Telehealth—An Effective Delivery Method for Diabetes Self-Management Education?

Abstract

Diabetes is a chronic disease that is often comorbid with cardiovascular disease, hypertension, kidney disease, and neuropathy. Its management is complex, requiring ongoing clinical management, lifestyle changes, and self-care. This article examines recent literature on telehealth and emerging technological tools for supporting self-management of diabetes and identifies best practices. The authors conducted a PubMed search (January 2008-2012) that was supplemented by review of meeting materials and a scan of the Internet to identify emerging technologies. Fifty-eight papers were reviewed; 12 were selected for greater analysis. This review supports earlier findings that the delivery of diabetes self-management and training (DSME/T) via telehealth is useful, appropriate, and acceptable to patients and providers. Best practices are emerging; not all technology is appropriate for all populations--interactive technology needs to be appropriate to the patient's age, abilities, and sensitivities. Telehealth is scalable and sustainable provided that it adds value, does not add to the provider's workload, and is fairly reimbursed. However, there are multiple barriers (patient, provider, health system) to remotely provided DSME/T. DSME/T delivered via telehealth offers effective, efficient, and affordable ways to reach and support underserved minorities and other people with diabetes and related comorbidities. The new generation of smartphones, apps, and other technologies increase access, and the newest interventions are designed to meet patient needs, do not increase workloads, are highly appropriate, enhance self-management, and are desired by patients.

Kidney transplant patients’ attitudes towards self-management support: A Q-methodological study

“…For example, a more directive, medical focused support style, typified by the 'Clinician' perspective described by van Hooft et al [26], may be more appropriate to use with patients in profile A. Similarly, a 'Coaching', holistic approach may be more appropriate with patients in profile B. Telemedicine [35] and home-testing of blood pressure and creatinine [36] may be most appreciated by patients in profile D+. We note however that, despite advances in eHealth to support selfmanagement, this patient population unanimously appreciated personal contact with professionals.…”

Are Telehealth Technologies for Hypertension Care and Self-Management Effective or Simply Risky and Costly?

“…Recent manuscripts further demonstrate the feasibility of virtual environments for educating adults with chronic illness. 62,63,64 Additionally, studies of telehealth programs show at least short-term clinical improvements for BP outcomes; such findings may be explained in part because home BP readings may be more reliable than those obtained in a physician's office because of ''white coat syndrome'' in which a patient's BP is elevated in the clinical setting, but not in other settings. As more robust studies emerge, it will be helpful to have a systematic review and/or meta-analysis conducted to show positive and negative impact of BP studies by type of intervention.…”

The role of digital communication in patient–clinician communication for NHS providers of specialist clinical services for young people [the Long-term conditions Young people Networked Communication (LYNC) study]: a mixed-methods study

“…270 Researchers have recently started to explore the use of more novel technologies in the care of diabetes mellitus patients. Text message (SMS)-based interventions have been used in the care of children and adolescents with diabetes mellitus to monitor blood glucose levels remotely and to send reminders and advice about medication and lifestyle choices.…”

“…274 Overall, digital communication technologies have the potential to positively affect the health of people with diabetes mellitus; however, the technology used must be appropriate to the patient group. 270 To date, only one review has focused on interventions that included two-way communications between clinicians and young adults with diabetes mellitus. 44 This review found that, although contact between clinician and patient increased, there was uncertainty about whether or not this led to improved clinical outcomes.…”