Telemedicine in Diabetes: How Virtual Care Is Changing Diabetes Management in the UK

Thanks to advances in telemedicine, diabetes patients no longer need to rely on in-person visits and can instead opt for digital alternatives.

With more than 4.3 million people in the UK living with diabetes mellitus, adopting a digital approach seems sensible. Telecare can expedite processes for you as a patient and your medical team. The right technologies may even improve the treatment’s cost-effectiveness.

This article provides insight into telemedicine and how it benefits diabetes care. It also covers how the NHS uses telemedicine and its future plans.

Telemedicine in clinical practice and diabetes mellitus care refers to using technology and remote communication tools to support patients. It includes services that allow healthcare professionals to monitor and manage those with diabetes without in-person visits.

The use of telemedicine in diabetes care includes:

• Remote consultations: The use of virtual consultations to obtain advice and guidance on managing diabetes.
• Continuous glucose monitoring: Devices that constantly monitor your glucose levels and share that information with you and your healthcare providers.
• Telehealth apps: Mobile applications that allow you to track your condition, access educational resources, and connect with your doctors.
• Medication management: The digital management of your prescriptions and medication guidance.
• Education and support: Self-management education programs, virtual classes, and webinars that support self-care.
• Telemonitoring: The monitoring of vital signs if your condition is complex.

Patients who do use telemedicine may only try some types. However, according to a study published in the BMJ, you may have a positive experience if you do use it.

Telemedicine makes it easier to connect with healthcare providers, giving you the chance to feel more support as you manage your condition.

Before the widespread use of telemedicine, diabetes patients faced several challenges in accessing excellent care. For example, blood glucose monitoring made efficient disease management challenging because of the possibility of inaccurate tests and the need for in-person appointments. Similarly, education and support were limited, forcing patients to rely on trial and error to manage their conditions.

Today, modern advancements in diabetes telemedicine make disease management smoother. Everything from glycemic control to handling diabetic retinopathy can benefit from a technological edge.

Glycemic control is a challenging aspect, though the extent of it can depend on whether you have type 1 or type 2 diabetes or how you manage your condition.

Individuals with type 1 diabetes are entirely dependent on insulin therapy to maintain glycemic control. They need to balance their insulin doses with dietary choices and physical activity to avoid errors. Even small ones may lead to hypoglycemia or, more rarely, hyperglycemia.

Persons who suffer from type 2 diabetes often have significant comorbidities, including high blood pressure and vascular disease. Therefore, they face the challenge of managing their diabetes alongside other conditions.

Telemedicine makes glycemic control easier regardless of your diabetes type. It achieves this through:

• Remote blood glucose monitoring: You can use these devices to monitor blood glucose throughout the day. Healthcare professionals can access your readings and make adjustments to your treatment plans.
• Medication management: Specialists can use telemedicine to manage your dosages and refills remotely. This increases the likelihood of you benefiting from an appropriate dose and reduces the risk of missing them.
• Alerts and notifications: You can benefit from alerts when there's a significant fluctuation in your blood glucose level. Likewise, healthcare providers receive notifications that allow them to make timely interventions.

According to one meta-analysis, using telecare monitoring results in better glycemic control than relying on routine follow-up. The NHS offers certain types of digital monitoring to many people with diabetes.

Education in diabetes care is a huge topic amongst NHS care providers. The NHS Long Term Plan offers free healthy living resources to those with type 2 diabetes. It also provides structured education to those with type 1 diabetes, including the MyType1 Diabetes resource and the DigiBete app for children and young people.

Digital education is important for several reasons:

• Enhancing accessibility: Making education materials digital ensures they're accessible to a broad audience. It allows you to access information from your home or on the go.
• Convenience: When digital education is available, you can digest materials at your own pace.
• Personalisation: Digital content allows you to access appropriate material for your age. As an example, the NHS's DigiBete app takes a tailored approach to helping children with type 1 diabetes.
• Peer support: You can access peer support through diabetes care apps, allowing you to connect with others in a similar situation. As a result, you might feel less isolated and more confident in managing your condition.

Few areas demonstrate the importance of telemedicine than the management of those living in rural locations. NHS England acknowledges that telemedicine features such as video consultations may reduce wait times in rural areas.

Access to specialist health services is sometimes challenging in rural areas, but diabetes telemedicine can change that through:

• Reducing the travel burden: Using video consultations removes the need to repeatedly travel to specialist facilities. Living in a rural area can be a relief in terms of time, travel costs, and the physical burdens of travelling.
• Improved access to specialists: Some remote areas have a shortage of healthcare providers and may not provide any access to specialists such as endocrinologists. Telemedicine makes it possible to consult with relevant specialists and receive expert guidance.
• Timely care: When you can attend virtual consultations, you're more likely to benefit from timely care in underserved rural healthcare settings.
• Emergency support: When a diabetes-related emergency occurs, you can quickly consult with healthcare providers and identify ways to manage your condition.
• Follow-up care: Using telemedicine ensures those who live in rural settings benefit from the same follow-up care as those who live in urban areas. As a result, there are fewer disparities in terms of treatment outcomes.

One study demonstrates just how effective telemedicine is in treating rural populations. It reveals that telemedicine reduces costs, increases appointment attendance, and improves patient satisfaction.

The digital management of diabetes medication refers to the use of software and technology to help individuals manage their medications. Taking a digital approach makes it easier to streamline medication management by:

• Medication reminders: Managing diabetes can often mean diligently remembering to take multiple medications, which is sometimes hard to balance.  Digital tools take a bespoke approach to reminding patients to take their diabetes medications, reducing the risk of forgetting any.
• Dosage adjustments: Some apps make it easier for doctors to adjust doses based on trends. With more tailored medication, you may benefit from better glycemic control.
• Preventing contraindications: Storing information about diabetes medications prevents doctors from administering the wrong treatments. For example, when they have digital access to a patient's medications in emergency settings, they avoid using drugs that could worsen a diabetes patient's condition.
• Health data integration: Health apps are popular throughout the UK, including among diabetes patients. When digital medication management tools interact with those apps, it becomes easier to make better-informed decisions.

The Professional Records Standard Body (PRSB) focuses on increasing the digital tools for managing diabetes records. Thanks to organizations like PRSB, more people now have access to tools that make it easier to manage diabetes records.

Both type 1 and type 2 diabetes may result in complications. Around 10% of diabetes patients develop a foot ulcer at some point in their lives, and roughly 7000 diabetes-related amputations occur in the UK every year.

Much of the UK's ulcer management takes place in community healthcare settings, with specialist nurses leading patient care. While community health interventions are already more convenient than attending a hospital, there are ways telemedicine makes improvements:

• Telemonitoring: Diabetic foot ulcers don't occur in a vacuum. They arise following a series of improper management and risks, including obesity and poor blood glucose control. Telemonitoring alerts doctors if you're at increased risk and make interventions sooner.
• Self-care tools: These can make it easier to report on ulcers. For example, the Quality of Life Wound Checklist provides nurses with valuable patient information and allows them to triage accordingly. As a result, those with ulcers may have a reduced risk of amputation.
• Self-referral tools: Many NHS trusts offer self-referral tools for services such as podiatry. Early interventions in diabetic foot care can reduce the risk of conditions such as peripheral neuropathy resulting in foot ulcers.

Of course, foot ulcers aren't the only complication that benefits from telemedicine. But they do stand as a good example of how life-altering telecare may benefit you when used appropriately.

Digital diabetes education resources must meet National Institute of Clinical Excellence (NICE) guidelines. In the future, more courses should receive approval once they meet NICE guidelines.

In the future, courses may be more likely to reflect each patient's wishes or background. As an example, Desmond BME offers courses specific to South Asian individuals, including guidance on diabetes management during Ramadan.

Patients with an initial type 2 diabetes diagnosis may benefit from a low-calorie diet. Evidence shows that calorie restriction can push some patients into remission.

In 2020, the NHS introduced a 'soups and shakes' program in some areas of England. The daily calorie intake when following this program is around 800-1000. Patients accessing the program can receive support in face-to-face or digital settings, which makes the diet easier to use for those with busy lifestyles and those who don't live near groups.

Eventually, the NHS will roll out the program to all trusts in England. This should offer some hope to those in the earlier phases of type 2 diabetes who want to enter remission. The program may act as a template for similar services in diabetes care.

Continuous Glucose Monitoring (CGM) can act as a lifeline for patients with diabetes. Although it is available in much of England and Wales, access varies in Scotland and Northern Ireland.

Advocacy groups such as JDRF focus on improving CGM access across the UK. With their efforts, patients of all ages and backgrounds may benefit from CGM regardless of their location.

Telemedicine offers multiple ways to streamline services and improve patient outcomes. Services such as CGM, digital education, and digital support for those following certain treatment programs result in patient-centred care that's effective.

While such services vary across the UK, more are in development. If you want to benefit from such services, consulting with your GP or diabetes nurse can help you access what's available in your area.

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