Shaping Workflows in Digital and Remote Diabetes Care During the COVID-19 Pandemic via Service Design: Prospective, Longitudinal, Open-label Feasibility Trial

Braune, Katarina; Boß, Karina; Schmidt-Herzel, Jessica; Gajewska, Katarzyna Anna; Thieffry, Axel; Schulze, Lilian; Posern, Barbara; Raile, Klemens

doi:10.2196/24374

Cited by 28 publications

(48 citation statements)

References 65 publications

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“…Self-care has proven to be a robust tool in times of the COVID-19 pandemic. Important diseases such as diabetes [20] or cardiac diseases [21] benefit greatly from mHealth initiatives that rely on self-care and remote monitoring.…”

Section: Why the Need Of A Study On The Digital Dividementioning

confidence: 99%

The Digital Divide in the Era of COVID-19: An Investigation into an Important Obstacle to the Access to the mHealth by the Citizen

Giansanti

Veltro

2021

Healthcare

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In general, during the COVID-19 pandemic there has been a growth in the use of digital technological solutions in many sectors, from that of consumption, to Digital Health and in particular to mobile health (mHealth) where an important role has been played by mobile technology (mTech). However, this has not always happened in a uniform way. In fact, in many cases, citizens found themselves unable to take advantage of these opportunities due to the phenomenon of the Digital Divide (DD). It depends on multifaceted aspects ranging from the lack of access to instrumental and network resources, to cultural and social barriers and also to possible forms of communication disability. In the study we set ourselves the articulated goal of developing a probing methodology that addresses the problems connected to DD in a broad sense, capable of minimizing the bias of a purely electronic submission and evaluating its effectiveness and outcome. At the moment, we have submitted the survey both electronically (with an embedded solution to spread it inside the families/acquaintances) and using the wire phone. The results highlighted three polarities (a) the coherence of the two methods; (b) the outcome of the entire submission in relation to key issues (e.g., familiarity on contact tracing Apps, medical Apps, social Apps, messaging Apps, Digital-health, non-medical Apps); (c) a Digital Divide strongly dependent on age and in particular for the elderly is mainly evident in the use of mTech in general and in particular in mHealth applications. Future developments of the study foresee, after adequate data-mining, an in-depth study of all the aspects proposed in the survey, from those relating to access to resources, training, disability and other cultural factors.

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Section: Why the Need Of A Study On The Digital Dividementioning

confidence: 99%

The Digital Divide in the Era of COVID-19: An Investigation into an Important Obstacle to the Access to the mHealth by the Citizen

Giansanti

Veltro

2021

Healthcare

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“…Most of the studies included did not include a formal telemedicine component, rather they collected data from an observational standpoint and made no assessment of the nature of telemedicine contacts between patients and their diabetes HCPs, although these are acknowledged to have happened. However, 4/27 studies did involve an active telemedicine intervention and in each of these studies [23][24][25][26] there was an improvement in glucose metrics. Most tellingly, in the study by Alharthi [26], CGM users were categorized into two groups, one that participated in a single telemedicine consult during the 6-week lockdown study period (n = 61) and one that did not (n = 40).…”

Section: Time In Range During Covid-19mentioning

confidence: 99%

“…In doing so, the most agile services have emphasised and adopted systems and technologies that support people with diabetes in new models of care that minimise their need to attend busy medical centres. It is not a coincidence that the early adopters of new service designs are paediatric diabetes clinics [9,23,70], one of which reports more than 80% of scheduled visits had been accomplished by telemedicine within 3 weeks of starting, with fewer missed appointments [70].…”

Section: Diabetes Services Already Employ Tools Needed For Telemedicine and Telemonitoringmentioning

confidence: 99%

Telemonitoring, Telemedicine and Time in Range During the Pandemic: Paradigm Change for Diabetes Risk Management in the Post-COVID Future

et al. 2021

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People with diabetes are at greater risk for negative outcomes from COVID-19. Though this risk is multifactorial, poor glycaemic control before and during admission to hospital for COVID-19 is likely to contribute to the increased risk. The COVID-19 pandemic and restrictions on mobility and interaction can also be expected to impact on daily glucose management of people with diabetes. Telemonitoring of glucose metrics has been widely used during the pandemic in people with diabetes, including adults and children with T1D, allowing an exploration of the impact of COVID-19 inside and outside the hospital setting on glycaemic control. To date, 27 studies including 69,294 individuals with T1D have reported the effect of glycaemic control during the COVID-19 pandemic. Despite restricted access to diabetes clinics, glycaemic control has not deteriorated for 25/27 cohorts and improved in 23/27 study groups. Significantly, time in range (TIR) 70–180 mg/dL (3.9–10 mmol/L) increased across 19/27 cohorts with a median 3.3% (− 6.0% to 11.2%) change. Thirty per cent of the cohorts with TIR data reported an average clinically significant TIR improvement of 5% or more, possibly as a consequence of more accurate glucose monitoring and improved connectivity through telemedicine. Periodic consultations using telemedicine enables care of people with diabetes while limiting the need for in-person attendance at diabetes clinics. Reports that sustained hyperglycaemia and early-stage diabetic ketoacidosis may go untreated because of the lockdown and concerns about potential exposure to the risk of infection argue for wider access to glucose telemonitoring. Therefore, in this paper we have critically reviewed reports concerning use of telemonitoring in the acute hospitalized setting as well as during daily diabetes management. Furthermore, we discuss the indications and implications of adopting telemonitoring and telemedicine in the present challenging time, as well as their potential for the future.

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“…However, the concept has most effectively been validated by a successful switch to telemedicine during COVID-19, in which one clinic reported that > 80% of scheduled visits were accomplished by telemedicine [ 38 ], with fewer missed appointments. A separate prospective study of a COVID-safe paediatric telemedicine workflow [ 39 ] found that %TIR and percent time above range (%TAR) significantly improved in children with T1DM, whilst percent time below range (%TBR) did not change, and that psychosocial health improved after 6 months.…”

Section: The Reality Of Telemedicine Telemonitoring and Mhealth In Diabetesmentioning

confidence: 99%

The Challenge of Sustainable Access to Telemonitoring Tools for People with Diabetes in Europe: Lessons from COVID-19 and Beyond

et al. 2021

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Telemedicine in diabetes care has been evolving over several years, particularly since the advent of cloud-connected technologies for diabetes management, such as glucose monitoring devices, including continuous glucose monitoring (CGM) systems, that facilitate sharing of glucose data between people with diabetes and their healthcare professionals in near-real time. Extreme social distancing and shielding in place for vulnerable patients during the COVID-19 pandemic has created both the challenge and the opportunity to provide care at a distance on a large scale. Available evidence suggests that glucose control has in fact improved during this period for people with diabetes who are able to use CGM devices for remote glucose monitoring. The development of telemedicine as part of the standard of care in diabetes faces significant challenges in the European context, particularly in terms of providing consistent and effective care at a distance to large populations of patients while using robust systems that can be supported by large regional and national healthcare services. These challenges include a fragmented approach to healthcare technology assessment and reimbursement, lack of eHealth education and literacy, particularly amongst healthcare professionals, lack of data integration, as well as concerns about electronic health records, patient consent and privacy. Here we review the benefits of and challenges to wider application of telemedicine and telemonitoring in the post-pandemic future, with the aim to ensure that the value of these eHealth services is provided to patients, healthcare providers and health systems.

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Shaping Workflows in Digital and Remote Diabetes Care During the COVID-19 Pandemic via Service Design: Prospective, Longitudinal, Open-label Feasibility Trial

Cited by 28 publications

References 65 publications

The Digital Divide in the Era of COVID-19: An Investigation into an Important Obstacle to the Access to the mHealth by the Citizen

The Digital Divide in the Era of COVID-19: An Investigation into an Important Obstacle to the Access to the mHealth by the Citizen

Telemonitoring, Telemedicine and Time in Range During the Pandemic: Paradigm Change for Diabetes Risk Management in the Post-COVID Future

The Challenge of Sustainable Access to Telemonitoring Tools for People with Diabetes in Europe: Lessons from COVID-19 and Beyond

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