Telehealth and Diabetes: Bridging Gaps in Diabetes Care Access

Diabetes has become a global public health crisis, with approximately 537 million adults living with the condition according to IDF Diabetes Atlas.

Still, many patients from around the world face challenges in accessing the care they deserve. This is especially true for patients in rural and underserved areas.

Fortunately, the rise of telehealth has helped bridge the gaps in diabetes care access through virtual visits, remote patient monitoring, and other digital solutions.

It has enabled diabetics to conveniently manage their condition from the comfort of their homes while having access to qualified endocrinologists.

Read on to explore the several ways in which telehealth is helping advance diabetes care and management through improved access, patient engagement, and care coordination.

Telehealth is the use of digital information and communication technologies to remotely deliver healthcare services. It goes by many other names, including telemedicine, connected care, and eHealth.

Though the utilization of telehealth was rising prior to COVID-19, it grew at an exponential rate during the pandemic, as it provided a safe alternative to in-person visits.

According to McKinsey, virtual visits increased by 38x from 2019 to 2020. The same resource indicates that, during that period, telehealth adoption in the US soared to 46% from only 11%!

Key technologies and devices that come into play in the utilization of telehealth include:

• Video conferencing software (e.g., Doxy.me, Zoom, and Google Meet)
• Peripheral medical devices (e.g., glucose meters and blood pressure cuffs)
• Wearable sensors (e.g., continuous glucose monitoring systems and ECG patches)
• eHealth apps (e.g., mySugr and OneTouch)

Combined, these technologies and devices help facilitate adequate diabetes care services for patients from all over the world.

Telehealth offers several benefits that have helped improve diabetes care and management, not just in metropolitan areas but also in rural areas where specialists are scarce.

Below are some of the gaps telehealth has helped bridge in diabetes care:

Patients in rural areas often lack access to endocrinologists and other diabetes experts. Luckily, this has changed with the emergence of telehealth, particularly after COVID-19.

Telemedicine has enabled convenient virtual consultations between diabetics from around the world and qualified healthcare providers, expanding access to specialized care.

Patients no longer have to travel long distances to receive proper care, which saves a lot of time and money. At the same time, specialists are now able to serve more people remotely.

Additionally, telehealth has helped higher-risk patients get diabetes prevention education. For instance, the CDC’s National Diabetes Prevention Program can now be delivered remotely to at-risk individuals to prevent or delay the onset of type 2 diabetes.

The patient should always be in the driver’s seat when it comes to diabetes management, and telehealth has ensured the patient is comfortable behind the wheel.

Several telehealth tools, such as medication reminders and RPM tools, have proven effective in helping patients better adhere to their care plans.

This is paramount because when a patient adheres to their diabetes management plan, they’re more likely to see positive results and avoid serious complications.

You can find many controlled trials concluding that telehealth can improve patient adherence by facilitating easy blood glucose monitoring and medication adjustments.

Diabetes care providers using telehealth can closely track blood glucose data and continuously monitor trends through connected meters.

This allows for timely interventions when blood sugar levels get too high or too low, which in turn makes it possible to control HbA1c levels and keep them within the target range.

Several studies have shown significant HbA1c reduction with telehealth interventions, similar to in-person follow-ups, but with fewer appointments and no-shows.

Telehealth provides patients with tools and resources that improve their ability to manage their condition through coaching, monitoring, and education.

Also, remote monitoring and tracking of glucose, blood pressure, and other important biometrics help patients gain insights into how their behaviors influence their health.

With telehealth, diabetics can follow appropriate meal plans, take suitable medications, and sustain new habits that are essential for diabetes control.

Many diabetes patients appreciate the convenience of getting appropriate care from the comfort of their homes. Many also appreciate the flexibility of setting telehealth appointments compared to in-person visits, which is a big deal for diabetics with busy schedules.

In a survey of 1,452 diabetics, around 62% of the patients reported that telehealth was just as effective, if not more effective, than in-person care. Further, 82% of the patients reported that they would use telehealth for some or all of their future appointments.

This shouldn’t come as a surprise, not just because of convenience, but also because of how telehealth allows for tailored care plans based on individual patient needs.

For instance, patients struggling with their condition can receive more frequent contact with their primary care providers through telehealth.

On the other hand, patients with high glycemic control and self-efficacy can replace most, if not all, of their in-person visits with telemedicine appointments.

While not specific to diabetes, there’s high-quality evidence solidifying that telehealth has led to small-to-moderate reductions in mean all-cause and condition-related hospitalizations, with 50 and 110 fewer hospitalizations per 1,000 patients, respectively.

Within the context of diabetes management, telehealth helps reduce emergencies by facilitating early interventions for issues such as high/low blood sugar levels.

Diabetics are now able to have appointments with their healthcare providers for routine care without needing to go into a clinic. This is done through video conferencing software, phone calls, or secure messaging.

Simultaneously, providers can conduct assessments, prescribe new medications, order medical diabetes tests, and refer to other specialists via telehealth mediums.

For high-risk patients, telehealth provides increased and regular access to care, which helps in addressing urgent needs and titrating medications like insulin between in-person visits.

Diabetes self-management is all about positive behavioral changes and sustainable healthy habits, which can be achieved with health and wellness coaching.

Coaches provide guidance and motivation to their patients, as well as teach them accountability, through telehealth mediums and individualized action plans.

Health and wellness coaching helps diabetes patients in aspects such as:

• Weight loss and nutrition
• Keeping HbA1c within normal range
• Managing stress and anxiety
• Quitting smoking
• Promoting physical activity

Diabetes clinics now utilize specialized cameras to photograph the retina (fundus photography) and transmit high-resolution images to ophthalmologists for evaluation.

Studies suggest that tele-retinopathy programs can help screen more patients and identify more cases compared to traditional in-person exams as the latter may not be available in rural areas.

Other studies indicate that tele-retinopathy offers significant cost savings compared to in-person exams, which in turn contributes to its accessibility.

Diabetes experts now provide customized education programs remotely not just through video conferencing but also patient portals and mobile apps.

These programs cover important topics such as monitoring blood sugar, meal planning, staying active, and taking medications correctly.

Some programs are heavily focused on reducing the risks of complications down the road and managing stress. These programs are intended for high-risk patients.

Living with a chronic disease like diabetes can have a negative impact on a patient’s emotional health, and as you probably know, strong psychosocial health plays a huge role in improving a patient's ability to manage their medications, exercise, and nutrition.

Telehealth helps expand the options for mental health support. Patients can now attend therapy, counseling, and support groups remotely to cope with their stress and anxiety.

The CDC’s guide on diabetes and mental health is an excellent read if you want to find out more about the mind-body connection and diabetes distress.

Wearable activity trackers and specialized mobile apps enable diabetes mellitus patients to monitor their exercise patterns and share key pieces of data—heart rate, step counts, and activity levels—with their doctors and wellness coaches.

Based on the provided information, doctors and health coaches can provide tailored exercise recommendations and set goals for their patients to improve diabetes management.

Telemedicine offers a convenient way to keep medications optimized without frequent in-person consultations, which improves safety and oversight with high-risk medications like insulin.

Based on trending blood sugar, blood pressure, and weight patterns, remote monitoring can be used to identify when treatment intensification is needed. This allows for timely adjustments to insulin and oral hypoglycemic agents, among other drugs.

A major barrier that’s impacting access to telemedicine interventions is the huge divide in digital literacy among certain groups of people, specifically low-income patients, the elderly, and racial minorities.

These patients are less likely to have a computer or smartphone device, let alone stable internet access. And even if they do, they may lack sufficient digital literacy to navigate their way around their devices.

This disparity takes away from these people’s ability to take advantage of telehealth platforms, so more effort is needed in that aspect to increase access.

Diabetics in rural or remote regions often lack reliable internet connectivity, which impedes the use of some telehealth services like videoconference-based consultation.

Overcoming this issue requires upgrading broadband infrastructures in underserved areas and providing subsidized internet or cell service.

Some critics argue that telehealth could lead to the overprescription of medication, which raises some ethical concerns.

At the same time, there are studies that show comparable prescribing rates between telehealth and in-person care.

Clearly, there are discrepancies in this area. Overcoming these discrepancies isn’t about choosing a side. Rather it’s about providing education on appropriate virtual prescribing.

Data privacy and security issues present another notable challenge for telehealth. We’re not just talking about hacking and authorized access to patient data here, which can be mitigated with:

• HIPAA compliance
• Strong data encryption
• Secure storage
• Multi-factor authentication (multi-step login)

We’re also talking about the inability to discuss sensitive health topics during telehealth visits, which is common among patients living in small or multigenerational homes.

Data exchange and the integration of telehealth can be quite difficult across different platforms and devices when relying on systems that lack interoperability.

The development of shared data standards and improved electronic health records (EHRs) are key to overcoming this challenge.

We can confidently say that telehealth is rapidly transforming diabetes care by improving access and health outcomes through its wide range of digital technologies and services.

Thanks to telemedicine, barriers that once stood in the way of underprivileged patients in rural areas like the lack of specialist availability and long distances to clinics are no longer a hurdle.

Be that as it may, there are still several challenges and limitations that are yet to be addressed, from privacy and security concerns to the digital divide among certain groups of people.

Addressing these challenges will help take telehealth to new heights and ensure equal care for all diabetes patients, regardless of what part of the world they’re in.