Telediabetology: Telemedicine to fight diabetes

Interview with Dr. Young Hee Lee-Barkey, Chief Physician, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen


World Diabetes Day is on November 14 of this year. This is reason enough to get informed about the options available in medicine on the subject of "diabetes". One area is telediabetology, a combination of telemedicine and diabetology. It is still not widespread in Germany, but that is about to change because the benefits for patients, physicians and hospitals are obvious.

Dr. Lee-Barkey will give a lecture on this subject at the MEDICA EDUCATION CONFERENCE at the MEDICA 2016. spoke with her about the use of telemedicine and wearables in diabetes. 

Image: Smiling woman; Copyright: Herz- und Diabeteszentrum NRW

Dr. Young Hee Lee-Barkey; © Herz- und Diabeteszentrum NRW

The title of your lecture at the MEDICA EDUCATION CONFERENCE is "Telediabetology in Germany". That's why our first question is, how can we envision telediabetology?

Dr. Lee-Barkey: Telediabetology is not a clinical discipline and there is also no specialty physicians in telemedicine. When we talk about telemedicine or telediabetology, we refer to the professional level, or more specifically the medical diagnosis and treatment with the help of new communication technologies. It can overcome spatial distance. By monitoring the patient's vital signs, the physician remains up-to-date and is able to provide therapeutic intervention if needed. This has proven successful in the case of heart failure for example. However, telemedicine can only be a supplement and will not replace a doctor. The physician still needs to see the patient. A person's state of health can only be assessed if he/she is also physically examined. Having said that, telemedicine can help to improve the relationship with the doctor and prevent unnecessary office visits. Ideally, patients should also be treated by a network in which, aside from hospitals, family doctors and outpatient specialists are joint treatment partners. These types of networks are currently being developed in the field of diabetology. One example is the Fußnetz Bayern (Diabetic Foot Network of Bavaria) that jointly keeps a patient medical file and coordinates any treatments. Another example is KADIS in Mecklenburg-Vorpommern. Here, recommendations for an enhanced therapy are made based on recorded monitoring. There is a lot of activity in the market and also on projects pertaining to the telemedical care of diabetes patients.

Image: In the middle of a computer window is written in big white letters Diabetes. A hand is tapping onto the word; Copyright: Wissawapipat

With the help of telemedice it is possible for patients to receive diagnosis and therapy from their docotor - despite spatial distance. Telemedicine is also suitable for patients with diabetes; © Wissawapipat

Why is telemedicine used in the field of diabetes?

Lee-Barkey: For one, there are many patients with diabetes and the number continues to increase. On the other hand, medicine's mission is to ensure the comprehensive care of people nationwide. In sectors with less infrastructure like rural areas, physicians are not always readily available. If care facilities are missing, telediabetology could provide relief and help to provide better care for patients. Another example is the diabetic foot syndrome. Patients need to visit different specialists for this. A telemedicine network makes it possible to optimize coordination among experts, improve the general processes and ultimately also the treatment results by enabling physicians to jointly reach a diagnosis and monitor the disease or recovery progression. For patients, it definitely means more quality of life if their feet can be preserved. 

You have already mentioned the benefits of telediabetology for patients. What about the advantages for physicians and insurance companies?

Lee-Barkey: Telediabetology has the potential to save costs. The advantage is that resources can be used more efficiently, both in terms of staff, institutions and facilities. What's more, routes and duplicates of the principal diagnosis could be avoided. The main focus for physicians is clearly on improving the quality of care and treatment, which must be demonstrated. Time savings is also an aspect if telediabetology helps to free up more time for the actual treatment. Needless to say, insurance companies are primarily hoping for cost savings but definitely also for their insured clients to stay fit and healthy for as long as possible. That's why they often offer their own coaching programs. A chronic disease like diabetes is a high-cost factor in the health care sector, especially if secondary complications occur. That is why it is in the best interest of insurance providers for patients to assist in this process by living a healthy lifestyle and avoiding problems.

Who is best suited for utilizing telediabetology and for whom is it rather unnecessary or perhaps even unsuitable?

Lee-Barkey: Unlike cardiology, where telemedicine is able to prevent life-threatening events by monitoring vital signs, telediabetology is particularly suited for patients who are willing to document their own data. Usually younger, tech-savvy patients utilize the options diabetology has to offer. Diabetics who check their blood glucose levels several times per day, inject insulin and count their carbohydrate intake can benefit from it. Things are more difficult if someone is not able to manage this technology at all, as is the case with dementia or geriatric patients for example. It is essential for patients to be willing to assume an active role in all this. Telediabetology is primarily suited for people who are mentally and physically fit and self-sufficient.

Image: A woman is sitting in the grass using a smartwatch. Beside her stands a bottle with water; Copyright: Rattanaburi

Health apps and wearables are no telemedicine. But they are suitable to encourage the health consciousness of patients with diabetes; © Rattanaburi

How widespread is telediabetology in Germany and other countries?

Lee-Barkey: The spread in Germany continues to be slow. One reason for this is legal hurdles. Germany stipulates the so-called prohibition of remote treatment. Another reason is that there is still not sufficient scientific evidence proving the benefits of telediabetology. There is no billing option for this type of medical service either. An added complicating factor is that patients with diabetes use a number of various devices and many platforms are not designed to handle this. Outside of Germany, and particularly in Europe or the U.S., the spread of telemedicine is happening faster. Some places already offer online consultations which is something that's currently being tested by dermatologists in Germany. That being said, not everything with the name "tele" in it is also a telemedicine service. Health apps or fitness trackers, for instance, don't constitute telemedicine. They are among the services available to customers. They aim at the "quantified self", that being the goal to improve your own life through athletic activity and a healthier way of life. This technology can serve to support health and prevent diseases.  

I think in the future, we will definitely see more telemedicine projects in the field of diabetology due to the many health care deficits. The market for apps and wearables will continue to grow regardless of this particular aspect.   

The market offers a wide variety of wearables for diabetes patients, primarily to measure and chart blood glucose levels. Do you think the future is in a patient's independence and self-reliance?

Lee-Barkey: I actually believe that wearables like fitness trackers and smartwatches as well as health apps can lead to more self-care behavior and health awareness among users. Some offers feature reminder or alarm functions, whether that's to prompt movement, sleep, fluid intake or reminding you to take your medicine or indicate a drop in blood glucose levels. However, it can be problematic if now you are only concerned with monitoring your own health around the clock. Another risk is misinterpretation; certain aspects run the risk of being overrated. Oftentimes, it's also mainly those people who already live a healthy lifestyle who use these smart technologies and not those, who actually should live a healthier life. Nevertheless, wearables obviously have an increased potential to promote health awareness and to encourage a better way of life.

The interview was conducte by Olga Wart and
translated from German by Elena O'Meara.