.Use of Telemedicine in the Management of Patients with Diabetes The Topic is on
Running head: TELEMEDICINE IN THE MANAGEMENT OF PATIENTS WITH DIABETES
Use and Effectiveness of Telemedicine in the Management of Patients with Diabetes
Quadasia Dukes
The Liberty University
BUSI505
September 26, 2021
TELEMEDICINE IN THE MANAGEMENT OF PATIENTS WITH DIABETES 2
Abstract
Using telemedicine solutions to decrease outpatient visits to physicians’ offices and clinics have
become popular due to their time saving and cost-effectiveness. In the times of the covid-19
pandemic, necessary adjustments had to be made regarding outpatient services that need frequent
in-person consultations. People living with diabetes constitute a vulnerable population that
requires protection, especially during outbreaks of pandemic diseases to avoid further
complications. However, patients with diabetes care need regular and careful monitoring and
adjustments of diabetes therapies by healthcare providers. Factors such as age, insufficient access
to health services due to low income, and cognitive impairment make it difficult for a one-on-one
consultation with healthcare providers. These factors are why telemedicine in diabetes
management may offer an alternative solution to clinic consultations, thus providing access to
diabetes care to marginalized patients. However, telemedicine methods are yet to be widely
accepted due to barriers since their effectiveness regarding cost-effectiveness, quality control,
and time consumption are yet to be revealed. The purpose of this paper is to explore existing
facts about telemedicine applications in diabetes management, its benefits, and possible
barriers to its acceptance. Some areas of further research for adopting telemedicine,
combining new organizational models and technology, are discussed. For methodology, this
paper reviewed several studies on telemedicine use in diabetes management to help
determine its efficacy in improving the quality of care for patients. The studies looked into
various aspects such as perspectives and factors influencing acceptance among patients in
healthcare, the effectiveness of telehealth in managing diabetes and associated clinical
outcomes, and factors inhibiting the application of telemedicine in managing diabetes.
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Findings suggest that the management of diabetes through telehealth technology is effective
in lowering blood sugar levels and blood pressure, improving adherence to diabetes
therapy and patient satisfaction. Benefits of telemedicine include reduction in traveling,
time-saving, cost-effective compared to one on one, enhanced patient-healthcare provider’s
communication, improved access to health care, allows consistent monitoring and lifestyle
adjustments. On the other hand, the barriers to telemedicine application to diabetes
management include poor economic status and poor internet connectivity, technical know-
how of operating telehealth systems and devices, thus making its adoption difficult.
Furthermore, since telemedicine is a new technique possibility of malpractice and licensing
of healthcare providers is yet to be investigated in detail. Finally, systemic barriers such as
data loss and data privacy make it difficult for telemedicine to be broadly accepted. These
findings support the growing evidence that telemedicine is an excellent alternative in
delivering safe diabetes care and overall health care.
Use of Telemedicine in the Management of Patients with Diabetes
Introduction
Diabetes is a chronic disease that is highly prevalent globally, especially in Asia.
According to Rho, Kim, Chung, & Choi (2015), as of 2018, 34.5 million Americans were
diagnosed with diabetes which accounted for 10.5 percent of the total population. People living
in rural areas are primarily affected by diabetes due to few healthcare providers, long distances to
health facilities, and the inability to afford a comprehensive health cover. Furthermore, as the
global population increases, the ratio of people living with diabetes to healthcare providers is
expected to increase, making access to health services even more difficult. In addition to the
reduction of healthcare providers, the Covid-19 pandemic has made it challenging to conduct in-
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patient care since “social distancing” is encouraged to safeguard physicians’ and patients’ health.
Social distancing champions the need for non-contact provision of healthcare services to patients
to curb the spread of Covid-19 and other diseases spread through contact.
Even though the diabetes guidelines advocates for regular consultations with the
physicians to check HbA1c levels and regulate diabetes therapy accordingly, majority of the
people living with diabetes do not need to physically present themselves in hospitals and clinic to
obtain diabetes management guide. The ability to offer guidelines and diabetes therapy remotely
to patients ushers in the need for telemedicine in the management of diabetes. As the number of
people living with diabetes keeps increasing in the middle of the Covid-19 pandemic, the
adoption of telemedicine in the management of diabetes is essential.
Telemedicine in Diabetes Management
Telemedicine involves collecting data accurately from patients via digital tools, analyzing
the data, and giving correct feedback. The information is communicated through computers,
laptops, mobile phones, and other digital handheld devices. Data transmission may be conveyed
in voice, text, email, audio, or video. The collected data from patients is added in their medical
records from where it is analyzed, and the results send back to the patient’s device alongside
proper measures and recommendations.
One way telemedicine is applied in diabetes management is through developing systems
that organize objective and subjective data of patients. Telemedicine systems store patient’s
physiological data such as blood pressure and glucose levels, laboratory data such as HbA1c,
behavioral data such as exercise schedules and diets, images of wounds and retina, medication
history and dosage, and pertinent event information such as emergency visits and vaccines taken
TELEMEDICINE IN THE MANAGEMENT OF PATIENTS WITH DIABETES 5
(Lee, Greenfield, & Pappas, 2018). The data stored in the systems help a specialist gauge the
disease’s extent, any improvements noted, and advise patients on the necessary measures to
manage diabetes.
The impact of telemedicine on people living with diabetes care includes behavioral,
structural, and informational. On the behavioral aspect, telemedicine offers frequent reminders to
patients and adjustments of diabetes therapy, thus educating and empowering the patient. On the
other hand, the structural impact of telemedicine involves time-saving on the patient side as long
regular visits to the physician’s office are not required. Finally, the informational impact
involves strategic and quality data available at any time since the records are stored online,
unlike handwritten records (Wu et al., 2018). Therefore telemedicine aims at making service
delivery from healthcare providers to people living with diabetes smooth.
Theory
Orem’s self-care model helps show the effectiveness of self-care programs to
improve the quality of life for patients with diabetes. Telemedicine is a promising
instrument in helping to increase access to health care. It may serve as a great tool in
supporting the prevention and effective management of diabetes for health care providers.
Significance of Application of Telemedicine in Diabetes Management
Using telemedicine in the care of people living with diabetes lowers HbA1c levels
significantly compared to the traditional care means. According to Xu, Pujara, Sutton, & Rhee
(2018), in a research study where telemedicine was administered to veterans residing in the rural
areas of Alabama and Georgia, HbA1c levels was measured at the baseline and after three and
TELEMEDICINE IN THE MANAGEMENT OF PATIENTS WITH DIABETES 6
six months where the results showed a significant reduction in HbA1c levels compared to
patients treated through the traditional means. Furthermore, the veterans showed improved
hypoglycemic cycles. The study demonstrated the effectiveness of telemedicine in managing
diabetes. In addition, in their research, Zhai, Zhu, Cai, Sun, & Zhao (2014), to evaluate the
effectiveness of telehealth in managing diabetes, among the 47 credible sources reviewed, 35 of
them supported that telemedicine in the management of diabetes reduces blood sugar levels.
Also, Wu et al.’s (2018) research to determine clinical outcomes of telehealth to people living
with diabetes, 6294 patients participated in the research showed improved glycemic control and
reduction in blood pressure as compared to clinical care. Also, So & Chung’s (2018) research
found that telehealth positively impacted glycated hemoglobin among patients with Diabetes
mellitus. Finally, Lee et al.’s (2018) research investigating the impact of telemedicine glycemic
control in patients living with diabetes type II found significant HbA1c improvements compared
to clinical care. Therefore, the management of diabetes through telehealth technology is effective
in lowering HbA1c levels and blood pressure.
Telemedicine use in people living with diabetes improves adherence to diabetes therapy.
According to Xu et al.’s (2018) study, people living with diabetes on telehealth demonstrated a
higher follow up on required treatments, appointments, and meetings and actively took
measurements such as blood sugar levels and blood pressure. Furthermore, patients under
telemedicine showed satisfaction and even opted to share it with other people living with
diabetes, not in the program, thus increasing access to healthcare. According to Xu et al.’s (2018)
research, after reviewing medical records of patients who received telehealthcare at VAMC
telehealth clinic, there was 88 percent adherence. Therefore, telemedicine improves adherence to
diabetes therapy, which reduces complications that may be fatal to the patients.
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Telemedicine has been demonstrated to improve patient-healthcare provider’s
communication. According to Zhai et al. (2014), patients under telehealth are more interactive
and curious to know their health progress than those under traditional one-on-one care.
Telemedicine involves the patient gathering the necessary data such as pictures of a wound,
taking blood sugar level measurements, taking blood pressure measurements, and uploading in
the telehealth systems for interpretation and analysis. The healthcare provider checks the
information collected, correct any mismatch and guide the patient. The interaction between
patients and healthcare providers improves their communication.
Another benefit of telemedicine in the management of diabetes is that it is time-saving.
According to Xu et al.’s (2018) study, since there is no traveling for specialty care, patients save
time for other activities, especially in rural areas. Furthermore, since most tests are performed at
home, healthcare providers can serve more patients than one-on-one patient care. Also, since
measures and medication are communicated remotely, much time is saved for other activities.
Therefore telemedicine is time-saving, allowing more room for more patients to be served.
Another benefit of telemedicine in diabetes management is no traveling. Since telehealth
is done through digital handheld devices, patients are not required to travel for diabetes therapy
and care. Furthermore, patients living in rural areas with no diabetes health facilities can access
the services remotely instead of traveling to major cities and towns. According to Polinski et al.’s
(2016) study to evaluate the satisfaction of telehealth in the management of diabetes, out of 1734
participants in the research, 94 to 99 percent participants were satisfied with the technology due
to its efficiency and quality of the service. Telemedicine is thus convenient to all patients
irrespective of where they are located.
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Furthermore, telemedicine has been demonstrated to be cost-effective compared to one
on one healthcare. According to Xu et al.’s (2018) research, no need to travel and less time taken
are the main factors that reduce the costs of telemedicine. For one-on-one care for people living
with diabetes, patients, especially from rural areas, had to cover several miles to the nearest
centers. In some cases, others need lodging services overnight, which added the cost. However,
since telehealth is done remotely, lodging and transport costs are eliminated, thus making it
affordable and convenient. Furthermore, according to Zhai et al. (2014), in their study to evaluate
the effectiveness of telehealth to patients with diabetes, out of 47 sources scrutinized, 35 sources
supported telehealth as being cost-effective compared to clinic care. In addition, J. Lee & S.
Lee’s (2018) research on the cost-effectiveness of telemedicine for people living with diabetes
researchers found that telemonitoring and telephone reminders were cost-effective compared
with the traditional healthcare provider fee. Therefore, no accommodation and no traveling make
telemedicine cost-effective in managing diabetes.
Another benefit of telemedicine is that it improves access to health care. According to So
& Chung (2018), the number of diabetes specialists is lower than that of people living with
diabetes. Since telemedicine makes such services available to a large population irrespective of
their geographical location, more patients are served by the available health providers. The
increased access to diabetes care makes it possible for patients to receive proper treatment to
check their condition and prevent catastrophic occurrences.
Finally, telemedicine in the management of diabetes allows consistent monitoring and
lifestyle adjustments. Telehealth offers 24-hour monitoring, thus providing accurate information
to healthcare providers at all times. Furthermore, telehealth systems can enable patients to
engage in healthy behavior such as proper diets and regular exercising to reduce blood sugar and
TELEMEDICINE IN THE MANAGEMENT OF PATIENTS WITH DIABETES 9
pressure levels. Therefore, telemedicine digital tools are essential for monitoring and thus
effective in controlling diabetes.
Barriers of Application of Telemedicine in Diabetes Management
Despite the benefits that come with telemedicine, some barriers hinder or limit its
application. The obstacles are both from the healthcare providers’ side and patients’ side.
Furthermore, the barriers of telemedicine to healthcare providers are further subdivided into
technical and systemic. These barriers need to be addressed to allow the application of
telemedicine to a larger population.
One of the main barriers to the application of telemedicine to diabetes management is
technical know-how. The technical barriers to telemedicine involve an inability to operate
computers and other communication devices and the inability to afford or access the devices.
According to Ghosh, Dutta, Tyagi, Gupta, & Misra’s (2020) research on factors limiting
telehealth application to diabetes management, low internet speeds, and poor internet
connectivity were the significant factors. Furthermore, data privacy of patients’ information
raises concerns as the number of data breaches increases in other industries such as hospitality
and banking. In addition, the data saved on servers is not accessible during a power failure or
system malfunction making access to such information difficult. Finally, the telemedicine
systems should be able compatible with different brands of blood pressure and glucose meters.
Therefore, technical know-how and poor internet connectivity to telemedicine systems pose a
barrier to its adoption.
On the other hand, systemic barriers involve malpractice, reimbursement, and licensing
concerns. Telemedicine results in few hospitals or clinic visits. Telemedicine is yet to be covered
TELEMEDICINE IN THE MANAGEMENT OF PATIENTS WITH DIABETES 10
in most health plans. Hence, a healthcare provider who initially performed services for a fee will
spend time offering telemedicine, reducing revenue for the healthcare facility. Furthermore, state
laws governing licensing and malpractice have not yet embraced telemedicine completely. It is
unclear whether a healthcare provider can offer telemedicine services beyond their states as
telemedicine is remote. Thus licensing, malpractice, and state laws may hinder the further
application of telemedicine in diabetes management in the US.
Another barrier to telemedicine application in diabetes management is providers’
barriers, such as poor workflow integration and online health technology. According to
Ayatollahi, Mirani, Nazari, & Razavi’s (2018) research, some physicians find the system
intrusive, and since most call centers are far away from clinical areas, there arise workflow
challenges. Also, as more people embrace telemedicine, personnel shortage with sufficient
training with telehealth systems and devices is expected, making it hard for telemedicine to be
adopted widely. Insufficient training mainly results in poor and inaccurate data uploads and
collection, precisely when patients deliver incomplete, incorrect, or delivered at the wrong time.
According to Ayatollahi et al.’s (2018) research on the effectiveness of health professionals in
the management of diabetes using telemedicine, 240 nurses and 55 physicians were the research
participants. The results of their study showed lower faith in telemedicine in diabetes
management. Furthermore, there was low compatibility of clinical services and telehealth
activities in managing diabetes. Therefore insufficient training on telehealth makes it difficult for
health providers to accept the technology entirely.
Lastly, patients’ barriers such as literacy levels and economic status are significant threats
to the application of telemedicine to people living with diabetes. According to Ayatollahi et al.
(2018), most people living in rural areas are uncomfortable with technology compared to those in
TELEMEDICINE IN THE MANAGEMENT OF PATIENTS WITH DIABETES 11
urban areas. Furthermore, most people in the rural areas are low-income earners making the
affordability of the technology that comes with telemedicine to be expensive. According to
Ghosh et al.’s (2020) study to identify factors that hinder telehealth implementation for people
living with diabetes, the researchers found out that poor internet connectivity and low income
played a major role, especially in rural areas of India. Moreover, even though most people know
how to operate computers and handheld devices, they prefer phone calls over internet-based
communications. Also, it was difficult for people with impaired vision to read text messages and
emails on the screen, making such a communication medium difficult for people living with
diabetes. According to Rho et al.’s (2015) research to determine factors that hinder acceptance of
telemedicine among people living with diabetes, 116 people living with diabetes were selected
from 6 different universities. Rho et al. (2015) found out that the patients’ performance
expectancy, socioeconomic influence, and effort expectancy greatly impacted the acceptance of
telehealth. Therefore, the economic status and the level of education play a major role in
telemedicine acceptance.
Conclusion
In summary, diabetes is highly prevalent, with 10.5 percent of the US population
diagnosed with the disease. Also, as the global population increases, the number of patients
requiring care will increase more than that of health providers. This shows the need for
telemedicine to serve patients with quality services faster and cost-effectively. In addition, as
Covid-19 emphasizes the need for social distance to control its spread, other remote ways of
providing care to patients living with diabetes are essential. Telemedicine in diabetes
management involves collecting clinical data of patients through digital devices and systems,
TELEMEDICINE IN THE MANAGEMENT OF PATIENTS WITH DIABETES 12
analyzing the data provided, and giving the appropriate feedback to patients. Telehealth systems
stored patients’ physiological, behavioral, laboratory, and pertinent event data.
Telemedicine in diabetes has numerous benefits and barriers to its application. First,
telehealth has been demonstrated to be effective in reducing HbA1c levels, improving glycemic
cycles, reducing blood sugar levels, and reducing blood pressure compared to clinical care.
Another benefit of telemedicine is that it improves patients’ adherence to diabetes therapy
compared to clinical care, thus reducing complication occurrences. In addition, patients
practicing telehealth in the management of diabetes show improved communication. Finally,
telemedicine has proven to be time-saving and cost-effective as there are no more frequent health
visits and no health provider fees. On the other hand, the barriers to telemedicine application to
diabetes management include poor economic status and poor internet connectivity, as most of the
patients live in rural areas. Another barrier is the technical know-how of operating telehealth
systems and devices, thus making its adoption difficult. Furthermore, since telemedicine is a new
technique possibility of malpractice and licensing of healthcare providers is yet to be
investigated in detail. Finally, systemic barriers such as data loss and data privacy make it
difficult for telemedicine to be broadly accepted. Therefore, as the number of diabetes patients
increases, telemedicine offers a solution as it is effective, time-saving, and cost-effective
compared to clinical care.
Areas of further research
Further research in telemedicine for diabetes should center on offering new instruments
and technological tools seeking to improve the quality of telemedicine solutions and
developing telecommunication models to help support the effective delivery of the health
care process.
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