Telemedicine poised to replace in-person visits, improve patient outcomes in diabetes

CHICAGO — Telemedicine offers advantages for patients and providers in diabetes management, including opportunities to reach more patients at reduced cost, but researchers must take steps to ensure important metrics are considered so the best methods are utilized, according to a speaker here.

“Telemedicine has the potential to transform health care,” Ruth Weinstock, MD, PhD, distinguished service professor and division chief of endocrinology and metabolism at the State University of New York (SUNY) Upstate Medical University in Syracuse, said during a presentation at the Endocrine Society Annual Meeting. “The return of the house call may be enabled by virtual visits.”

The way health care is delivered, particularly in diabetes, is evolving, according to Weinstock. In 2016, the telehealth budget for the Department of Veterans Affairs was $1.2 billion, and last year, Kaiser Permanente health system had more telehealth visits than in-person visits. By the end of 2018, 76% of hospitals and health care providers in the U.S. will offer telemedicine services in some form or plan to implement such programs, she said.

“What if in-person care was option B?” Weinstock said. “We all need to be open to approaches that are proven to make sense, and not necessarily the face-to-face options that we are used to.”

Multiple uses

In diabetes, telemedicine can serve multiple uses, Weinstock said, including disease management, education and support and lifestyle changes, posthospitalization monitoring and support, monitoring of wounds and even retinal eye exams, as well as mental health care or monitoring of comorbid conditions like congestive heart failure. Virtual visits can be conducted in group and individual settings, in homes or at libraries, schools or even correctional facilities, according to Weinstock, with the mode of delivery tailored to patient needs and preferences.

“You have to fit the technology to the patient,” she said. “Young patients love their smartphones, and I can tell you my [older] patients cannot see the print on the smartphones, or they have arthritic hands, so it is not one-size-fits-all. And of course, there are differing needs for type 1 vs. someone with type 2 diabetes on oral agents.”

Metrics for consideration

There are hundreds of telemedicine studies, but many have limitations, Weinstock said. Often, such studies combine patients with type 1 and type 2 diabetes or patients with varying levels of socioeconomic status, health literacy and access to the internet, which effect outcomes. Many studies also use combination interventions and technologies, making it difficult to assess which specific components are most useful, according to Weinstock.

“And also, it seems that as soon as something is published, the technology has changed, and now it’s better and usability has hopefully improved,” she said. “So that’s another challenge.”

When conducting telemedicine studies, Weinstock said researchers should consider several outcomes of interest that “go beyond HbA1c,” including glycemic variability, time-in-range (time spent with a blood glucose reading between 70 mg/dL and 180 mg/dL), as well as quality of life and social support measures. Cost-effectiveness of any intervention should also be measured for providers and patients, including metrics like cost savings when patients do not require transportation or child care for a telehealth visit.

Researchers should also assess the integration of any telemedicine program into routine clinical practice, and follow long-term outcomes, including hospitalizations, acute and chronic complications, Weinstock said. – by Regina Schaffer

Reference:

Weinstock RS. Role of telemedicine in diabetes management. Presented at: The Endocrine Society Annual Meeting; March 17-20, 2018; Chicago.

Disclosure : Weinstock reports she has received grant support from the JDRF, Helmsley Charitable Trust and the National Institute of Diabetes and Digestive and Kidney Disease, and has participated in clinical trials for Diasome, Kowa, Medtronic and Mylan.