November is Diabetes Awareness Month. More than 37 million U.S. adults live with this chronic condition, which can cause a variety of complications, such as stroke, kidney disease, heart disease and blindness.

To help address this epidemic, Dr. Sos Mboijana argued in a recent interview that providers should incorporate remote patient monitoring (RPM) into the standard of care for diabetes. Dr. Mboijana is a primary care physician and the assistant chief medical information officer at Kaiser Permanente’s Mid-Atlantic medical group.

Kaiser launched its RPM program for diabetes care in 2017 in California, and it has since spread to the health system’s other regions.

Dr. Mboijana asks all his patients with diabetes to participate in the program. He gives them a Bluetooth-enabled glucometer (a handheld machine that measures their blood sugar) and ensures that they sign up for the “KP Health Ally” app. As patients measure their blood sugar daily, the glucometer transmits their blood sugar data to the app and to their care team.

“It’s a mechanism for us to reach into the patient’s home and connect them to the healthcare team,” Dr. Mboijana said. “It further allows us to coordinate care, adjust care and adjust medicines.”

When treating chronic conditions like diabetes, having access to a continuous flow of patient data is critical, according to Dr. Mboijana.

When a patient is newly diagnosed with diabetes, their treatment plan will usually involve a new medication, often Metformin. Medication types and quantities often change for diabetic patients across the course of their life, so it’s rare that a patient will stick with the exact same prescription they received on Day One forever. With a continuous flow of blood sugar data, a patient’s care team can sooner figure out which adjustments need to be made to the care plan.

“When I started practicing initially, the standard for a patient with a new diagnosis was to collect all the data that we can, assign them for diabetic education, and then maybe a follow up with a month or a few weeks. And then we get into this cadence of about every three months. Essentially, what I would get is a snapshot in time of what’s happening with the patient. But diabetes is a dynamic clinical condition, and it’s a chronic medical condition. Things go up and down,”  Dr. Mboijana explained.

About 40,000 patients are enrolled in Kaiser’s RPM program for diabetes. Dr. Mboijana said that providers across the country should create similar programs, as he thinks it’s “integral to the whole care package that we should be offering patients.”

He also pointed out that diabetes can often lead to a host of complications. For example, diabetic retinopathy is the leading cause of blindness in working-age U.S. adults. Because RPM improves providers’ ability to intervene with diabetic patients’ care plans sooner, it can play a huge role in decreasing the amount of complications that occur.

“If we can track diabetes, in terms of chronic disease management, and improve on that from a population health standpoint — not just cast Kaiser Permanente patients, but everybody — the upside is dramatic,” Dr. Mboijana said.

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Type 2 Diabetes is a chronic condition that affects over 400 million individuals worldwide, and can lead to major health issues if not properly managed. In recent years there have been significant advances in the treatments available for people with diabetes. Thanks to new technologies, such as telehealth, outcomes for patients living with the disease are improving from year to year. In this blog, we will highlight the importance of managing type 2 diabetes, and how telehealth is improving the ways patients manage their condition.

The Importance of Managing Type 2 Diabetes

For patients with type 2 diabetes, blood sugar management is critical for avoiding or delaying the development of health-related problems. According to the American Diabetes Association, individuals with type 2 diabetes are more likely to develop cardiovascular illness, kidney disease, nerve damage, and other health problems. To avoid these complications, it is critical to control the disease by adopting a healthy lifestyle and taking medication as directed.

How Telehealth is Improving Care for Type 2 Diabetes

Telehealth is a fast-growing care delivery method that uses technology to provide healthcare services remotely. It allows patients to obtain care from providers who are not physically present, which increases access to both regular, and urgent care. There are many potential applications for telehealth, including mental health counseling, physical therapy, and disease management. Telehealth can also be used for preventive care, such as health screenings for pre-diabetes diabetes, and educational resources for patients who may be at risk for developing diabetes.

Telehealth platforms offer a range of features including options for patients to log their blood sugar levels, remote patient management tools for healthcare providers, and additional patient resources. Each of these features has its own unique benefits that can improve patient care. For example, when patients keep track of their daily blood sugar levels, they can recognize what patterns and habits contribute to healthy readings. The remote patient management tools help providers proactively manage the patient’s health without the need for frequent in-person healthcare visits

Enhanced Patient Engagement

Telehealth increases accessibility to healthcare services and enhances patient engagement throughout the care process by providing continuous monitoring. Better access to care is achieved by providing a virtual communication platform for healthcare providers and patients to connect virtually at any time. This is especially beneficial for patients living in rural areas where access to quality care is limited. In addition, telehealth can improve patient engagement by providing a convenient way for patients to receive education and support services. It can also provide constant monitoring to keep diabetes under control and prevent complications.

With telehealth, patients with type 2 diabetes can get check-ups and questions answered in the comfort of their homes. Patients can track their blood sugar levels at home using monitoring devices such as blood sugar meters, diabetic test strips, or insulin pumps. Although quarterly and semi-annual testing may still necessitate in-person visits, many other symptoms of diabetes management may be handled virtually.

Daily Self-Management With Telehealth

It can be difficult for diabetic patients to self-manage and reach their goals if they are not regularly guided by a healthcare professional. Patients may have difficulty monitoring blood sugar levels, injecting insulin correctly, and recognizing changes in their condition due to a lack of training. Therefore, regular medical attention from a healthcare specialist or accredited diabetes educator is required to maintain and improve their health.

Patients can use telehealth platforms to access daily self-management tools such as checklists to ensure they are getting the right amount of exercise, eating the right diet, and taking medications on time. They can also collaborate directly with various members of their care team through these platforms, including their primary care provider, diabetes educators, or other specialists. Individuals who are provided with the tools they need to improve their self-management will be more likely to adhere to their routines and avoid the negative effects of diabetes over time.

Utilizing Telehealth To Manage Type 2 Diabetes

Many different telehealth platforms can be used to help manage type 2 diabetes. These platforms can be used to track blood sugar levels, monitor medication adherence, and provide education and support. Some telehealth platforms, such as aTouchAway also offer additional features, such as the ability to schedule appointments and send reminders. It is important that all healthcare providers choose the right telehealth platform that best fits their patients’ needs.

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Remote patient monitoring can help enhance chronic care management in many ways, including allowing clinicians to track their patients daily and adjust treatment plans in real time.

May 27, 2022 – Amid the rapid expansion of virtual care, remote patient monitoring (RPM) has emerged as a reliable tool for treating both acute and chronic conditions.

RPM involves leveraging connected digital tools to record personal health data in one location that a provider reviews at a different location, either in real time or later, according to the Department of Health and Human Services’ Health Resources and Services Administration.

RPM programs employ different devices, like weight scales, pulse oximeters, blood glucose meters, blood pressure monitors, and heart monitors. These enable providers to keep track of patient health metrics between clinic visits and adjust treatment plans as needed, making RPM a beneficial tool for long-term chronic disease management. Further, hospital-at-home programs have proved to be a viable alternative to in-hospital stays for patients with chronic diseases.

Here are some of the chronic conditions that could benefit from RPM services:

DIABETES

There is strong evidence showing that RPM can improve diabetes care, and as a result, providers are increasingly incorporating the care modality into their diabetes services.

A study published in 2019 showed that patients with more frequent and regular participation in remote monitoring had lower hemoglobin A1c levels — which measures average blood sugar — at the end of the program.

Even during the COVID-19 pandemic, RPM helped providers manage type 2 diabetes patients. A study conducted at St. Joseph’s/Candler health system in Savannah, Georgia, showed that an RPM platform managed by a pharmacist helped reduce A1c levels by 2.2 percent over a six-month period in 2020.

In addition to type 2 diabetes patients, RPM tools can be used to improve care for young children with type 1 diabetes. Stanford Children’s Health in Palo Alto, California, conducted a study that showed 53 percent of children provided with continuous glucose monitors reached the standard of care goal of having an A1c below 7 percent.

“There has been debate in the medical community about when is too early to start diabetes technology,” Priya Prahalad, MD, Stanford Children’s Health pediatric endocrinologist and member of the Maternal and Child Health Research Institute at Stanford Medicine, previously told mHealthIntelligence. “And I think what we are able to show is that starting diabetes technology early does not have any adverse effects on patients and families. It does not decrease their quality of life.”

Among providers, RPM strategies are increasingly being applied to diabetes care. In April, UBMD Pediatrics, a medical group in New York State, announced a collaboration with Cecelia Health to enhance care for children with type 1 diabetes by providing RPM.

Last year, the University of Mississippi Medical Center partnered with a federally qualified health center to increase access to diabetes care through RPM.

HYPERTENSION

Several studies have found that RPM can help maintain and decrease hypertension or high blood pressure (BP).

One published in 2018 showed that 81 percent of hypertension patients who enrolled in a home-based BP monitoring program achieved their BP goal in about seven weeks. Another study showed an RPM program that combined home BP monitoring with virtual nursing support helped maintain and even reduce BP during the pandemic.

Not only that but home-based BP measurements were found to be more reliable and accurate than those taken in clinics or kiosks.

Based on this clinical evidence, several providers have incorporated RPM into their hypertension treatment programs.

Last year, Northwestern Medicine piloted OMRON Healthcare’s VitalSight RPM service for its high-risk hypertensive patients. The service provides patients with the necessary devices to measure and share BP readings with their care team.  

And it’s not just the major health systems — smaller facilities with fewer resources are also turning to RPM to manage hypertension. In January, North Carolina-based federally qualified health center Robeson Health Care Corporation announced a partnership with HealthSnap that would enable it to offer RPM to more than 2,500 patients living with hypertension.

CANCER

Research showing that RPM can be used to enhance cancer treatments was available long before the pandemic.

In a study published in 2016, some patients receiving routine outpatient chemotherapy at Memorial Sloan Kettering Cancer Center were asked to report 12 common symptoms via tablet devices. Health-related quality of life improved for patients who reported their symptoms via the tablet than those who received usual care, which did not include remote self-reporting of symptoms. Further, patients receiving the intervention were less frequently admitted to the emergency room or hospitalized.

More recently, researchers at Huntsman Cancer Institute at the University of Utah found that the patients who participated in its adult oncology hospital-at-home program were 58 percent less likely to be admitted for an unplanned hospital stay than those not in the program.

Amid the recent disruptions in cancer care, RPM has helped ensure continued care access for cancer patients in their own homes, including those who contracted COVID-19.

A study published last September showed most COVID-19-positive cancer patients enrolled in an RPM program agreed that the program was worthwhile, enabled better management of their COVID-19 symptoms, and made them feel more connected to their care team.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems.

Studies show that RPM can be used to improve care for COPD patients, including one where researchers concluded that “remote monitoring of COPD patients holds promise for detection of exacerbation events.”

Another study published in 2021 revealed that RPM could help make COPD diagnoses and treatment more efficient.

In addition, research indicates that patients are ready to use a telemonitoring system for at-home pulmonary rehabilitation. The study published in 2018 shows that 98 percent of the participants agreed the system was easy to use and said they would be willing to use it throughout the pulmonary rehabilitation period.

As the initial COVID-19 surges slowed, providers and payers began adding COPD care to their home monitoring programs.

In 2021, West Tennessee Health modified its RPM platform to monitor patients with congestive heart failure and COPD, and Deaconess Health made a similar move.

Humana also launched a home healthcare service last year that included RPM. The payer announced plans to develop care pathways for members with various chronic conditions, including COPD.

As RPM becomes further integrated into care delivery, the physical boundaries of the healthcare system will shift, opening up possibilities for more comprehensive chronic care management.

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