Telemedicine for Diabetes

Leonard Thaler, MD, FACE, ECNU

Telemedicine appears to be particularly well suited for the management of diabetes. Given the growth of diabetes in the population and an increasing shortage of Endocrinologists, patients with diabetes often face long delays in medical care. Travel distances may be hundreds of miles and wait times for appointments can be several months duration. For those with more advanced illness or age, these obstacles may be insurmountable. Even in urban areas with more specialists, traditional doctor visits require a significant time commitment and time off work.

Traditional care generally involves assessment of glucose patterns and adjustment of medications at scheduled medical appointments, often a month or more apart. This may be enhanced with occasional phone calls between scheduled appointments. However, especially in cases with erratic glucose levels or hypoglycemic episodes, more frequent assessment of data and adjustment of medications and diet would be greatly beneficial; not only to improve glycemic control more rapidly, but also to allay the anxiety that many patients suffer when glucose control is unstable.

The morbidities associated with diabetes occur from a cumulative period of hyperglycemia and, therefore, more rapid and frequent access to care would be expected to improve outcomes.

Numerous medical studies, thus far mainly in rural and underserved areas, have confirmed significant improvements in diabetes control with the utilization of telemedicine procedures. Technology is also rapidly advancing and likely to further enhance these benefits.

Many companies that currently produce home glucose monitors, continuous glucose monitoring systems, and insulin pumps are working on cloud connectivity for their products, with web portals designed for easy access by physicians.

Furthermore, technology companies such as Apple are working to integrate existing medical device technologies with smart phone apps, in order to provide physicians with meaningful data, with the goal of integrating the data of multiple devices with electronic health records.