Can using the Internet and telemedicine in diabetes care change bring improvement to patient outcomes?
One of the reasons many patients have sub-optimal diabetes control is due to poor adherence to treatment regimens as well as noncompliance with scheduled doctor visits. One possible solution to this problem is the use of telemedicine. Telemedicine is the use of information and communication technologies, such as the Internet, to help further patient care and can include diagnosing or even treating the patient. It has already been put to use in treating chronic conditions, such as COPD. Previous studies looking at the effects of telemedicine showed a benefit in glycemic control in patients with poor glycemic control (HbA1c ≥8%). These studies also showed a gain in decreasing the number of times patients missed work and school. The authors of this study were unable to find a previous study that looked at the effect of telemedicine in patients with type 1 diabetes who had an HbA1c of <8%. Thus, the need for this study was identified.
This study was a 6-month, randomized, open-label, multicenter, parallel-group controlled study (PLATEDIN). Patients ranged from 18-65 years old, must have been diagnosed with type 1 diabetes over two years ago, have an HbA1c that is stable below 8%, and be receiving multiple daily injections of insulin. Anyone with a continuous subcutaneous insulin infusion, chronic kidney disease, a thyroid disease (other than hypothyroidism that was controlled), type 2 diabetes, a severe psychological disorder, or was already in another clinical study was excluded. The primary endpoint of the study was the mean change in HbA1c. Other areas of study included quality of life and satisfaction with treatment. Physician satisfaction with the diabetic platform was also measured. During the study, both groups met face-to-face at month 0 and then again at month 6. The second visit is where the groups differed – it was either face-to-face or via the telemedicine platform.
In the group that met face-to-face, the number of mild and severe hypoglycemic events, as well as the number of hyperglycemic events per week, decreased. The number of mild hypo- and hyper-glycemic events per week increased slightly in the telemedicine arm. Severe hypoglycemic events per three months remained constant in the telemedicine arm. The only statistically significant change between the groups was the number of mild hypoglycemic events per week (P < 0.05). The baseline information of mild hypoglycemic events was collected over two weeks before the study and again two weeks before the last meeting, limiting the generalizability of the results. Physicians showed a moderate to a high level of satisfaction with the use of the diabetic platform with more than 50% being very or quite satisfied with the data accuracy as well as the utility, platform flexibility, and metabolic control outcomes. The questionnaire used to obtain these results was explicitly designed for this study and, as such, has not been used in previous studies. The questionnaire’s internal reliability has not been proven at this point. That said, physicians were mostly satisfied with their telemedicine experience, with their lowest satisfaction being the speed of the platform as well as improvement of adherence.
The outcomes for telemedicine’s use in patients with type 1 diabetes that have an HbA1c <8% appear to be similar to those when patients meet with providers face-to-face. These results were in line with the results of previous studies when telemedicine was used in patients with an HbA1c ≥8%. This study adds support to the idea that telemedicine may be used to replace some face-to-face visits. The advantages of telemedicine lie in its ability to improve access to healthcare. It can provide a way for patients to see specialists that would generally be too far away for them to visit easily. In this study, patient-reported quality of life did not change significantly in either group, meaning that the telemedicine did not impair patient lifestyle. Though it does offer many advantages, telemedicine still needs to have a significant amount of infrastructure in place before it can be used. Providers and patients must be able to access and make use of the available technology for any potential benefits to be seen. Overall, telemedicine has an impact that was shown to be similar to face-to-face meetings with providers.
- Telemedicine has been previously shown to decrease costs to the patient, increase adherence rates, and increase patient satisfaction.
- Telemedicine showed results similar to face-to-face meetings in terms of glycemic control.
- If patient follow-up or schedule is a concern, telemedicine may be beneficial to increase patient participation in counseling.
Adana, Maria S. Ruiz de, et al. “Randomized Study to Evaluate the Impact of Telemedicine Care in Patients With Type 1 Diabetes With Multiple Doses of Insulin and Suboptimal HbA1c in Andalusia (Spain): PLATE DIAN Study.” Diabetes Care, American Diabetes Association, 4 Jan. 2020, care.diabetesjournals.org/content/early/2020/01/02/dc19-0739.
George McConnell, PharmD. Candidate, LECOM School of Pharmacy