The use of technology in diabetes self-management

2014-05-18 15.08.09

Natalie Wischer RN, BN, RM, CDE, Grad Dip Mgt

Executive Director, Australian Diabetes Online Services

Introduction

Diabetes is a complex condition that requires a range of treatment, support and educational strategies to achieve goals well beyond simple attainment of a euglycaemic state. A key to long-term health success is in the accomplishment of diabetes self-management (DSM) skills, and to enable this clinicians must find ways to facilitate sustained behaviour modifications that will last once the initial motivation has waned. A challenging task of DSM is keeping track of the many glucose readings, pathology results, medications, insulin doses, appointments, dietary intake, exercise and activity and advice/recommendations of 4-5 (or sometimes more) health care professionals (HCPs). It is here that technology can provide us with an incredibly powerful tool to significantly impact on diabetes health-related outcomes.[1] [2] A recent survey has found nearly half of all Australian adults now own a smartphone. An Australian Communications and Media Authority study found a 104% increase in smartphone use in the last 12 months.[3] These findings paint Australians as more ‘tech-savvy’ than even some experts had anticipated and with this rise in use, HCPs can expect that clients will be using and seeking more information on what is available to assist them in managing their diabetes.

Devices

The range and sophistication of diabetes meters and insulin pumps is growing enormously. The consumer is inundated with choice and will often need guidance from their HCP on which meter or pump will best to meet their needs. Some of the additional tools that are available within these devices include data uploads and detailed charts, that can be shared with the individual’s care team for easy interpretation and overview of blood glucose values, insulin, food intake and activity levels. Some meters also offer a recommended dose of insulin in response to recorded blood glucose levels.

Websites

The internet is no longer seen as new technology, but it is without a doubt one of the most popular sources of information. How can we ensure our clients are being fed the right type of information, from reputable online sources? Whilst some online health information is useful and evidence-based, there is also medical misinformation and clients should be warned about the risks of this. To help prevent individuals falling victim to internet health misinformation or scams, it is wise to provide a list of reputable websites at the time of diagnosis and at clinical review. Suggested websites would include Diabetes Australia (http://www.diabetesaustralia.com.au), the Juvenile Diabetes Research Foundation (http://www.jdrf.org.au) and the diabetes fact sheets from Baker IDI (http://www.bakeridi.edu.au).

Applications A clinical trial in Diabetes Care showed that patients with type 2 diabetes (T2D) who received behavioural mobile coaching through the use of tracking mediations, caloric intake, glycaemic levels and other management information, compared with usual care were more likely to experience reduction in glycosylated haemoglobin (HbA1c). The difference was 1.2% over a 12 month period (p<0.001).[4] Applications (‘apps’) to track glucose concentrations, activity levels, medication compliance and food intake are extensively available. These should be simple to use and provide a variety of features; at their best, they may combine many of these features all in one app. Some highly-rated diabetes-specific apps that do this are Diabetes App Lite, Glucose Buddy, On Track Diabetes and the Australian-developed Rapid Calc. Some of these apps are free and increasingly many are becoming available on Android devices.

Social Media

A Nielsen poll in 2012 (see Table 1) showed that people trust 70% of consumer opinions posted online, which demonstrates the paradigm shift in consumer confidence in newer forms of communication. Consumers are also clients with health issues, who go online to seek understanding and support from others with the condition. This in turn is leading to an ever-growing market of bloggers, and groups on Twitter and Facebook chatting about all things diabetes. We are fortunate in Australia to have some incredible resources in this online space. OzDoc is an online diabetes community (@OzDiabetesOC) that uses Twitter as its platform and meets every Tuesday night  at 8.30pm Australian Eastern Daylight Time. The allotted moderator for the evening sends out 4-5 questions over the hour long chat, which are responded to by their over 1,000 followers. Questions include topics such as, “Have you set diabetes-related goals for the New Year?” The Type 1 Diabetes Network has developed Reality Check, which offers a moderated online forum for people with T1D to share their experiences and learn from others (http://www.realitycheck.org.au/RCforum/). Diabetes Counselling Online is another Australian-based online support network (http://www.diabetescounselling.com.au/). People living with diabetes who use social media want their HCPs to appreciate that they can find it a catalyst in their learning process, accelerating behavioural change and assisting with the adoption of new habits.[5] 

Text messaging

Mobile phone messaging is an inexpensive method of delivering health and wellness advice that can assist with lifestyle modifications. In a study published in the Lancet – Diabetes and Endocrinology, researchers have shown that text messaging can significantly prevent the incidence of T2D over a two-year period in a high-risk population in urban India.[6] Given the wide use of mobile phones, text messaging is a cheap and effective method to reach a large population and disseminate behavioural modification information and education. Video consultations The Australian Government rolled out the National Telehealth Initiative in July 2011 and while face-to-face consultations will often be the preferred option, there are scenarios where a video consultation is clinically justifiable and can enable more convenient and accessible healthcare delivery without compromising patient safety. Diabetes is a condition which is often well suited to video consultations. A study published in the Journal of Telemedicine and Telecare demonstrated that video consultations are appropriate and effective in most cases for people with diabetes in rural Australia.[7] This study showed that from the endocrinologist’s point of view, video consultations are adequate and suitable for patients with diabetes who live in rural areas. This method would save both time and discomfort of patients with diabetes, who may otherwise need to travel up to 2,000 km to the main capital city to see their specialist. 

Games

Online games such as Carb Counting with Lenny, and motivational, behavioural change games such as Bant and EndoGoal, are part of the growing set of resources available to engage people of all ages.

Conclusion

A major benefit of technology is the ability to tailor care to the individual patient and have it available at any time, any place, and when the person with diabetes needs it most. Also exciting is the scalability of these resources for improving efficiencies, access and outreach. “The opportunity for online treatment of diabetes is to improve outcomes, expand services to more patients, and decrease costs (such as service, reporting, oversight and long term care).,” said Dr Neal Kauffman, endocrinologist . Health care professionals need to understand the technology that is available, consider our individual clients, reflect on what their needs are and consider how best to present the information required. We have a growing toolbox of technology that can be used to deliver what is required, in the most appropriate time and manner. “The only thing that is constant is change” Heraclitus

Declaration of Interest:

Natalie Wischer has served on advisory boards, provided education and/or received grants from the following: Astra Zeneca, Sanofi Aventis, Novo Nordisk, Bristol Myer Squibb, Merck, Sharpe & Dohme. She currently has research grants from Novo Nordisk and Sanofi Aventis

Practice Points:

  • Diabetes is extremely well-suited to digital interventions.
  • We will see an incredible acceleration of technology and social media opportunities in diabetes self-management over the next 10 years .
  • HCPs can start by improving existing processes but also look for opportunities that can transform the way that diabetes monitoring and care is delivered.
  • Tailor the use of mobile technology so that it provides education, support and monitoring of progress.
  • Validation matters! Work with, be interested and support what your patients are using.

References:


[1] Quinn CC, Shardell MD, Terrin ML, et al. Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control. Diabetes Care. 2011 Sep;34(9):1934-42..
[2] Murray E, Burns J, See TS, et al. Interactive Health Communication Applications for people with chronic disease. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD004274.
[3] Australian Communications and Media Authority. Telecommunications equipment: Smartphones use doubles in 2012 [Internet]. 2013 February 1 [Last updated: 2013 October 11; accessed 2014 January 13]. Available from: http://www.acma.gov.au/theACMA/Newsroom/Newsroom/Media-releases/mr-52013-smartphones-use-doubles-in-2012
[4] Quinn CC, Shardell MD, Terrin ML, et al. Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control. Diabetes Care. 2011 Sep;34(9):1934-42.
[5] Labate, C. The influence of social media on diabetes treatment and self-care. Diabetes Voice. 2013 Apr;58(1):14-5.
[6] Ramachandran A, Snehalatha A, Ram J, et al. Effectiveness of mobile phone messaging in prevention of type 2 diabetes by lifestyle modification in men in India: a prospective, parallel-group, randomised controlled trial. Lancet Diabetes Endocrinol. 2013 Nov;1(3):191-8. [7] Fatehi F, Gray LC, Russell AW. Telemedicine for clinical management of diabetes – a process analysis of video consultations. J Telemed Telecare. 2013 Oct;19(7):379-82.
To see the full article in pdf format, please click here: DMJ Article (PDF)
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