Expanding Telehealth for Diabetes Management

Writer: Rehan Mehta • Editor: Keshav Kailash

The COVID-19 pandemic has forced society to restructure and adapt. Unsurprisingly, technology has been at the center of almost every adaptation and this is clearly evident in the field of medicine. This pandemic has dramatically accelerated the use of telehealth as a way to ensure the safety of patients and healthcare providers while still providing optimal care. The potential benefits of telehealth are now being realized, and it is now clear that telehealth will serve an important role in the future of healthcare.

One area in which telehealth is well suited for and can improve patient health outcomes, is diabetes management. According to the CDC, about 10.5 percent of the U.S. population has diabetes, which is about 34.2 million people. In addition to this, the total cost of diagnosed diabetes in the U.S. is estimated to be over $320 billion. Most of these costs are spent on treating complications that are a result of poorly controlled diabetes [1]. It is evident that diabetes and its resulting complications place a substantial economic and social burden on our society and that there is an urgent need for improvements in diabetes management. Existing evidence suggests that telehealth provides an opportunity to effectively monitor and manage people with diabetes at a distance and as frequently as needed. The goal of diabetes management is to keep one’s blood sugar levels as close to normal as possible and therefore reduce the risk of complications [7].

Hemoglobin A1c, or just A1c, is considered to be the gold standard for monitoring blood sugar levels in people with diabetes. According to the American Diabetes Association, adults with diabetes should aim to have an A1c level

Illustrator: Lucy Chen

of below seven percent [2]. The higher the A1c level, the greater one’s risk is of developing complications due to diabetes. This level can be maintained with a combination of a healthy diet, exercise and medication. One meta-analysis of 25 randomized controlled trials has shown that telehealth interventions result in a small but statistically significant lowering of hemoglobin A1c levels when compared to usual care in adults with type two diabetes [7]. In these trials, telehealth involves patients sending their daily blood glucose readings to their healthcare professional who will then follow up by reviewing and

discussing the values with his or her patient. The results of the meta-analysis provide evidence that telehealth can be beneficial and can effectively control A1c levels in people with type two diabetes.

In addition, several mobile applications are now available which can help people better manage diabetes by enabling blood sugar tracking, medication reminders and nutrition and physical activity tracking.

In addition to these findings, improvements in glucose monitoring systems allow for more data that is easily accessible and transmitted. The traditional way of measuring one’s glucose level is with a blood glucose meter which can only generate a single reading at a time. Continuous glucose monitoring is a newer method for evaluating glucose levels and generally consists of a sensor that is worn on the body that automatically obtains periodic glucose readings [5]. The data can then be wirelessly transmitted to be displayed on one’s phone. In addition, several mobile applications are now available which can help people better manage diabetes by enabling blood sugar tracking, medication reminders and nutrition and physical activity tracking. Continuous glucose monitoring systems can generate up to 288 readings per day and continually check glucose levels during both day and night. With more readings, health professionals can determine patterns in glucose fluctuations, leading to more informed decisions about what the patient should do to control their A1c levels [5]. These aspects of continuous glucose monitoring make it well suited for and easily integrated with telehealth. One study designed to assess the feasibility of initiating continuous glucose monitoring through a telehealth approach consisted of 27 adults with type one diabetes and seven adults with type two diabetes using insulin who were interested in starting continuous glucose monitoring. The results revealed a statistically significant decrease in mean A1c levels and an increase in the percentage of time the patients’ blood glucose levels were in target range from 48 percent at baseline to 59 percent with continuous glucose monitoring [6]. Patients also reported a very positive impact on measures of quality-of-life [6]. These findings suggest that continuous glucose monitoring combined with telehealth has the potential to empower patients with diabetes and substantially improve glycemic control. Additionally, the study notes that telehealth could significantly increase the adoption of continuous glucose monitoring systems [6].

Often, many patients with diabetes do not reach treatment goals due to barriers in accessing healthcare, especially in underserved and rural areas. Telehealth has the advantage over traditional medicine in that it can potentially overcome these barriers and expand access to care. In one study evaluating telehealth’s effectiveness in delivering diabetes care to rural areas, 32 veterans with type one diabetes living in rural areas of Alabama and Georgia faced barriers to receiving proper diabetes care due to a lack of endocrinologists in the area. The patients received care from endocrinologists not in the area and overall mean A1c levels decreased. More importantly, patients saved, on average, 78 minutes of travel time going one way and the Veterans Health Administration (VHA) saved $72.94 per patient for travel reimbursements [8]. It is estimated that the VHA would save $9,336.32 per year in reimbursements just for those 32 patients. Not only did telehealth expand access to care, but it led to substantial cost savings, suggesting that telehealth can deliver additional benefits while being a viable alternative to traditional diabetes management.

Given its benefits and with continuous glucose monitoring systems becoming more common, telehealth is poised to replace clinical visits when it comes to diabetes management. Not only has it demonstrated that it can enhance the quality of diabetes care, but it can also reduce the substantial costs associated with diabetes and expand access to care. As telehealth is further stud-

...telehealth is poised to replace clinical visits when it comes to diabetes management.

ied and developed, it will soon be integrated into other areas of medicine. Telehealth has paved the way for a new age of virtual medical care and will redefine the landscape of tomorrow’s medicine. •