If you’re looking for a silver lining in the COVID-19 dark cloud still enshrouding the world, consider this: The pandemic has turbocharged widespread acceptance of at-home digital health solutions. Forced to function in a world of social distancing, healthcare providers and physicians have quickly discovered how easily telehealth visits, remote patient monitoring (RPM) and digital therapeutics can improve patient care.
Many of these digital health innovations are designed to address what the American Medical Association (AMA) calls “an epidemic of chronic diseases,” especially diabetes, which, in 2017, was an underlying or contributing cause of more than 270,000 U.S. deaths. According to a 2020 CDC report, 122 million U.S. adults – one-third of the population — either have or are at risk of developing diabetes. And, in fact, the number of U.S. adults diagnosed with diabetes has more than doubled in the last 20 years.
An Onerous Patient Burden
As we know, the elevated levels of blood glucose that characterize diabetes can, over time, lead to serious damage of the heart, blood vessels, eyes, kidneys and nerves. Conversely, diabetes researchers demonstrated more than 25 years ago in two landmark studies—the Diabetes Control and Complications Trial and the UK Prospective Diabetes Study—that glycemic control (i.e., maintaining glucose levels within a specified range) is the Rosetta stone of diabetes management. Numerous studies have since confirmed that intensive therapy—guided by frequent blood glucose monitoring to maintain blood glucose concentrations close to the normal range—could delay the onset and slow the progression of diabetic retinopathy, nephropathy, and neuropathy.
Unfortunately, despite continuing advances in technology for monitoring blood glucose levels and administering therapy, patients still find it exceedingly difficult to keep their glucose levels under control. Studies have found, for example, that fewer than 50% of Type 2 diabetes patients on long-acting insulin are able to achieve their target glycemic outcomes.
Although multiple factors cause such subpar results, one of the biggest and knottiest problems is that, for most people with diabetes (PWDs), the self-care needed to maintain glycemic control remains an onerous, time-intensive burden. Each day, the “role model” diabetes patient will eat healthy foods; exercise regularly; comply with and track numerous medications and insulin regimens; measure blood glucose levels multiple times; and track and record behaviors and even moods.
But even when patients do everything right, physicians may still not have access to real-time information (or sufficient time and resources) to initiate timely, appropriate interventions.
RPM Platforms, the Linchpin of Virtual Diabetes Care Management
The primary value of using RPM solutions with diabetes is to remotely yet continually observe, report and analyze clinical indicators (e.g., self-monitored blood glucose {SMBG} readings), insulin injections and other patient behaviors such as use of medications, physical activities and food intake, then combine them as needed with telehealth coaching to provide just-in-time care, or precision engagement. The ultimate purpose of supplementing medical office visits with this kind of remote monitoring and more frequent interventions is to keep patients on track to achieve better outcomes than are possible with quarterly in-office visits alone, the latter of which is the standard of care.
To optimize care for PWDs in their homes, RPM solutions also should facilitate the collection and sharing of data from multiple sources — including EHRs, insulin delivery devices and patients’ health/ fitness devices – among physicians, clinicians, payers, patients. Ideally, these solutions should also automate tracking and reporting tasks while effectively engaging patients to practice better self-care.
Today, RPM platforms for diabetes perform all these functions and more. By linking together various devices, analytical tools and data, RPM platforms can facilitate personalized dosing adjustments, interventions and ongoing support of PWDs. Ideally, these platforms also should:
– Enable data collection from whatever diabetes devices a patient wants to use or their insurance company requires.
– Offer patient-friendly tools that allow participants to easily upload and share their data remotely or in the clinic.
– Allow physicians, health systems and patients to securely view all patient information through a single portal.
– Provide personalized support to enhance patient engagement and improve adherence to treatment protocols.
Clinical Studies Show RPM’s Effectiveness in Maintaining Glycemic Control
Through extensive clinical research of RPM solutions for diabetes is still in its early stages, emerging evidence indicates that RPM platforms, tools, devices and complementary telehealth coaching can help healthcare providers working with diabetes patients to improve glycemic outcomes. For example:
– In a real-world study, PWDs enrolled in RPM pilot programs across U.S. healthcare systems used a diabetes management mobile app to sync blood glucose, medication, and lifestyle information. RPM care teams monitored these data remotely and provided coaching as needed. When researchers compared results with SMBG data collected at enrollment, they observed immediate and sustained improvements across multiple glycemic outcomes for up to a year.
– In a randomized clinical trial, an app-based self-titration tool analyzed fasting blood glucose levels and recommended insulin dose adjustments based on a physician’s pre-configured treatment plan and/or published clinical guidelines. Compared to the control group (which used an enhanced paper titration tool with diabetes educator support), people using the app-based tool demonstrated a greater proportion of SMBG readings between the target range of 70-180 mg/dL and fewer high SMBG readings (>250 mg/dL).
Final Word
As we have seen, the U.S. health system is embracing robust RPM-based solutions as a viable, promising approach to effectively manage and treat diabetes and other complex diseases. Even before the pandemic, a 2019 study found that 68% of physicians strongly intend to use RPM technology – a percentage that no doubt will continue to rise as RPM and digital health devices and tools become a familiar part of everyday at-home care.
Though prognostications can be risky, it’s fairly safe to assume that RPM and other at-home digital health innovations will eventually become part of the standard of care for diabetes and other chronic diseases.
About Dr. Mark Clements
Mark Clements, MD, Ph.D., CPI, FAAP is Chief Medical Officer at Glooko Inc., He is a Professor of Pediatrics at the University of Missouri-Kansas City School of Medicine, and a pediatric endocrinologist. He is also a clinical researcher of new diabetes treatments and technologies, having served as a principal investigator or co-investigator in more than 30 clinical studies and patient registries. He has served as chair for the Type 1 Diabetes Exchange Clinic Registry and currently serves as data science co-lead for the Type 1 Diabetes Exchange Quality Improvement Collaborative.
