BOSTON (October 15, 2018) – Harnessing the power of digital health technology --- smart phone apps, telemedicine and mobile health (m-health) --- can provide powerful tools to help people with diabetes self-management, ultimately improving A1c levels, reducing complications and lowering healthcare costs, suggests a recent systematic review of studies first published online September 27 in the journal Cell Metabolism.

Image removed.The Centers for Disease Control and Prevention estimate that about 30 million Americans have diabetes. And the vast majority of those are living with type 2. Additionally, about 84 million people in the U.S. have prediabetes.

Self-management is the key to successful health outcomes in diabetes, but that requires patients commit to significant behavioral and lifestyle changes that are difficult to accomplish alone, says review coauthor Osama Hamdy, MD, PhD, FACE, Medical Director of Obesity Clinical Program and Inpatient Diabetes Program at Joslin Diabetes Center. “Through technology, we can address the need to better engage people in their own diabetes care and start to reverse this growing epidemic.”

This review on digital health examined existing data from original research studies conducted within the last two decades to evaluate patient-driven diabetes care of the future in the era of technology. According to the report, tapping into technology can help people with diabetes overcome common challenges they face– inadequate time spent with doctors, lack of access to specialists and diabetes educators, and inadequate support for proper self-management, all of which contribute to poor diabetes control and the development of diabetes-related complications. 

The review found that recent studies showed that telemedicine care is just as good as diabetes care received in-person, showing no differences in A1c levels, blood pressure or blood lipids between the two groups. In fact, some meta-analyses included in this review showed that patients participating in telemedicine programs had greater reductions in A1c levels on average compared to patients who received standard in-clinic care.  

When short visits are totally conducted remotely through electronic communication, multiple health professionals can easily be involved in diabetes care, visits can be scheduled more frequently and customized to each patient’s needs outside the limitations of location and time. The result is significant improvements in A1c levels because patients stay compliant with their regimens, says Dr. Hamdy.  “This review confirms the benefits of telemedicine diabetes care models --- they may ultimately produce similar or better health outcomes, be more cost-effective than in-person care models and scalable to reach patients in most remote areas.”

This review also identified promising effects that telemedicine has on specific complications, such as diabetic retinopathy.  It allows for tele-screening of vision at primary care sites. Images are sent remotely to an ophthalmologist for evaluation. Studies on tele-screening for diabetic retinopathy showed that rates of vision loss and blindness decreased significantly due to adherence to retinopathy screening.

“Over 50 percent of healthcare expenditures for patients with diabetes are due to the complications of diabetes,” says Dr. Hamdy. “Our paper should open the eyes of every health care organization that technology is at the door and it’s time to open that door to take advantage of innovative interventions that can significantly improve diabetes health outcomes and reduce healthcare costs.” 

The review also found that the use of m-health in diabetes self-management is very beneficial—apps and text-based systems that deliver reminders to patients improve dietary and exercise practices, glucose testing, communication with healthcare teams and medication adherence rates.  

In one study, clinicians implemented a comprehensive, text-based diabetes education program. After six months, A1c levels were reduced by 0.7 percent.

In another study, a comprehensive smartphone application incorporating blood glucose readings, manual dietary tracking, exercise tracking by a fitness tracker, diabetes education, and communication with healthcare providers resulted in A1c reduction by 0.6 percent in just 12 weeks.

Telemedicine and m-health have shown great promise in making diabetes care, education and group support more convenient and accessible to patients,” says review coauthor Sahar Ashrafzadeh, AB, a researcher at Joslin Diabetes Center.  “And increased connectivity to diabetes care teams can allow for remote blood glucose monitoring and medication adjustments that are aligned with real-time patient progress.”

“In the future, what we would like to see is a “virtual diabetes clinic”, a diabetes healthcare ecosystem that connects hospitals, clinics, pharmacies, gyms, restaurants and diabetes educators,” says Dr. Hamdy. “We now have the technology to nicely close this gap and go beyond time and location.”