Unlocking the potential of digital health
Digital health has been much talked about as one of the great hopes of better diabetes management, and with so many new technologies now established in the market - continuous or flash glucose monitoring (CGM or FGM) in particular, as well as remote data-gathering platforms – the supply side of that expectation seems to be doing very nicely thank you.
But what about uptake? Are people with diabetes and their healthcare teams unlocking the full potential of digital health? And do some patient types (e.g. older or younger? type 1 or type 2?) make better use of it than others?
A recurring theme of this year’s EASD Annual Meeting was the way that, amidst all the devastation, COVID-19 has precipitated a major shift towards telemedicine. As Catarina Limbert reported in a presentation on type 1 diabetes and COVID-19, remote approaches implemented out of necessity have yielded marked benefits in terms of better autonomy for patients and a reduced burden of routine care. She also cited studies that suggest improvements in blood glucose control during lockdown.
Such improvements were the subject of another presentation, from Federico Boscari, who reported results from a study undertaken at the University of Padova, which gathered data from 33 type 1 patients using FGM who were remotely connected to the diabetes clinic via FreeStyle’s LibreView platform. The study compared glycaemic measures from three months prior to the COVID-19 outbreak in Italy; one week pre outbreak; the period of the first educational and sports activities restrictions; and the first week of complete lockdown. Patients were divided between those who continued working during lockdown (essential workers) and those who didn’t.
Interestingly, those who stayed at home showed better glycaemic control, reduced mean glucose and time in hyperglycaemia, and increased time in range. By contrast, those who continued to go out to work showed no change. This study had its limitations: for instance, no data was gathered on the number of injections or meals, so it is difficult to tease out exactly why the improvement took place. Nor was data gathered on subsequent weeks of lockdown (after the first week most patients were remotely contacted by their care team with advice on how to manage their diabetes, thereby introducing bias). Even so, this presentation was a great example of research enabled retrospectively by digital technology.
More engagement with personal CGM data has been associated with better glycaemic outcomes over time. Other presentations addressing this topic at the conference included a study from CGM manufacturer Dexcom, which showed that type 1 and type 2 patients had similarly high levels of engagement with the various features offered by the Dexcom device. Another presentation, from Ken Snow, reported the effect on HbA1c of the One Touch Reveal Plus app. Again, use of this device showed significant improvements in blood glucose control and demonstrated a high level of engagement. Significantly, nearly 50% of the patients in the study were on oral medication only, a finding which counters the widely held belief that digital therapeutics mainly benefit people with insulin-treated diabetes.
Such benefits should translate into savings for the health system, and this was a clear finding in another presentation – from Nadege Costa, who presented evaluation results for the EDUC@DOM telemonitoring and tele-education programme. As well as significant benefits for improved glycaemic control, use of this programme - which was designed for people with type 2 diabetes - was also associated with substantial reductions in pharmacy costs.
But what about access? Another session heard from Timothee Froment about the vast disparities in access to diabetes technologies between different populations with diabetes around the world. Even in countries where public coverage of the cost of diabetes treatments is extensive, out-of-pocket expenses are often required to access the latest in digital diabetes therapeutics. As Catarina Limbert emphasised in her presentation, we need to beware of advances in digital health that are restricted to ‘bubbles’ of excellence. Action is needed to mitigate disparities in access and skills, including funding to improve telemedicine.
For more on digital diabetes therapeutics, see our courses on Time in range and Technology and type 1 diabetes.
For more on global discrepancies in access to technology and telemedicine, see our series of films Around the Diabetes World in 80 Days.
A new e-Learning course on telemedicine in diabetes is currently in development, for launch in 2021.
Any opinions expressed in this article are those of Dr Eleanor D Kennedy.
Sessions at the EASD 56th Annual Meeting 2020
COVID-19 and diabetes
Catarina Limbert. What have we learned from COVID-19 in persons with type 1 diabetes?
OP 18: Unlocking the potential of digital health
Federico Boscari. Glycaemic control among people with type 1 diabetes during lockdown against the SARS-CoV-2 outbreak in Italy.
R Dowd. Real-time CGM usage and estimates of glycaemic control among individuals with type 1 or type 2 diabetes.
Ken Snow. Beyond BG testing: digital health and intelligent monitoring.
Nadege Costa. Evaluation of the one-year efficiency of the EDUC@DOM telemonitoring and tele-education programme for type 2 diabetic patients.
OP 42: Diabetes care is expensive
Timothee Froment. Economic burden associated with diabetes technologies: a cross-national comparison of out-of-pocket expenses.