Assessing the Global Impact of Telemedicine Services for Patients with Diabetes

It is projected that in the next 20 years more than one in ten adults will be affected by diabetes. However, the most important issue is that the disease, although silent, is associated with serious com-plications. Diabetes is the leading cause of cardiovascular diseases including stroke, end-stage renal disease, blindness and amputation.

It is also responsible for more than 4.6 mil-lion deaths per year. The attendant economic burden for health-care systems and individual patients is enormous, owing to the costs associated with treatment and diabetes complica-tions.

The International Diabetes Federation (IDF) has proposed a National Diabetes Programme with three core elements:

a) Primary prevention: preventing the development of risk factors;
b) Secondary prevention: preventing the development of diabetes; and finally
c) Tertiary prevention: preventing the development of complications through early diagno-sis and effective monitoring, treatment and care of people with diabetes.

Telemedicine can contribute significantly in tertiary prevention by providing an effective approach for coaching-education about the disease, improving compliance with medication and recommendations, supporting timely transmission and remote interpretation of pa-tients' data for follow-up and preventive interventions, and finally meeting safely the target for glycaemic control.

Small clinical trials of different telehealth services have shown neutral or positive results in glycaemic control, hospitalizations and quality of life, but in the UK an evaluation of the Whole System Demonstrator trial reported that telecare improves at least quality of life and independence in a cohort of patients including diabetics. However, further research is re-quired to give a more precise assessment of telemedicine applications and this is what the project Renewing Health is about.

RENEWING HEALTH is a project co-funded by the European Commission. It will evaluate whether the introduction of telemedicine applications to pa-tients with Type 2 diabetes, both with and without health counselling, produces benefits in terms of clinical outcomes such as HbA1c, health-related quality of life (HRQoL), self-management and empowerment.

In addition, the economic and organisational impact of the new services will be assessed, together with their acceptability by patients and health professionals. More than 1.800 dia-betics have already been recruited. Recruitment will be completed by the end of the year, and the first results are scheduled to be reported at the end of 2013.