The prevalence of diabetes is rising globally. About 70 million people live with diabetes in India and the World Health Organization estimates that an additional 36 million remain ignorant of their condition. This means that nearly 1 in 10 Indians suffers from this condition but is either unaware of it or is slipping through the treatment cracks with inadequate reporting and monitoring. As the number of people with diabetes grows worldwide, the disease takes an ever-increasing proportion of not only the patient’s household budgets but also the overall healthcare budget. Poor glucose control results in higher rates of diabetes-related complications and an increase in health care expenditure. Without primary prevention, the diabetes epidemic will continue to grow. Even worse, diabetes is projected to become one of the world’s main disablers and killers within the next twenty-five years. Immediate action is needed to stem the tide of diabetes and to introduce cost effective treatment strategies to reverse this trend.
Tremendous improvements have modified diabetes management from pure clinical diagnosis and the discovery of insulin, to Continuous Subcutaneous Insulin Infusion (CSII) coupled with continuous glucose monitoring (CGM). This has allowed patients to adapt insulin delivery to glycaemia on a virtually “real-time” basis. Insulin was first discovered in 1923 and, in less than a century, it has been purified, humanized and now synthesized by genetically modified microorganisms. Although advances in medicine can improve diabetes health outcomes and potentially help control medical costs, recommendations for care are often neglected. As a result, diabetes often is poorly controlled despite adequate access to health care resources.
Diabetes can be managed effectively with multidisciplinary care and self-managing by patients. Good management reduces the risk of developing complications, enhances health-related quality of life and reduces hospital admissions to a great extent. Conversely, poorly managed diabetes is associated with serious complications including stroke, blindness, heart disease, kidney disease, nerve damage, amputations, and may even lead to death.
A productive and informative interaction between the patient and the care team by using information technology based interventions can lead to improved diabetes care. Existing and emerging technologies such as wireless devices (cell phones) with email and text messaging (SMS) functionality, pagers, and the internet can help facilitate patient self-management of diabetes. These types of devices are practical and cost-effective methods for monitoring clinical outcomes and increasing patient adherence to treatments. Wireless technologies can be used as intermediary tools to facilitate the information between patient and provider and treatment advice between clinic visits.
Self-monitoring of blood glucose continues to be an effective tool for the management of diabetes. Wireless technologies help in effective lifestyle management and can potentially improve self-care for lifestyle driven chronic conditions. There is much enthusiasm amongst industry and patients to use digital tools for diabetes self-management. Large randomized control trials are needed to establish the effectiveness and cost-benefits of digital tools in improving diabetes-related outcomes.
The future of the digital health industry is promising. If a self-monitoring device is useful, and if patients are motivated to use the technology, then it is beneficial for both doctors & patients alike. Health care providers may in turn discover that they have more reliable clinical information and improved communication with their patients through the usability feedback they might obtain as a result of patient self-monitoring technologies.
Technology intervention in diabetes management has significant potential for improving patients’ care, preventing development of diabetic complications, and generating cost savings. Barriers of adoption may relate to IT (Information Technology) characteristics at individual or professional or organisational level. Important barriers to using IT(Information Technology) in diabetes care include privacy and confidentiality concerns, lack of time and anxiety about change, inadequate funding, workforce shortages, and lack of or inadequate training. However, using IT (Information Technology) for self-care is highly dependent on the individual’s motivation; without the patient’s willingness to be an active participant in their care; IT (Information Technology) implementation will not generate the desired optimal outcomes.