Skip to main content
Home
Browse topics
Cardiovascular disorders Chronic kidney disease Diabetes devices & technology GLP-1 receptor agonists Hyperglycemia Hypoglycemia Obesity, diet, & lifestyle interventions SGLT2 inhibitors Type 1 diabetes Type 2 diabetes Browse all topics
EN
EN
In focus
Novel clinical evidence in continuous glucose monitoring Fasting for religion and health in people with diabetes The challenge of type 2 diabetes in children HFpEF & diabetes: Diagnosis and management in the wake of EMPEROR-Preserved Addressing suicide risk in diabetes: Rates and risk factors, HCP fears, and practical advice The SURPASS trials: Summarizing efficacy data on tirzepatide Semaglutide for weight loss: STEP and SELECT trials: Results from the STEP and SELECT trials Why psychosocial care matters DiRECT: Type 2 diabetes remission through weight management
Congress coverage
EASD 58th Annual Meeting 2022 The American Diabetes Association 82nd Scientific Sessions
About us
Medicine Matters Diabetes
EXTENDED SEARCH
Top

24-05-2018 | Devices and technology | Review | Article

Telemedicine in Complex Diabetes Management

Journal: Current Diabetes Reports

Author: Marie E. McDonnell

Publisher: Springer US

Login to get access

Abstract

Purpose of Review

Telehealth has the potential to positively transform the quality and cost-effectiveness of complex diabetes management in adults. This review explores the landscape of telemedicine approaches and evidence for incorporation into general practice.

Recent Findings

Telemedicine for diabetes care is feasible based on over 100 randomized clinical trials. Evidence shows modest benefits in A1c lowering and other clinical outcomes that are better sustained over time vs. usual care. While telemedicine interventions are likely cost-effective in diabetes care, more research is needed using implementation science approaches.

Summary

Telehealth platforms have been shown to be both feasible and effective for health care delivery in diabetes, although there are many caveats that require tailoring to the institution, clinician, and patient population. Research in diabetes telehealth should focus next on how to increase access to patients who are known to be marginalized from traditional models of health care.
Literature
1.
American Diabetes, A. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36(4):1033–46.CrossRef
2.
Health Expenditure, total % of GDP. 2017 1/1/2018; Available from: https://​data.​worldbank.​org/​indicator/​SH.​XPD.​TOTL.​ZS?​locations=​US.
3.
Hero JO, Blendon RJ, Zaslavsky AM, Campbell AL. Understanding what makes Americans dissatisfied with their health care system: an international comparison. Health Aff (Millwood). 2016;35(3):502–9.CrossRef
4.
Gregg EW, Williams DE, Geiss L. Changes in diabetes-related complications in the United States. N Engl J Med. 2014;371(3):286–7.PubMed
5.
Shojania KG, Ranji SR, McDonald KM, Grimshaw JM, Sundaram V, Rushakoff RJ, et al. Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis. JAMA. 2006;296(4):427–40.CrossRefPubMed
6.
Seaquist ER. Addressing the burden of diabetes. JAMA. 2014;311(22):2267–8.CrossRefPubMed
7.
UK Prospective Diabetes Study 6. Complications in newly diagnosed type 2 diabetic patients and their association with different clinical and biochemical risk factors. Diabetes Res. 1990;13(1):1–11.
8.
DCCT. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The diabetes control and complications trial research group. N Engl J Med. 1993;329(14):977–86.CrossRef
9.
Ashwood JS, Mehrotra A, Cowling D, Uscher-Pines L. Direct-to-consumer telehealth may increase access to care but does not decrease spending. Health Aff (Millwood). 2017;36(3):485–91.CrossRef
10.
Sepah SC, Jiang L, Peters AL. Long-term outcomes of a Web-based diabetes prevention program: 2-year results of a single-arm longitudinal study. J Med Internet Res. 2015;17(4):e92.CrossRefPubMedPubMedCentral
11.
Rushakoff RJ, Sullivan MM, MacMaster HW, Shah AD, Rajkomar A, Glidden DV, et al. Association between a virtual glucose management service and glycemic control in hospitalized adult patients: an observational study. Ann Intern Med. 2017;166(9):621–7.CrossRefPubMed
12.
Duffy S, Lee TH. In-person health care as option B. N Engl J Med. 2018;378(2):104–6.CrossRefPubMed
13.
Vidscrip. A series of videos about a health topic created by your very own healthcare provider [cited 2018 1/1/2018]; Available from: https://​www.​vidscrip.​com/.
14.
Moy FM, et al. Techniques of monitoring blood glucose during pregnancy for women with pre-existing diabetes. Cochrane Database Syst Rev. 2017;6:CD009613.PubMed
15.
Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform. 2017;5(4):e41.CrossRefPubMedPubMedCentral
16.
•Faruque LI, et al. Effect of telemedicine on glycated hemoglobin in diabetes: a systematic review and meta-analysis of randomized trials. CMAJ. 2017;189(9):E341–64. In this meta-analysis of 111 trials, telemedicine interventions in diabetes were found overall to result in clinically significant A1c reductions. CrossRefPubMedPubMedCentral
17.
•Shea S, et al. A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus: 5 year results of the IDEATel study. J Am Med Inform Assoc. 2009;16(4):446–56. This is the first large randomized trial comparing synchronous virtual visits and remote data monitoring (glucose and blood pressure) to usual care in patients with diabetes. The trial demonstrated that the telemedicine approach improved A1c and blood pressure, and patients in the active group were overall more able to sustain improvement. CrossRefPubMedPubMedCentral
18.
Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, et al. Diabetes in older adults: a consensus report. J Am Geriatr Soc. 2012;60(12):2342–56.CrossRefPubMedPubMedCentral
19.
Garber AJ, Abrahamson MJ, Barzilay JI, Blonde L, Bloomgarden ZT, Bush MA, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of endocrinology on the comprehensive type 2 diabetes management algorithm—2017 executive summary. Endocr Pract. 2017;23(2):207–38.CrossRefPubMed
20.
UKPDS. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):837–53.CrossRef
21.
Kempf K, Altpeter B, Berger J, Reuß O, Fuchs M, Schneider M, et al. Efficacy of the telemedical lifestyle intervention program TeLiPro in advanced stages of type 2 diabetes: a randomized controlled trial. Diabetes Care. 2017;40(7):863–71.CrossRefPubMed
22.
Bouchonville MF, Paul MM, Billings J, Kirk JB, Arora S. Taking telemedicine to the next level in diabetes population management: a review of the Endo ECHO model. Curr Diab Rep. 2016;16(10):96.CrossRefPubMed
23.
Kerfoot BP, Gagnon DR, McMahon GT, Orlander JD, Kurgansky KE, Conlin PR. A team-based online game improves blood glucose control in veterans with type 2 diabetes: a randomized controlled trial. Diabetes Care. 2017;40(9):1218–25.CrossRefPubMed
24.
Lauffenburger JC, Lewey J, Jan S, Nanchanatt G, Makanji S, Ferro CA, et al. Rationale and design of the ENhancing outcomes through goal assessment and generating engagement in diabetes mellitus (ENGAGE-DM) pragmatic trial. Contemp Clin Trials. 2017;59:57–63.CrossRefPubMed
25.
Lewey J, Wei W, Lauffenburger JC, Makanji S, Chant A, DiGeronimo J, et al. Targeted adherence intervention to reach glycemic control with insulin therapy for patients with diabetes (TARGIT-diabetes): rationale and design of a pragmatic randomised clinical trial. BMJ Open. 2017;7(10):e016551.CrossRefPubMedPubMedCentral
26.
Daskivich LP, Vasquez C, Martinez C Jr, Tseng CH, Mangione CM. Implementation and evaluation of a large-scale Teleretinal diabetic retinopathy screening program in the Los Angeles County Department of Health Services. JAMA Intern Med. 2017;177(5):642–9.CrossRefPubMedPubMedCentral
27.
•Lee SWH, Ooi L, Lai YK. Telemedicine for the management of glycemic control and clinical outcomes of type 1 diabetes mellitus: a systematic review and meta-analysis of randomized controlled studies. Front Pharmacol. 2017;8:330. This meta-analysis included 38 studies that investigated several telemedicine techniques in type 1 diabetes and found that adults are more likely to benefit than children. CrossRefPubMedPubMedCentral
28.
NEJM Catalyst. Website 2017. Available from: https://​catalyst.​nejm.​org/​challenges-launching-telehealth-program/​. Accessed 2 February 2018.
29.
The American Telemedicine Association policy resource center. Website 2018. Available from: www.​americantelemed.​org/​policy-page/​state-policy-resource-center. Accessed 4 April 2018
30.
Kakkar A, Jacobson BC. Failure of an Internet-based health care intervention for colonoscopy preparation: a caveat for investigators. JAMA Intern Med. 2013;173(14):1374–6.CrossRefPubMed
31.
Yusif S, Hafeez-Baig A, Soar J. e-Health readiness assessment factors and measuring tools: a systematic review. Int J Med Inform. 2017;107:56–64.CrossRefPubMed
32.
McIntosh JRD, Jay S, Hadden N, Whittaker PJ. Do E-health interventions improve physical activity in young people: a systematic review. Public Health. 2017;148:140–8.
33.
Tucker KL, et al. Self-monitoring of blood pressure in hypertension: a systematic review and individual patient data meta-analysis. PLoS Med. 2017;14(9):e1002389.CrossRefPubMedPubMedCentral
34.
Hunter CM, McKinnon RA, Esposito L. News from the NIH: research to evaluate “natural experiments” related to obesity and diabetes. Transl Behav Med. 2014;4(2):127–9.CrossRefPubMedPubMedCentral

Be confident that your patient care is up to date

Medicine Matters is being incorporated into Springer Medicine, our new medical education platform. 

Alongside the news coverage and expert commentary you have come to expect from Medicine Matters diabetes, Springer Medicine's complimentary membership also provides access to articles from renowned journals and a broad range of Continuing Medical Education programs. Create your free account »

Image Credits