February 14, 2020 Digital diabetes care

Welcome to the new world of digital diabetes care, where medical help is as close as your smartphone. Here are a few examples of people with diabetes who have had “e-visits” with a health-care professional, using their computer, cellphone, or tablet to connect through a secure network.

How does digital care work?

A woman living with type 1 diabetes thought the insertion site of her insulin pump might be infected. She made a video and sent it to her doctor, who watched it in real time, diagnosed an infection, and arranged for a prescription for an antibiotic to be sent to the patient’s pharmacy.

An elderly woman with type 2 diabetes was confused about when to take all her medications. Her daughter arranged them on the dining room table and took a video. After watching the video, her mother’s doctor asked the mother’s pharmacy to prepackage all her medications in a specially designed blister pack to ensure the woman took the right dose at the right time of day.

For a first-year university student with type 1 diabetes who was living away from home for the first time, one of the challenges was unpredictable blood sugar levels. She checked in with her dietitian via video on her cellphone; the dietitian was then able to offer food suggestions based on what the video showed was in the student’s fridge and cupboards.

These examples are from a pilot study being carried out with the Ontario Telehealth Network by Dr. Janine Malcolm, an endocrinologist and clinical investigator at the University of Ottawa and the Ottawa Health Research Institute. While such virtual e-visits are still rare so far, she says this type of care will transform how diabetes is treated and managed. “Canadians are looking for ways to integrate technology with their health care,” she says, noting that 88 per cent of Canadians own a mobile phone and that a recent survey by Ipsos Reid shows 69 per cent say they would use digital strategies to improve their health care if this option was available to them.

How would digital diabetes care work?

Virtual care can provide much-needed support for people living with chronic diseases such as diabetes, who often need to see their doctor many times in a year. It can reduce emergency room visits. It also means you would not necessarily need to leave your home or office to get health care.

You would not need to spend hours waiting to see your doctor, or pay for parking. Innovations such as videoconferencing, remote patient monitoring, apps, and web-based solutions such as the Canadian Diabetes Prevention Program (CDPP) are changing health care in Canada. And digital innovation is not just for patients: Technology will also allow family doctors to connect online with specialists to get faster access to professional advice.

“The average person is not actually aware of how many digital tools and technologies are out there—these tools will become the future of diabetes care,” says Shivani Goyal, a scientist at Toronto’s University Health Network. Goyal is currently heading a $1 million four-year study at Toronto’s SickKids hospital to examine how the use of personalized text messaging can better support young people with diabetes as they move from pediatric to adult care.

There has been an explosion in the number of digital tools—from fitness trackers to calorie counters—that can help people lead healthier lifestyles. Some are specifically designed to help people with diabetes measure their carb intake, offer reminders to check their blood sugar (glucose), calculate insulin dosages, and track blood sugar levels and blood pressure. Some are designed to sync with a glucose monitor to provide data and charts to a doctor who can then provide feedback by phone, text, email, or video.

New diabetes technology

Virtual care also encompasses new forms of digital glucose monitoring, such as a first-of-its-kind flash glucose monitor recently introduced in Canada. It tracks blood sugar level for up to 14 days, using a sensor worn on the back of the upper arm. A one-second scan of the sensor with a hand-held reader or smartphone provides a real-time glucose reading and a complete picture of the user’s recent blood sugar history.

“Instead of someone coming in with a handwritten logbook and a doctor or nurse trying to make sense of it, now—with the click of a button—a chart can show glucose levels for the past month on a physician’s screen. The ability to transmit that information and make judgments based on richer patient information is appealing,” says Dr. Jan Hux, president and CEO of Diabetes Canada.

The reality of digital diabetes care

This all sounds exciting, but there are still many questions and concerns about virtual care. Hux points out that face-to-face appointments can help doctors address health issues that might not be obvious during an e-visit. For example, mental health challenges are common for people with diabetes, and may be easier to detect in person. “There’s the risk that digital health care may reduce opportunities to address these aspects of patient care,” Hux says.

As well, there are many questions about virtual care: Can digital tools be shown to be effective, with science to back them up in the same way as with drugs? What happens to those Canadians who cannot afford expensive cellphone plans or are nervous about using technology? How do doctors and patients ensure private health information stays private? How will physicians be paid for e-visits and e-consultations?

Experts are trying to determine how to identify and make the various changes that will be required to support virtual care. The World Health Organization recently released its guidelines for the adoption of digital health care. In Canada, the Virtual Care Task Force was created earlier this year. It is a joint initiative of the Canadian Medical Association, the Royal College of Physicians and Surgeons of Canada, and the College of Family Physicians of Canada.

Malcolm has found that in her study of e-visits, patients may be enthusiastic about digital care, but most still want the opportunity to meet in person with their doctor. “Patients like the technology but don’t want to give up seeing their doctor. They like it as an alternative to an in-person appointment or if they need a quick touchpoint.”

Goyal believes that new technologies have the potential to offer better patient care. However, there is no one-size-fits-all approach. “Once you find the technology or app that best suits your daily routines and unique needs, those tools become indispensable, the default,” she says. Her mother lives with multiple chronic diseases, including diabetes, and at age 32 herself, Goyal wants to do all she can to stay healthy. “Given my family history, I am very aware of my risk for type 2 diabetes, and I am in prevention mode.” Her family history has also motivated her to choose a career in researching digital health. “I’ve been a caregiver to my mother since I was 10, and have witnessed all sorts of health-care interactions that were frustrating to her as a patient and to me as a caregiver. I am motivated to change that experience so other people don’t have to live through this.”

Did you know?

You can find resources—from webinars to carb-counting tips, meal planning guidelines, and information on how to reduce diabetes-related complications and much more at Managing My Diabetes.

The last word

“Virtual care is another tool in our toolbox to help provide care to patients when they need it.”— Dr. Janine Malcolm, endocrinologist and clinical investigator

“New technologies can enhance the patient’s sense of being in control.” — Dr. Jan Hux, president and CEO, Diabetes Canada

“The best digital tools are those that reduce how much time you spend worrying about your diabetes.” — Shivani Goyal, digital health strategist and scientist

Want to reduce your diabetes risk?

A 12-month digital coaching program that empowers people to reduce their risk of developing type 2 diabetes has been introduced by Diabetes Canada and LMC Healthcare. Learn more about the Canadian Diabetes Prevention Program now.

(This article appeared in Diabetes Dialogue, Winter 2020)