Applying telemedicine in diabetes care management

Telemedicine-the use of medical information exchanged from one site to another via electronic communications-can improve outcomes, expand access, and provide better economic value for patients.

Diabetes is well suited for being treated with telemedicine. According to an article in Journal of Diabetes Science and Technology by David C. Klonoff, MD, the disease has better outcomes when patient information is monitored.

Many types of data can be digitalized for diabetic patients, including blood glucose levels, exercise patterns, and food intake. Telemedicine allows monitored data to be transmitted, stored, and analyzed.

“[Telemedicine’s] digital features are well suited to optimizing the many numbers reflecting outcomes generated by patients with diabetes,” says Klonoff, who is the medical director, Diabetes Research Institute Mills-Peninsula Health Services, San Mateo, California. “Software containing best practices can assist patients with decisions.”

In the medical literature, telemedicine has been shown to have favorable clinical and economic outcomes. “Although only a small number of randomized controlled trials using telemedicine for diabetes have been done, they suggest that there are better outcomes at a lower cost,” Klonoff reports.

Some health plans getting on board

Accountable care organization (ACO) payers are finding sufficient evidence to use telemedicine both as a tool to treat more patients for less money and as a method for attracting additional patients to their programs.

“In general, telemedicine allows patients to forgo traveling to a physician’s office for in-person care (which can often be more time consuming and costly for an ACO to deliver than remote care),” Klonoff says.

On the other hand, traditional fee-for-service care encourages patients to go to a physician’s office for care. In addition, “fee-for-service healthcare professionals currently receive lower reimbursement for real-time telemedicine visits than for in-person visits and don’t [receive] reimbursement for non-real-time (asynchronous) communications,” Klonoff says.

Next: Gaining popularity

Gaining popularity

Despite the pros and cons, telemedicine is becoming increasingly adopted. This is due, in part, to ACOs managing more of the U.S. population. According to a 2015 study of medical and information technology professionals by HIMSS Analytics, from 2014 to 2015 the percentage of respondents with a telemedicine solution increased from 54.5% to 58%. Telemedicine use in physicians’ offices increased from 33.3% to 36.9%, and in hospitals or health systems it increased from 59% to 62.5%.

The study also reported that two-way video was the most frequently used tool, with adoption increasing from 57.8% to 69.5%. The use of patient portals was the second most widely used technology, increasing from 43.1% to 58.6%.

Health plans have found that providing telemedicine care for diabetes in the form of asynchronous messaging (e.g., e-mail connectivity between professionals and patients) provides marketing advantages and can attract patients to their plans.

“As diabetes is increasingly managed with the assistance of data that is uploaded from portable devices to remote servers automatically, it will become increasingly possible to target this data and work on improving glycemia and other quantitative elements of diabetes using telemedicine,” Klonoff says.

What the future holds

Blood glucose monitors and continuous glucose monitors are increasingly connecting with the cloud and can provide information about glycemic patterns by way of proprietary software.

Klonoff predicts that cloud storage of glucose data and insulin pump data will become widely adopted as new types of software for metabolic analysis of data that can work with multiple products are developed.

Furthermore, the artificial pancreas is becoming established as a treatment for type 1 diabetes. This so-called closed-loop device consists of a continuous glucose sensor, an insulin pump, and software that controls the amount of insulin being delivered. The device collects a large amount of data and requires the patient to have troubleshooting skills because it is an autonomous insulin delivery system.

It will be beneficial for a patient transmitting data to have the ability to get advice on how to fix a problem if a system failure occurs. Much like General Motors’ OnStar telemetry system for emergencies, Klonoff says a similar remote assistance system has been proposed to protect patients with an artificial pancreas system in the event that the glucose level crashes.