served as president and CEO of Gordian Health Solutions.

For more details on behavior modification for specific diseases, please visit:

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

3. HealthSounds Podcast: Identifying Diabetes Patients & Avoiding Complications

In this week's disease management podcast, David Larsen, director of quality improvement at SelectHealth, provides a brief overview on how technology is having a big impact on performance improvement and HEDIS results at SelectHealth. Larsen and Dr. Jaan Sidorov, medical director with Geisinger Health Plan, describe how their programs identify potential members for diabetes DM programs, the interventions given and the impact these programs have on patient outcomes and the bottom line.

To listen to this complimentary HIN podcast, please visit:

4. MIND Study Finds Potential Treatment for Huntington's

MassGeneral Institute for Neurodegenerative Disease (MIND) researchers have identified a compound that could protect against the effects of Huntington's Disease (HD). A small molecule called C2-8 appears to delay the loss of motor control and reduce neurological damage lab mice.

C2-8 was first identified as a possible treatment for HD based on its ability to block the aggregation of the mutant huntingtin protein in yeast and animal tissue and to improve function in fruit flies. The current study was designed to further investigate its potential as a therapeutic drug. The researchers first confirmed that oral doses of C2-8 can cross the blood-brain barrier and are nontoxic in a mice with HD. They also found that C2-8 does not interact with a number of molecules predictive of negative side effects.

HD mice that were treated with C2-8 starting at the age of 24 days scored significantly better on tests of strength, endurance and coordination than did HD mice that did not receive the molecule. While treatment significantly delayed progressive motor disability, the animals receiving C2-8 did not live longer. Examination of brain cells from the striatum, where the deterioration of HD occurs, showed that treated mice had less shrinkage of brain cells and smaller aggregates of huntingtin protein than did untreated HD mice.

To see more of this study's results, please visit:

5. Survey of the Month: Healthcare Trends in 2008

Complete our survey on healthcare trends in 2008 and you'll get a free executive summary of the compiled results.

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

6. Changing Lives with Lifestyle Management

Abandoning long-standing behaviors that are detrimental to one’s health is no simple feat, but it is necessary for an increasing number of people with life-threatening conditions such as diabetes, heart disease and obesity. This is why healthcare organizations are aiding such undertakings with lifestyle management (LM) programs. This executive summary provides the general character of more than 60 such initiatives, including the differing approaches and techniques in identification, treatment and outcome assessment.

To download this complimentary white paper, please visit:
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