Book Title: The Diabetes Lifemap: Data-Driven Diabetes Care for the 21st Century
Author: David Bleich
Publication Information: New York, Morgan James Publishing, 2021, 196 pp., $16.95, paperback
David Bleich, MD, chief of endocrinology and professor at Rutgers Medical School, opens this book thus: “The LIFEMAP evolved as a logical extension of my need to organize and prioritize patient care” (p. xi). Upon moving his practice from California to Newark, New Jersey, seeing many patients with multiple layers of complexity to their medical care and lives led Dr Bleich to devise an approach to outpatient care that differs from the History-Physical Examination-Assessment-Plan model. Rather, he classifies interventions as high-, moderate-, or low-impact and allocates time to them accordingly.
The book has 13 chapters. The first introduces the LIFEMAP as an approach to diabetes that changes care delivery from a health care provider-centric approach to a patient-centered, data-driven model. Chapter two discusses diagnosis (and classification) of diabetes as well as insulin production and resistance. Dr Bleich adds that, for “robust 21st-century diabetes care, it is important to personalize the treatment approach from the bottom up, starting from the lifestyle and habits of the individual” (p. 20).
Although the book is written by a physician to help clinicians improve the quality of diabetes care, it is presented simply enough for patients to follow most sections. For instance, chapter three opens by addressing the patient on the dangers of high glucose levels, then recommends two methods of monitoring: trend analysis and active management. Trend analysis involves self-blood glucose monitoring at wake-up time and 2 hours after each meal, two to three times a week. This offers a structured approach to testing at relevant times and personalization of days and times for testing, and can inform adjustments to treatment and testing, which can be cut to four times per day, once per week when diabetes is controlled. Active management, on the other hand, calls for perhaps seven or more tests per day: before and 2 hours after each meal, before and after snacks, and at bedtime; although some insurance carriers do not cover enough supplies to do this, clinically-important patterns of hyper- and/or hypoglycemia may be uncovered. Dr Bleich closes chapter three by offering a loose basal scale for bedtime insulin based on bedtime glucose in place of fixed bedtime insulin dosing.
Chapter four discusses situations in which hemoglobin A1c values do not accurately reflect glucose control, including anemia and chronic kidney disease. The LIFEMAP is introduced as a more accurate way to estimate the average blood glucose and A1c monthly using patient test data. Chapter five suggests the LIFEMAP can monitor the blood sugar trajectory on an individual patient “more closely with less effort” (p. 40) before the A1c documents worsening in diabetes control.
Chapter six shows how some patients need two LIFEMAPs; shift workers may have different eating patterns on workdays compared to their days off, and dialysis patients have different routines on dialysis days compared to nondialysis days, so a LIFEMAP can be created for each type of routine. Examples of adjustments to the LIFEMAP and treatment strategies are presented.
Chapter seven shows how nutrition may be assessed by a clinician or nutritionist and incorporated into the LIFEMAP. Chapter eight describes the LIFEMAP as an application of the chronic care model. Chapter nine specifies high-impact activities for the first three visits with a new patient, including building a LIFEMAP in visit one, addressing nutrition and starting treatment 4-5 weeks later, and assessing social determinants of disease in visit three. Chapter 10 identifies blood sugar control as the high-impact intervention for the diabetes chronic care model. Recognizing and filling care gaps arising from trend analysis LIFEMAPs or false A1c readings is explored in chapter 11. Chapter 12 employs case studies to illustrate use and revision of the LIFEMAP, including use of a continuous glucose monitoring device to generate data for the LIFEMAP; chapter 13 reflects on the case studies and the role the patients’ LIFEMAPs played in control of diabetes and its complications. The conclusion predicts a mobile version of the LIFEMAP.
This unique book is excellent value for the price. Office visit coding changes in 2021 make some billing examples obsolete while affirming reduced emphasis on physical examination. It differs from books on diabetes recently reviewed in this journal in focusing on data rather than motivational interviewing1 or fasting.2 No published evidence is cited to confirm that the LIFEMAP outperforms traditional diabetes care; however, it can predict A1c readings just 1 month after treatment is adjusted, so glucose control can be pursued more aggressively. I therefore recommend it to any clinician needing to improve glycemic control in willing patients.
