PHIConnect CDC Center of Excellence in Public Health Informatics

The  TuAnalyze  project  

 Mission  -­‐-­‐  To  empower  people  touched  by  diabetes  to  track,  share  and  compare  their  health  informa=on  for  research  advancing  diabetes  care  and  public  health  response  

  TuAnalyze  is  a  so.ware  “app”  developed  for  TuDiabetes  

  TuAnalyze  launched  May  2010  in  English,  December  2010  in  Spanish  

  TuAnalyze  supports  reporEng  &  sharing  of  diabetes  informaEon  

  Data  are  used  in  aggregate  community  reports,    in  charts  and  maps  generated  for  the  community,  and  in  public  health  research  

  The  project  is  led  by  faculty  from  Children’s  Hospital  Boston  and  Harvard  Medical  School  in  collaboraEon  with  the  Diabetes  Hands  FoundaEon,  with  funding  from  the  US  Centers  for  Disease  Control  and  PrevenEon  

In collaboration with:

PHIConnect CDC Center of Excellence in Public Health Informatics

Early  results:  Who’s  using  TuAnalyze?  

  So  far  20  US  states  and  2  Canadian  provinces  have  reported  enough  A1c  values  to  “light  up”  these  map  regions    

  ArgenEna,  Spain,  Great  Britain  and  several  Mexican  states  are  geQng  close.  

       1  in  10  TuDiabetes  members  using  TuAnalyze  (about  1700  users)  

         Users  from  43  countries  and  all  50  US  states  are  parEcipaEng  

In collaboration with:

PHIConnect CDC Center of Excellence in Public Health Informatics

Glycemic  control  in  the  community  TuAnalyze  is  the  first  online  social  network  based  repor=ng  

system  for  A1c—a  key  measure  of  diabetes  control    

  The  average  A1c  of  TuAnalyze  users  is  6.9%  

  A1c  ranges  from  4.0%  to  13.7%  

0%  

5%  

10%  

15%  

20%  

25%  

30%  

35%  

40%  

5%  or  lower   6%   7%   8%   9%   10%   11%   12%  or  higher  

%  of  Total    

A1c    Value  Among  1453  Users  

Frequency  Distribu=on  of  A1c%  Among  TuAnalyze  Users  

In collaboration with:

PHIConnect CDC Center of Excellence in Public Health Informatics

Glycemic  control  in  the  community    Most  users  (>  80%)  are  reporEng  current  A1c  values    

  As  app  use  has  increased,  users  with  a  wider  range  of  A1c  have  begun  parEcipaEng—providing  a  more  complete  picture  

  1  of  4  users  have  entered  more  than  one  A1c  into  TuAnalyze  

  Users  who  are  updaEng  their  A1cs  with  new  values  are,  on  average,  reporEng  lower  A1c  values  over  Eme  

August  2010   December  2010  May  2010  

In collaboration with:

PHIConnect CDC Center of Excellence in Public Health Informatics

US  na=onal  comparison    Among  users  with  diagnosed  diabetes,  the  average  A1c  reported  by  US  

TuAnalyze  users  is  lower  than  the  average  A1c  esEmated  from  a  US  naEonal  health  reporEng  system*  (avg.  A1c  respecEvely,  6.7%  vs.  7.3%)  

  A  close  look  shows  different  A1c  distribuEon  in  the  two  groups  

0%  

5%  

10%  

15%  

20%  

25%  

30%  

35%  

40%  

45%  

5%  or  lower   6%   7%   8%   9%   10%   11%   12%  or  higher  

Percen

t  of  total  with  given  A1c  

Rounded  A1c  340  par=cpants  from  TuAnalyze  and  704  from  NHANES  

TuAnalyze  

NHANES  

In collaboration with: *2007-­‐08  NaEonal  Health  and  NutriEon  

ExaminaEon  Survey  (NHANES)  

PHIConnect CDC Center of Excellence in Public Health Informatics

TuAnalyze  survey  

Among  this  group:      60%  are  female  

  Average  age  is  44,  age  ranges  from  14-­‐81  

  Average  A1c  is  6.75%  

  A1c  does  not  differ  by  age,  diabetes  type,  or  by  dura5on  of  diagnosis   Type  1  

62.7%  

Type  2  26.1%  

LADA    10.5%  

Pre-­‐Diabetes  0.7%  

Diabetes  Type  Among  Survey  Par=cipants  

Among  437  Survey  ParEcipants    

In collaboration with:

1  in  3  TuAnalyze  users  has  taken  the  1st  TuAnalyze  survey,  so  far!  

PHIConnect CDC Center of Excellence in Public Health Informatics

Type  1  Diabetes       Average:  

•   A1c  6.75%  •   Age:  42  •   Age  at  diagnosis:  17  

   74%  use  a  pump     Most  important  treatment:  

•   Pump  (70%)  •   InjecEons  (23%)  

Type  2  Diabetes     Average:  

•   A1c  6.77%  •   Age:  52  •   Age  at  diagnosis:  44  

   48%  on  insulin;  23%  of  those  use  a  pump     Most  important  treatment:  

•   Diet  (39%)  •   Insulin  injecEons  (25%)  LADA  Diabetes  

 Average:  •   A1c  6.8%  •   Age:  51  •   Age  at  diagnosis:  40  

   69%  use  a  pump     Most  important  treatment:  

•   Insulin  pump  (61%)  •   Insulin  injecEons  (28%)  

In collaboration with:

PHIConnect CDC Center of Excellence in Public Health Informatics

Caregivers  in  TuAnalyze  

8%  of  survey  par=cipants  use  the  TuAnalyze  applica=on  on  behalf  of  a  loved  one  with  diabetes  

   89%  of  them  are  using  the  applicaEon  for  a  child  

   60%  spend  at  least  7  hours  per  week  helping  with  their  loved  one’s  diabetes  care  

   91%  are  the  primary  medical  liaison  for  their  loved  one  

In collaboration with:

PHIConnect CDC Center of Excellence in Public Health Informatics

   32%  of  survey  parEcipants  report  obtaining  all  five  recommended  care  pracEces  

44.6%  

68.7%  

90.2%   86.0%  

69.1%  

0%  10%  20%  30%  40%  50%  60%  70%  80%  90%  

100%  

%  of  Survey  Respondents  who  Follow  ADA  Care  Guidelines*    

*  The  American  Diabetes  AssociaEon  recommends  that  all  persons  with  diabetes  receive  a  yearly  flu  vaccinaEon,  cholesterol  check,  foot  exam,  dilated  eye  exam,  and  a  one-­‐Eme  pneumonia  vaccinaEon.        

Preven=ve  Care  

In collaboration with:

PHIConnect CDC Center of Excellence in Public Health Informatics

64.8%  

47.7%  50.6%  

31.6%  

50.1%  

0%  

10%  

20%  

30%  

40%  

50%  

60%  

70%  

%  of  S

urvey  Re

spon

dents  

Care  Behavior  

Frequency  of  Care  Behaviors  

Check  their  blood  glucose  5+  Emes  per  day  

Check  their  blood  glucose  before  driving  

Saw  a  DNE  in  the  last  year  

Saw  a  nutriEonist  in  the  last  year  

Saw  their  diabetes  physican  4+  Emes  in  the  last  year  

Self-­‐Care  Behaviors  and  Medical  Visits    

In collaboration with:

PHIConnect CDC Center of Excellence in Public Health Informatics

Challenges  in  the  Community  

8.9%  

37.5%  

14.9%  

28.2%  

19.7%  

37.1%  

0%  

5%  

10%  

15%  

20%  

25%  

30%  

35%  

40%  

Frequency  of  Health  Challenges  in  the  Survey  Popula=on  

%  of  survey  respondents    

   2  of  3  survey  respondents  report  at  least  one  challenge  

In collaboration with:

PHIConnect CDC Center of Excellence in Public Health Informatics

What’s  Next?  

Brief,  targeted  surveys  on  specific  topics,  such  as:  

•     ConEnuous  Glucose  Monitoring  

•     Pump  and  device  use  

•     Hypoglycemia  

•     Women’s  reproducEve  health  and  diabetes  

In collaboration with:

Thank  you  to  everyone  who  has  par=cipated  in  TuAnalyze!      By  contribu=ng  your  data,  you  have  provided  an  invaluable  

window  into  the  TuDiabetes  community.  

Our  research  is  ongoing:  if  you  haven’t  yet  used  TuAnalyze,  we  invite  you  to  join,  enter  your  A1c  and  take  the  survey  at  hkp://tud4.us/TuAnalyzeProfile  .