The Virtual Examination Room: How New Technology Can Improve Diabetes Care

Last Thursday a study was presented at the American Association of Clinical Endocrinologists (AACE) 21st Annual Scientific and Clinical Congress which highlighted the benefits of using Telemedicine in the examination and treatment of patients located in remote, especially rural, areas. The prevalence of diabetes and other endocrine diseases such as obesity, thyroid disease and osteoporosis continues to rise nationally. Diabetes is particularly concerning in rural populations of the USA where its likelihood is approximately 17% higher than in urban centers. Compounding this disparity is the lack of medical specialists, especially endocrinologists, in rural areas.

Telemedicine (TM) entails the transfer of electronic medical data such as high resolution images, sound, video and patient records to remote locations utilizing telecommunications technology, with the intention of providing high quality medical care or facilitating medical research. This study was designed to investigate the effectiveness of examining and treating patients with endocrine diseases using TM, and to analyze the ability of a telemedicine-based endocrine consultative service to improve outcome measures in endocrine patients in rural communities.

"The ability to communicate directly with a patient is crucial for proper diagnosis and treatment. Unfortunately this is not always possible with patients in remote locations," states Dr. Ebenezer Nyenwe, FACE, lead researcher on this study. "Bringing telemedicine technology into play creates a viable alternative and increases the likelihood of the implementation of a more successful treatment plan."

A clinical endocrinologist located in an urban center was connected through video teleconference to patients in rural locations, allowing for visual inspection/examination and real-time "face-to-face" doctor/patient feedback. Using video cameras, television monitors and the internet to transmit video, audio and electronic records, a "virtual examination room" setting was created. A nurse in the remote location facilitated the communication between the doctor and the patient, while assisting with the physical examination.

Sixty-six patients were seen during this study over two and a half years. Progress was shown to occur in the condition of a majority of the patients where follow-up data was available, including a significant improvement in the health of type 2 diabetes patients. Nearly all patients (97%) were comfortable with receiving care this way, finding value in using the "virtual examination room."

"TM has proven to be an acceptable means of providing affordable and accessible care to patients in remote areas where endocrine care was not available," conclude the authors of the study. "Though there were initial set-up costs, they were far outweighed by the benefit of reaching many patients who might not otherwise have been seen by a specialist." A prospective study to replicate the success of this pilot project in a larger population is desirable.

Presented at AACE 21^st Annual Scientific and Clinical Congress