healthcarebriefing.com

Category: Patient Engagement

  • Loneliness And Diabetes: Harnessing an Opportunity for Better Outcomes

    Loneliness And Diabetes: Harnessing an Opportunity for Better Outcomes

    In recent years, health plans have invested heavily in improving diabetes care, with expanded access to medications, continuous glucose monitoring (CGM), and digitally enabled care management programs. Yet despite these advances, only around 40% of adults with diabetes achieve recommended glycemic targets, highlighting that important gaps remain despite substantial advances in diabetes care. 

    If the clinical infrastructure for diabetes care is so much better, but real-world experiences and outcomes are declining, it’s time to consider that there are other powerful factors influencing the ability of people with diabetes to effectively manage their care.

    One important factor may be human connection — or the lack thereof. 

    There’s no question that modern society is struggling with increasing isolation. Nearly one in three adults reports experiencing loneliness, and one in four say they don’t have social or emotional support in their lives.

    This includes over 3 in 10 adults with diabetes, who often find that loneliness increases the challenges of completing daily self-care activities, including monitoring glucose levels, taking medications, and making positive choices around diet and exercise.

    With emerging research suggesting that loneliness may influence how successfully individuals can manage their chronic conditions, health plans need to consider more comprehensive strategies for identifying and addressing members who could benefit most from additional education and engagement.

    How loneliness provides the missing context behind diabetes outcomes

    Healthcare organizations have become increasingly sophisticated in identifying clinical risk. Claims data, utilization patterns, medication adherence metrics, and biometric indicators all provide valuable insights into which members may be struggling.

    However, those data points do not always explain why two individuals with similar diagnoses, treatment plans, clinical profiles, and access to clinical resources can experience dramatically different outcomes.

    Loneliness may help explain part of that difference.

    Unlike social isolation, which refers to limited social contact, loneliness reflects a person’s perception of connection. An individual can be surrounded by family members, coworkers, and community networks while still feeling alone in managing a chronic condition.

    Loneliness can influence motivation, confidence, resilience, and engagement. Together, these factors shape diabetes self-management. Because the vast majority of diabetes care occurs outside the healthcare setting, people must make dozens of health-related decisions every day, often without immediate clinical support. 

    For example, a recent poster presented at the American Diabetes Association Scientific Sessions examined adults with diabetes who initiated CGM as part of a structured education and coaching program. The findings provided important insights into the relationship between loneliness and diabetes outcomes. 

    At baseline, individuals reporting loneliness demonstrated significantly poorer glycemic profiles than those who did not. 

    Average blood glucose levels were nearly 185 mg/dL among lonely participants compared with approximately 162 mg/dL among non-lonely participants. Glucose management indicator (GMI), an estimate of A1C derived from CGM data, was also significantly higher, while time in range was substantially lower.

    In short, participants experiencing loneliness entered the program at a clear disadvantage. What happened next suggests that individuals experiencing loneliness may have the greatest opportunity to benefit from structured education, coaching, and ongoing human support. 

    When participants received structured diabetes education and ongoing coaching from certified diabetes care and education specialists, those experiencing loneliness demonstrated some of the most substantial improvements observed in the study.

    Within three months, average glucose levels declined by more than 34 mg/dL, GMI improved by nearly one percentage point, and time in range increased by more than 17 percentage points.

    While some variation occurred over the remainder of the nine-month study period, outcomes remained improved relative to baseline and narrowed many of the initial differences between lonely and non-lonely participants.

    These findings suggest that loneliness is not simply a marker of poor outcomes, but also a valuable data point that can pinpoint individuals who have the most to gain from meaningful support and engagement.

    The research shows a promising opportunity for health plans to connect with members who may benefit the most from more personalized engagement with experienced diabetes coaches, educators, and clinicians and therefore reduce the delta in outcomes for people with loneliness in their lives.

    Recalibrating how health plans investigate poorly controlled diabetes

    The study highlights the need for a more comprehensive understanding of the underlying reasons a person may be experiencing poor control of their chronic disease.

    When looking at a member who is having trouble maintaining their health, the first questions usually revolve around how to connect a member with medications, CGM devices, and clinical care management resources.

    But if all those are in place and the member isn’t experiencing improvement, it should trigger a deeper dive into the member’s nonclinical circumstances.

    Who helps this person manage their diabetes? Do they have a caregiver, or are they trying to juggle being a caregiver for someone else? Are they socially connected outside of the home? Are they struggling with depression, anxiety, or other mental health conditions? Do they have the health literacy and confidence to participate in decision-making around their own health needs?

    Asking the right questions about community support, caregiving responsibilities, emotional well-being, and the availability of trusted social networks can establish important context for a person’s outcomes — and spark conversations about social needs that might never otherwise take place.

    As healthcare continues moving toward more personalized and holistic models of care, it is important to consider that “success” with diabetes care isn’t just about achieving glycemic control, but also about improving the quality of life for the whole person in multiple dimensions.

    Photo: FrankyDeMeyer, Getty Images

    Coni Dennis

    Coni Dennis DNP, RN, NE-BC, is SVP and Chief Clinical Officer at CCS, where she leads evidence-based chronic care strategies focused on improving outcomes for health plans, providers, and individuals living with chronic conditions. Prior to CCS, she spent 16 years at Humana leading clinical strategy and population health initiatives at scale, providing deep experience across care delivery, quality improvement, and value-based healthcare operations.

    This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.

  • AI Can Flag Cognitive Decline Earlier — Health Systems Still Own What Happens Next

    AI Can Flag Cognitive Decline Earlier — Health Systems Still Own What Happens Next

    A patient completes a brief cognitive assessment during a routine primary care visit. The result shows a pattern associated with possible impairment. It is not a diagnosis, but it is concerning enough to warrant follow up. The neurologist schedule is full. The primary care team is unsure who should explain the finding. The family wants answers that the result cannot yet provide.

    This is the practical test for the next generation of cognitive screening. AI can now detect subtle changes in timing, speech, attention and task performance that may be missed during a conventional visit. Blood based biomarkers are also moving closer to routine clinical workflows. Together, these advances could help identify cognitive decline while people still have more options for treatment, planning and support.

    Earlier detection is valuable, but it creates a duty that does not end when an alert appears in the electronic health record. Health systems need to decide, in advance, how a risk signal becomes a clinically accountable pathway. Otherwise, screening can shift uncertainty from the clinician to the patient without moving either of them closer to care.

    An early signal creates a new clinical state

    A screening result occupies an uncomfortable space. It may be more significant than an ordinary abnormal lab value because it touches a person’s memory, judgment and independence. Yet it remains far less conclusive than a diagnosis.

    That distinction must be preserved. Cognitive performance can be affected by depression, poor sleep, medication, pain, hearing or vision problems, language, education and acute illness. A digital assessment may identify a pattern that deserves attention, but it cannot explain every cause behind that pattern. Even Alzheimer’s biomarkers are used within a broader evaluation. Recent MedCity coverage of blood based biomarkers noted that imaging or cerebrospinal fluid testing may still be necessary for some patients.

    The words used in the chart, patient portal and clinical conversation therefore matter. “Elevated risk,” “possible impairment” and “consistent with pathology” are not interchangeable. A health system should define what each result means, what it does not establish and which next action it triggers. That language should be consistent across primary care, neurology, radiology, laboratory medicine and patient communications.

    Assign responsibility before screening begins

    No cognitive screening program is ready for scale until someone owns the result. The accountable person may be the ordering clinician, a trained nurse, a cognitive care coordinator or a memory clinic team. The model can vary. The obligation cannot.

    The pathway should answer a few operational questions before the first patient is screened. Who reviews the result, and within what period? Which findings call for a repeat assessment, a clinical workup or specialist referral? Who checks for reversible contributors? Who contacts the patient? What happens when the patient cannot be reached or misses the next appointment?

    Primary care teams already face uncertainty when cognitive concerns surface. One MedCity analysis of cognitive screening in Medicare wellness visits described how limited confidence in available data can push clinicians toward referral even when specialist capacity is constrained. Adding a more sensitive tool without clarifying clinical ownership may increase the number of referrals while leaving the underlying uncertainty intact.

    A useful system does not merely flag risk. It routes the result to a person with the authority, time and protocol to act on it.

    Communicate uncertainty as part of care

    Patients should not receive a cognitive risk signal as an unexplained score. At minimum, the conversation should cover three points: what the assessment observed, what the result cannot determine and what will happen next. A concrete date or time range for follow up is more useful than a general instruction to speak with a specialist.

    The timing of disclosure also deserves attention. If a result can appear automatically in a patient portal, the health system should consider whether clinical review or an explanatory message needs to occur at the same time. Learning about possible cognitive decline alone, through unfamiliar language on a screen, can turn a screening program into a source of avoidable fear.

    Family involvement can help, particularly when a relative has noticed changes or supports appointments. It should still follow the patient’s preferences and consent. Caregivers are often treated as an informal extension of the care team, even though healthcare increasingly relies on them to coordinate complex care. They need clear information and defined support, not the responsibility of interpreting an uncertain result on their own.

    Capacity is part of diagnostic quality

    Earlier identification will increase demand for confirmation, counseling and longitudinal care. That demand should be estimated before screening expands. A health system needs to know how many additional assessments it can complete, how long patients will wait and which cases can remain in primary care with specialist guidance.

    New care models may help. NYU Langone’s virtual dementia care partnership was designed to shorten waits for memory care while keeping patients connected to in person diagnostics and treatment when needed. The important principle is continuity. A virtual visit, a memory clinic, a care coordinator or a primary care protocol can all contribute, but the patient should not have to assemble the pathway alone.

    Access must also be tested across language, culture, disability, education and digital familiarity. If a screening tool reaches a broader population but follow up remains available mainly to patients who can navigate complex referrals, the program may identify disparities without reducing them.

    Measure whether the pathway closes

    Model accuracy and the number of completed screens are necessary measures, but they do not show whether patients received care. Health systems should also track the time from flag to clinician review, the time to confirmatory evaluation, missed follow up, unresolved alerts, referral completion and the proportion of patients who understood their result and next step.

    These measures reveal whether early detection is functioning as a clinical service or simply producing more information. They also show where responsibility is being lost between primary care, specialty care and the home.

    AI can bring cognitive risk into view earlier than traditional observation alone. The benefit will depend on what the health system has built around that moment. A mature program is not defined by how many alerts it produces. It is defined by whether every clinically significant alert reaches an accountable professional, a timely evaluation and a conversation the patient can understand.

    Early detection creates more time. Health systems must make sure that time leads somewhere.

    Photo: Andrew Bret Wallis, Getty Images

    Nargiz Noimann

    Nargiz Noimann is a neuroscientist afounder focused on how immersive technology and AI can support cognitive resilience and emotional recovery in clinical and post treatment settings. She has more than 25 years of international experience across neuroscience, psychotechnology, and healthcare innovation, and has studied at institutions including Stanford University. Nargiz is the founder of X Technology, a UAE based healthtech company developing AI powered VR programs designed to support recovery experiences for patients and caregivers. She also leads the Scientific Research Center for Psychotechnologies in Kazakhstan, where her work explores structured approaches to mental resilience, attention, and recovery in high stress and chronic illness contexts.

    This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.

  • Perimenopause Anxiety: Sometimes It’s a Progesterone Deficiency

    Perimenopause Anxiety: Sometimes It’s a Progesterone Deficiency

    When women suddenly start feeling anxious in their 40s, the conversation needs to shift from serotonin and estrogen to understanding what’s happening to their progesterone levels.

    One of the biggest mistakes I see in perimenopause is assuming every symptom is caused by low estrogen. Hot flashes? Estrogen. Night sweats? Estrogen. Vaginal dryness? Estrogen.

    But when it comes to anxiety, irritability, feeling overwhelmed, poor stress tolerance, and that wired but tired feeling many women describe, the conversation often needs to shift. Because in many women, progesterone is the first hormone to decline consistently, making it an important contributor to anxiety and nervous system symptoms.

    The conversation needs to shift beyond estrogen

    Most medical discussions blame estrogen for every perimenopausal symptom, from hot flashes to mood swings. While estrogen levels do fluctuate wildly during this transition, this singular focus leaves women confused when typical estrogen treatments fail to soothe their frayed nerves. Progesterone is one of the most overlooked contributors to emotional stability during perimenopause.

    When progesterone levels drop faster than estrogen levels, it can trigger a spike in anxiety and a fight-or-flight response. This imbalance explains why women suddenly experience panic attacks, heart palpitations, and the inability to handle everyday stress.

    The perimenopause problem nobody explains

    Most women are told that menopause is a gradual decline in hormones, but that’s not actually what happens first. Perimenopause (the long stage prior to menopause) is characterized by hormonal volatility, not simple deficiency.

    During perimenopause, estrogen often fluctuates dramatically from cycle to cycle, while progesterone tends to decline earlier as ovulation becomes less consistent.

    Progesterone is usually the first hormone to decline consistently. Ovulation becomes less predictable. And when ovulation becomes less predictable, progesterone production falls. 

    This is often years before menopause. The result? Many women begin experiencing symptoms long before their periods stop.

    Why progesterone matters for the brain

    Progesterone is not just a reproductive hormone. It’s a neuroactive hormone. One of progesterone’s metabolites, allopregnanolone, interacts with GABA receptors in the brain.

    GABA is the primary calming neurotransmitter system. Think of it as the brain’s brake pedal. When progesterone signaling is adequate, many women experience better stress resilience, improved sleep, greater emotional stability, less irritability, and reduced anxiety.

    When progesterone declines, many women describe feeling wired but tired, more reactive, easily overwhelmed, unable to turn their brain off at night, and more anxious than they’ve ever been before. 

    The problem is that these symptoms are often labeled as purely psychological when there may be a significant hormonal component. As ovulation becomes less frequent, progesterone production declines significantly, reducing one of the brain’s important sources of neurosteroid support for stress regulation.

    Why normal labs don’t always give answers

    This is where many women get dismissed. They are told: “Your labs are normal.” But normal reference ranges do not always explain why someone is experiencing symptoms.

    Looking at a single lab value without understanding hormone signaling, metabolism, and symptoms misses the bigger picture. Hormones influence sleep, neurotransmitters, inflammation, metabolism, and stress response.

    The question isn’t simply: “What is the hormone level?” The better question is: “How is the body responding to that hormone?”

    Anxiety is often a systems problem

    This is why a systems-based approach matters. Progesterone doesn’t operate in isolation. Sleep quality matters. Blood sugar regulation matters. Stress physiology matters. Inflammation matters. And hormone metabolism matters.

    When progesterone declines during perimenopause, these systems often begin to unravel together. What looks like anxiety on the surface may actually be a convergence of hormonal volatility, sleep disruption, cortisol dysregulation, and declining neurosteroid support.

    The real takeaway

    When women in their 40s suddenly develop anxiety and feel like a different person, don’t assume it’s just stress. Stop assuming it’s just aging. And don’t assume it’s all in their heads. 

    Perimenopause is one of the most significant biological transitions a woman experiences. Progesterone is often the first hormone to change.

    For many women, understanding that connection becomes the first step toward getting answers. Because education is the first intervention. And understanding why symptoms happen is often where better outcomes begin.

    Clinicians should help women understand that treatment is individualized and depends on the underlying contributors to their symptoms. For some women, this may include discussing bioidentical progesterone therapy when appropriate. Supporting sleep, addressing chronic stress, optimizing blood sugar regulation, ensuring adequate magnesium intake, and improving overall nervous system resilience may also play important roles. Another focus should be prioritizing magnesium-rich foods to support GABA pathways. Together, these strategies can help improve symptom burden and quality of life while supporting healthier hormonal adaptation during perimenopause.

    Perimenopausal anxiety isn’t simply in our patients’ heads. It’s often the result of complex physiologic changes involving hormones, sleep, metabolism, and the nervous system. When clinicians look beyond estrogen alone and take a systems-based approach, women are more likely to understand what’s happening and receive care that addresses the root contributors rather than simply masking symptoms.

    Photo: kate_sept2004, Getty Images

    Lexi Yoo

    Lexi Yoo, NP, is a double board-certified nurse practitioner and the founder of Yoo Direct Health and YDH Training Academy. Women’s hormone expert, national keynote speaker, and host of The Better Yoo Project Podcast, Lexi is a longevity medicine expert, practitioner mentor, and education-first disruptor challenging outdated standards in midlife and metabolic care to advance a systems-based approach to hormone health, metabolism, and modern longevity care.

    This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.