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The rise and rise of telehealth

2nd February 2022

The huge potential of telehealth for education and managing diabetes was discussed at the International Diabetes Federation Middle East and North Africa Congress 2021 (IDF MENA). Lisa Buckingham reports.

One of the co-moderators of this patient education session began by pointing out that managing type 1 diabetes is so much easier when the patient, their family and peers are well educated on management.

How best to do this? Bassam Saleh Bin-Abbas, professor of paediatric endocrinology at Al-Faisal University and King Faisal Specialist Hospital and Research Center in Riyadh, covered what’s new in type 1 diabetes education, focusing on what is being used locally in Saudi Arabia.

Saudi Arabia is number three in the world for the incidence of type 1 diabetes at 31.4 people per 100,000 (Finland and Sweden are first and second). As we can’t prevent it, he said, we need to focus on preventing its acute and chronic complications.

Good management cannot be achieved without validated structured education programmes (SEP) targeting lifestyle modification and self-adjustment. SEP is defined as ‘a planned and graded process that facilitates the knowledge, skills and ability for diabetes self-management.’

To achieve that, more diabetologists and educators are needed, as well as regular clinics and group classes, and new ideas, including utilising technology effectively, phone clinics, virtual clinics and eHealth.

Technology can and should help, he said. Under eHealth, he discussed using text messaging, consultations via text and calls, and using mobile phone apps. During the COVID-19 pandemic, clinic visits were replaced almost entirely by these and both healthcare providers and patients liked it and wanted to continue even as lockdowns were relaxed.

He discussed trials done locally in Saudi Arabia on remote diabetes education. The first was the effect of mobile phone text messages on glycaemic control in children with type 1 diabetes. Over a six-month period, educational texts were sent out to parents and they were perceived by the parents and children as reminders to check blood glucose and be compliant with their insulin regime.

The results showed a good improvement in glycaemic control, taking the average HbA1c down. The frequency of missing insulin injections went down and frequency of glucose monitoring went up. This meant that frequency of hospital admissions and visits also improved. The mean score of the Parent’s Knowledge Test went up at the end of the six months.

After the success of this trial, they replicated it in their patients with type 2 diabetes, sending patients between three and five messages per day. Again, improvements were seen across average HbA1c and patient’s knowledge, and the mean frequency of hyper/hypoglycaemic attacks improved.

They concluded that telemedicine educational support using mobile phone text messaging offered a means of contact between clinic visits and increased the adherence with diabetes therapy and improved the clinical outcome in patients with type 1 and type 2 diabetes.

With regard to mobile apps, he pointed out that there are 500 million smartphone users worldwide using a healthcare application and outlined the diabetes apps used in Saudi Arabia, including ones that connect subscribers with a diabetes educator or dietitian and provide you with a remote consultation, and those that give information about carb counting, blood glucose readings and trends. This ultimately improves patients’ education and glycaemic control.

Some, such as BlueStar Diabetes, have been approved by the Food and Drug Administration (FDA) and Professor Bin-Abbas sees them as closing gaps in care by providing real-time support and expert coaching, along with personalised insights. They can also help to keep family and doctors informed about the patient.

Many apps also go beyond coaching, and track medical appointments, blood test results, routine examinations such as eye tests and kidney disease screens, medication refills, vaccinations such as flu shots, and your medication adherence.

He highlighted data from remote diabetes coaching app developers, which shows that users report an average weight loss of 10.9%, an average systolic reduction of 13% and average HbA1c decrease of 2.3%. This will ultimately help reduce long-term implications.

In Saudi Arabia, high numbers of people are engaging with these apps and the ‘Saudi Vision 2030 Plan’ stressed the importance of adopting and developing a national telehealth network. It will be efficient in reducing patient expenses for healthcare services by providing online consultations, prescription refills, and follow-ups.

In conclusion, this mode of care is the new trend in education and management of diabetes and other chronic illnesses, and is the key to bridging the gaps in diabetes services.

For more on this topic, see Professor Catarina Limbert’s presentation for our ‘Diabetes and COVID-19 series, ‘A booster shot for telemedicine’.

For more on diabetes in Saudi Arabia, see Dr Yousef Al Saleh’s presentation, Day 56 of our series ‘Around the Diabetes World in 80 days’.

Any opinions expressed in this article are the responsibility of the EASD e-Learning Programme Director, Dr Eleanor D Kennedy.