Telemedicine for diabetes care: An Indian perspective - feasibility and efficacy

Abstract

Diabetes is a chronic and costly disease. In India, the usual practice among patients is to visit the doctor once in every 2–3 months to get advice on changes in the dosages of medications. The Diabetes Tele Management System (DTMS®) is a telemedicine based follow-up program originally introduced at Jothydev's Diabetes Research Centre at Trivandrum South India in 1998. It is a chronic disease management system which enables patient to interact lively with a professionally trained multidisciplinary team comprising of diabetes educators, nurses, dieticians, pharmacists, psychologists, physicians, etc., in modifying the dosages of medications, diet, and physical activity either through telephone/email/secure website. The uniquely designed software and the trained multidisciplinary team overcomes the globally recognized major barriers to diabetes management namely fear of hypoglycemia, polypharmacy, discontinuation of stains, and antihypertensives or wrong injection techniques. DTMS is designed to provide individualized therapy advices on glycosylated hemoglobin, blood pressure, and low density lipoprotein customized to multiple patient characteristics which help attain goals of therapy. The system has been tested on various platforms over a decade and was shown to be a patient friendly approach with successful outcomes due to a live “round-the-clock” interactive communication in contrast to text or recorded messages. The major challenge to the widespread use of DTMS® is seeking a source of funding this unique telemedicine program.

Effect of COVID19 pandemic and national lockdown on persons with diabetes from rural areas availing care in a tertiary care center, southern India

“…from New Delhi reported a higher (69%) awareness about telemedicine services among PWDs. There are many challenges in tele-consultation such as low patients’ acceptance, poor internet facilities, patients’ inability to operate smartphones, error in communication and security issues [ 20 ]. But in the current scenario, telemedicine can fine-tune PWDs’ medications, ensure drug compliance, and support continuous diabetes education.…”

Diabetes self-care in primary health facilities in India - challenges and the way forward

“…Team-based DSME/S for patients in primary care need high-quality training of nurses, multipurpose workers and other paramedical stuff like pharmacists as diabetes educators. Decision support like when to initiate insulin to avoid clinical inertia can be provided to medical doctors working in rural and suburban areas through telemedicine-based consultation with specialists[60]. Peer-support based community linkages may help patients cope with stress and reduce physical inactivity through health promotion activities like yoga and meditation.…”

Mobile health technology in the prevention and management of Type 2 diabetes

“…[33] To address this concern, the US Food and Drug Administration under the Food, Drug, and Cosmetic Act ensures that all mHealth apps including devices are regulated, based on their functionality and risk of the data collected, and disseminated before it can be used. [39] A recent review on the feasibility and efficacy of telemedicine for diabetes in India[40] highlights the lack of strict regulatory protocols in delivering interventions for the prevention or management of health conditions through telemedicine. Standardized protocols need to be adapted to all eHealth interventions (thus including mHealth) which can help minimize communication errors between the provider and the user.…”

“…Standardized protocols need to be adapted to all eHealth interventions (thus including mHealth) which can help minimize communication errors between the provider and the user. [40] Many physicians are skeptical about transitioning to mHealth from traditional ways mainly because of the effort it will take to change from an old system to a new one. In addition, although many physicians believed that technology had the ability to improve quality of care, in the long run, they found adaptability a challenge.…”