The pandemic has caused chaos across the United States for many patients, throwing their lives into chaos as they have struggled to adjust to a virtual world, but there is one disease for which these changes might actually lead to better outcomes: diabetes.
More than 29 million Americans live with diabetes, also called hyperglycemia, which causes their blood glucose levels, or sugar, to rise higher than normal. This can have serious consequences if left untreated, with conditions such as nerve damage, circulation problems and potential strokes being just a few of the outcomes in those whose diabetes remains untreated. While 29 million may not seem like a huge number, the U.S. Centers for Disease Control and Prevention estimate that a further 86 million are living with prediabetes which, as the name suggests, is a potential precursor to diabetes.
The cost weighs heavy on the country too. According to the Centers for Medicare & Medicaid Services, Medicare spent $42 billion more in 2016 on beneficiaries with diabetes after deducting their costs had they not had diabetes. Furthermore, they estimated that diabetics cost Medicare $1,500 more on Part D prescription drugs, $3,100 more on hospital and facility services, and $2,700 more in physician and other clinical services.
So why is a worldwide pandemic such good news for diabetics and prediabetics across the U.S.? Why does it open up a whole new world of possibility as well as reduced costs for patients and practitioners alike?
Telemedicine Gives Practitioners Greater Control Over the Disease
Contrary to popular opinion, managing diabetes remotely actually gives practitioners greater, not lesser, ability to keep the disease under control. This is because diabetes is an ongoing disease that requires day-to-day management rather than the occasional follow up visit until it clears up.
In this context, being forced to go virtual has given practitioners the opportunity to use technology to their advantage and therefore reduce foot traffic and physical visits. Continuous glucose monitors, tracked by the patient through their smartphone, means that practitioners can receive detailed updates from patients with the press of a button, giving them a greater understanding of the patient’s responses to treatment; and should any concerns be raised, a virtual visit can be quickly and easily arranged without the patient having to leave the comfort of their home.
Although there may be cost restrictions for these devices for those who don’t have private insurance, the potential for all patients is clear to see should these innovative little devices become widely available.
Virtual Care Improves Outcomes for Patients
While it can be difficult to be sure that telemedicine has improved diabetic patient outcomes among outpatients without rigorous testing, several hospitals have conducted research to assess its efficacy on inpatients, with clear results.
The advantage of testing inpatients is that results are clear: inpatients are a good control group as they have to remain in the same place with the same routines.
At UC San Francisco (UCSF), for example, researchers have found that their virtual glucose management service (vGMS) has been highly effective with inpatients. Developed by a number of UCSF diabetes specialists, the system measures glucose levels and provides practitioners with a daily automated report. This report identifies patients whose levels may be of concern and gives an update about what those patients have eaten or done which may be relevant. These reports are reviewed daily by a diabetes specialist, with these results added to the patient’s electronic medical record, and these practitioners are able to respond promptly and effectively to the patient’s needs.
The hospital has found that the number of patients on the daily high-glucose hospital report has decreased by 39%, which has a profound impact on both the patient’s prognosis as well as their ongoing economic costs.
Likewise, another 15-week study confirmed that the virtual management of diabetes inpatients had no negative impact on a patient’s outcome. The report, conducted at the University of North Carolina, assessed the diabetes co-management service as it transitioned from physical to virtual visits in March 2020 in order to mitigate the effects of the COVID-19 epidemic. Assessing the transition’s efficacy, the report noted that not only were there no worsening outcomes during the pandemic, there was also the very real boon that lack of patient exposure in the hospital reduced the likelihood of nosocomial, or hospital-acquired, infections.
While both of these reports are specifically linked to inpatients, it’s clear to see just how beneficial virtual visits can be to outpatients too. With the ability to continually monitor and send results to their personal doctor through their smartphones and state-of-the-art technology, patients can feel reassured that should their results show something unusual, this will be flagged almost instantly and that very soon they will be talking to a doctor and discussing potential solutions.
A smaller advantage, although no less significant, is that all this can be done from the convenience of an office building or the living room, with little to no disruption to a patient’s daily life. A 15-minute appointment is now merely a 15-minute appointment rather than an hour-long round trip to the clinic, along with whatever waiting time that entails.
Telemedicine Reduces the Pressures on Practitioners
The UCSF report noted that practitioners no longer had to spend all day visiting patients; instead, they could focus on the patients that actually had problems, reducing the rounds to a 45-minute session. As a result, practitioners could use their time more effectively by ensuring that those with abnormal results were immediately seen to rather than having to assess everyone before getting to those who needed it most.
Likewise, diabetic outpatients who are receiving virtual care from their personal doctor may well be in a stronger position than those who are restricted to weekly or bi-weekly visits. With specialists monitoring the results recorded by their smartphones, patients can rest assured that they will be contacted only when it is necessary and from the comfort of their own home, with adjustments to their prescriptions being made virtually by an online doctor and not via a slip physically given to them at a visit a week or two later.
The Use of Telemedicine for Diabetes Management is Not a Novel Idea
Although it seems fresh and new, virtual care has been used by a variety of services when managing diabetes for a number of years now. For example, Montana’s Department of Public Health & Human Services (MDPHHS) has been using telehealth in its Diabetes Prevention Program (DPP) for several years. With 13 of its 19 sites across the state being telemedicine-accessible, it has fully embraced the concept. With their only limitation being the bandwidth, they can hold virtual meetings in libraries as well as health clinics. You name it, they can be there.
Rather than being seen as a weakness, it has been embraced as a way to expand the reach of its program and connect with more patients. Treatment can be personalized more and more to suit the individual’s needs rather than being a copy-and-paste solution; the greater variety of tools and systems can be used to offer greater insight into people’s lives and homes as well as being used to promote individual wellbeing. The ability to meet with your practitioner at a time that is convenient for both is being seen as one way to help reduce dropout rates. In the same way, tools such as weight scales and smart watches can provide even more data that enhances a practitioner’s ability to tailor a plan to a patient’s personal needs.
With a limited supply of practitioners and lifestyle coaches, the ability to free them up so they can spend more time catering to their patients’ needs by responding to these needs rather than physically following up on patients who are successfully managing their condition is a highly desirable option to have.
Another advantage to telemedicine is the ability to share resources online rather than relying on printed material, which can get lost and costs money to print. The convenience of being able to access a variety of relevant and informative material from your own phone cannot be underestimated. With the chaos of life often getting in the way of the things that should matter most, such as our own health, being able to access literal life-saving information with the touch of a button is an advantage only our generation has been able to experience.
The Challenge Ahead
With telemedicine being hastily accepted as a solution during a pandemic, the issue now is how to sustain and scale it effectively in a manner that fosters engagement from the patient while not clipping specialists’ wings. As seen from the studies undertaken already, the future is exceedingly bright when managed positively, with greater attention to detail and patient convenience two shining examples. With the right technology and investment from practitioners, diabetes management could become a well-oiled machine that provides convenience and accessibility to patient and practitioner alike, freeing up time and easing stress and pressures for both.