Science

Research Foundations & Clinical Results

1. Treating psychological insulin resistance in type 2 diabetes. (2017) Journal of Clinical and Translational Endocrinology.
   This paper describes a common, but often missed or unmanaged clinical problem related to insulin therapy initiation or intensification to improve diabetes control for patients failing clinically on lifestyle management and pills or basal insulin alone. This paper highlights practical clinical strategies for common insulin therapy barriers, including tailored patient education content and support that can be highly scalable across mobile and web channels. This work was instrumental in the development of Silver Fern’s Insulin Therapy Module.
   
   
2. Reducing social distress for chronic disease patients in primary care. (2017) Diabetes Spectrum.
   This paper describes a social determinants of health (SDoH) assessment developed by Dr. Welch that was used by front-line clinician teams in a busy community health center. The assessment allowed clinicians to quickly refer high-risk diabetes patients with identified SDoH issues to social support services and resources in the care network and community. The assessment and referral process were found to be acceptable to clinicians working with a Latino population with diabetes, and the use of the SDoH assessment and intervention were associated with improved HbA1c and quality of life outcomes. This study informed Silver Fern’s development of the Social Functioning Module.
   
   
3. Psychosocial care for people with diabetes: A position statement of the American Diabetes Association. (2016) Diabetes Care.
   This position paper from the American Diabetes Association outlines for front-line clinical teams a comprehensive diabetes team approach to assessing and managing key psychosocial issues that can improve patient engagement in treatment and patient health outcomes. Dr. Welch was part of the broader ADA workgroup that developed several clinical reference books and reviews, which led to the development of these 2016 ADA guidelines. The ADA specifically incorporates a recommendation that both diabetes distress and depression should be screened for and managed on a routine, annual basis for all diabetes patients. The CDC provides a similar recommendation.
   
   
4. An internet-based diabetes management platform improves team care and outcomes in an urban Latino population. (2015) Diabetes Care.
   This paper highlights a “diabetes dashboard” software application developed by Dr. Welch and his clinical team. The dashboard focused on care provided by the diabetes team and the systematic assessment and management of common upstream behavior and psychosocial issues such as diabetes distress and depression. It also evaluated other patient engagement and treatment adherence issues. The results showed that use of this patient assessment toolset and methodology within a comprehensive careteam model significantly improved HbA1c levels and patient quality of life. The study was performed in a large, attention-controlled, randomized control trial (RCT), carried out in busy community health centers. This paper was the pilot study that preceded a NIH-funded RCT and this paper is an earlier NIH-funded RCT in which Dr. Welch and his team developed and evaluated the clinical value of a highly scalable, cost-effective, web-based assessment approach that became the basis for later work, including the “diabetes dashboard” studied here. This study provided critical data inputs for the design of the Behavior Diagnostic Platform.
   
   
5. Telehealth program for type 2 diabetes: usability, satisfaction, and clinical usefulness in an urban community health center. (2015) Telemed J eHealth.
   This paper explores an innovative telehealth intervention for diabetes that used an electronic, “smart” pillbox and related monitoring technology delivered by RN care managers at a community health center. Silver Fern posits that coupling remote home monitoring devices can enhance outcomes when used in conjunction with the Behavior Diagnostic Platform.
   
   
6. Improvement in glycemic control following a diabetes education intervention is associated with change in diabetes distress but not change in depressive symptoms. (2012) Journal of Behavioral Medicine.
   Based on a secondary analysis of Dr. Welch’s RCT data, this paper was the first to report the clinically important association between changes in diabetes distress (but not depression) and changes in blood glucose control during a diabetes education program.
   
   
7. Telehealth program for Medicaid patients with type 2 diabetes lowers hemoglobin A1C. (2012) Journal of Managed Care Medicine.
   This paper examines the program features, clinical approach, and outcomes of an established, diabetes telehealth program that was delivered by registered nursing teams in a large hospital health plan to Medicaid patients with type 2 diabetes. This work informed Silver Fern’s approach to building a commercial version of the Behavior Diagnostic Platform.
   
   
8. Evaluation of clinical outcomes for gastric bypass surgery: results from a comprehensive follow-up study. (2011) Obesity Surgery.
   This paper describes the development and application of a practical, post-surgical behavior and psychosocial assessment approach. A sizeable minority of people who undergo gastric bypass have type 2 diabetes as a co-morbidity. The availability of this assessment is essential because traditional post-surgical care is weak in the critical areas of self-management and psychosocial support as compared to the high standard of patient assessment and management seen in pre-surgical and peri-operative care. Diabetes “remission” can also later fail. This study informed the development of Silver Fern’s Weight-Loss Module.