The potential advantages and disadvantages of the role of Tele-medicine in supporting the modern delivery of diabetes care in the community.

Dr. Omar Dahmosh Mustfa Mashhor

Corresponding Author: Dr. Omar Dahmosh Mustfa Mashhor, Endocrinologist, Future medical center, Doha, Doha, Qatar.

Copy Right: © 2022 Dr. Omar Dahmosh Mustfa Mashhor, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received Date: October 11, 2022

Published Date: November 01, 2022

Introduction           

DM Once diagnosed, is for life. The diabetic patients care needs constatnt visits and communication with the health care providers to seek advice about the diabetes, changes in the lifestyle, dosage of medications, and discover its complications. Rising Prevalence of DM, shortage of diabetes team and complexity of treatment translates to poor health outcomes and failure to reach therapeutic targets.

Therefore DM is disease costly.

Technological advances have created new opportunities for connecting diabetic patients to their diabetic team to help them  to improved the management in addition to reduce treatment costs. In the past two decades, telemedicine have been used to provide education for monitoring of blood glucose and to facilitate consultation with health providers.

What is Telemedicine:

Telemedicine defines as a communication between the patient and healthcare providers at a distance to provide medical care and may provide opportunities to serve the “triple aim” of better health and improved patient experience at reduced cost. It involves many applications of established and emerging technologies. Telemedicine interventions include, telephone, mobile phones, wirelss devices, electronic mail, website, or video conferencing.

The advantages of telemedicine in Supporting Diabetes Care:

Telemedicine may enhance patient access for certain at risk populations, such as those who are geographically (rural communities), functionally (elderly or disabled), abd socioeconomically isolated. It may amplify the inadequate and concentrated supply of diabetes specialist, educators, and mental health personnel, to support primary care teams and their patients with diabetes and may even provide an alternative for engaging people with diabetes less motivated to visit their healthcare team.

Telemedicine also helps gathering patients data, store important data such as investigation and as a reminder for future followup appointments with the diabetic team, and a reminder with the patient regarding the emerging development related to diabetes.

In other hand many studies have evaluated the effectiveness of remote glouse monitoring on improved glyceic control, there is still alaock of strong evidence for its effectiveness in improving HbA1c but there is a notable exception is telemedicine diabetic retinopathy screening system, where fundus is taken at primary healthcare sites and transferred to central reading  centres for assessment and grading of a retinal disease related to DM. These telemedicine retinopathy screening system have been shown to be both effective identifying individuals requiring referral for treatment and cost effective to implement across different resource settings.

They've been a number of well conducted meta analysis and meta regregations aimed  at assessing the clinical effectiveness of dozens of telemedicine interventions for diabetic care. the diversity  of  interventions has highlighted the wide range of opportunities, from diabetes education to medical care, including specialized service such as eye care and mental health support. these reviews have  generally reported positive findings in terms of clinical outcomes  (example glycemic control and self management) and patient experience (example care coordination and access).

 (idea tel) trial which compared telemedicine case management to usual care in the management of DM. the trial showed little, but considerable an improvement in HbA1C, BP, LDL-C, and sustained clinical improvement which will likelyto  reduce long term complication despite the high cost but no impact on mortality. it has been suggested that standardizing processes and outcomes may improve our understanding of the clinical and cost effectiveness of telemedicine in the care of individual with diabetes perhaps most importantly the absence of cost effectiveness data.

Although there is a problem in covering insurances in Tele medicine but fortunately there is evidence that reimbursement policies may be changing for certain at risk population and those receiving care in specific situations suggest Veterans Health Administration.

The disadvantages of telemedicine in diabetic care:

there are many challenges to widespread adoption telemedicine many of the clinical improvements were modest and not consistent across studies. there are also some unintended negative findings, including challenges with technologies dimensioned quality of interactions with healthcare team. in addition to the unavailability connection can be a Great Barrier in delivery of healthcare information to the patient an telemedicine needs an expert team and trainer all technical problems and find quick solutions for them,

There was significant attrition many years ago much owing to challenges or frustration with the computer. any independent evolution demonstrated no reduction in the Medicare user cost for health services.

Despite sustained clinical improvements the intervention cost what deemed excessive over 8000 USD per person annually given similar improvements noted in case management trials not using telemedicine which occurred at a fraction of the cost there were significant lessons learned and summarised in the final report for many studies which emphasized the need to target high risk populations likely to benefit from telemedicine and adoption of lower cost user friendly technologies which have since entered the marketplace.

 State level regulations and private insurance reimbursement a critical barriers to expanded use of telemedicine services they remain significant variation in reimbursement for telemedicine best care in the commercial insurance market.

Conclusion

Information technology has the potential not only to strengthen existing models of care but also to create new models of care for people living with DM. telemedicine is part of new digital age that is transforming the world it is well popular in treating diabetes.

Telemedicine interventions whether synchronous and asynchromous remind and important enabler of models off care that focus on providing better access especially in resource limited settings. increasingly healthcare teams recognise the critical importance of staying connected to people with diabetes in between routine impersonate clinical encounters in addition to improving access to people with diabetes for whom significant barriers may  impede access in traditional face to face encounters.

There is general consensus the effective telemedicine intervention like most successful technological innovation. although the advances in information technology hold emails promise in enhancing the different models of care for diabetes embracing those technologies remains a challenge. with the right design and careful implementation telemedicine will continue to play increasing role in supporting healthcare system. in generalizable and cost effectiveness of telemedicine diabetes care remind an improvement area for future investigation

Reference.

1. American telemedicine association what is telemedicine? available at HTTP:/www.american telemart.org/about-telemedicine/what-is-telemedicine#Vk6tD3arTIU. access November 23 2015.

2. Klonoff DC. the current status of mhealth for diabetes: will it be the next big thing? J diabetes sci technol. 2013; 7(3):749-758

3. Dvorack K. sensor based remote monitoring system keeps elderly out of hospital August 28 2015.

4. Landro L interactive video helps patients get access to medical specialist. May 12 2014.

5. Flogren G, Rachas, farmer AJ, Inzitari M, Sheppered S, interactive telemedicine effects on professional practice and healthcare outcomes. Cochrane databases Rev 2015: 9: CD 00 2098. Doi: 10. 1002/14651858.

6. Steinberg d, Horwitz G, Zohar D,  building a business model in digital medicine. net biotechnol 2015; 33; 910-920

7. Garcia-saez G, Hernando ME, Martinez sarriegui  I, Rigla M, Torralba V, Brugues  E, de Leiva A, Gomez EJ, architecture of a wireless personal assistant Patel medicine diabetes care. INT. J med inform, 2009; 78(6); 391-403

8. Boren SA, Puchbauer AM, Williams F. computorised prompting and feedback of diabetes care. review of literature J diabetes sci technol 2009; 3 (3); 509-516

9. Klonoff DC. diabetes and telemedicine is the technology sound effective cost effective and practical? diabetes care. 2003; 26(5) 162-168

10. Davis s, Alonso MD> hypoglycemia as a barrier to glycemic control. J diabetes complications 2004; 18: 60-8.

11. Cryer PE. hypoglycemia associated autonomic failure in diabetes. Handb Clin Neurol 2013-117:295-307.

12. Marcolino MS, Maia JX, alkmim MB, Boersma E, Ribeiro AL, telemedicine application: systemic review and meta analysis, plus one 2013: 8

13. The effectiveness of intensive treatment of diabetes on the development and propagation of long term complications in insulin dependent diabetes. the diabetes control and complications trail research group. N Engl J med 1993;329;977-86

14. Effect of I intensive blood glucose control with metformin on complications in overweight patient with  type 2diabetes.  UK prospective diabetes study. group Lancent 1998;352:854-65

15. Kesavadev J, Shankar A, Pillai PB, Krishnan G, Jothydec  S. cost to fit use of telemedicine under self monitoring of blood glucose via diabetes Delhi management system to achieve target with type 2 diabetes mellitus, A retrospective study diabetes technol ther 2012;14;772-6

16. Shea S, Weinstock, R,m teresi JA et.al J AM Med inform Assoc 2009;16 (4); 446-4.