Nicholas Giovinco


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Internet and Information Technology in the Treatment of Diabetes

This is newer publication from the UCLA School of Medicine

As described:

"With the increasing sophistication of diabetes treatment protocols and diabetes-related devices this new modality offers a remarkable opportunity for clinicians and patients."

Overall, the multifactorial progression and continuation of diabetic complications and treatment obviously merit technological intervention.  Technological assistance will continue to be a welcomed aid to medical care for patients with diabetes.

"For the first time, with online tools clinicians are in a position to have a major impact on diabetes outcomes by providing robust and affordable just-in-time support to large numbers of patients who want to improve their diabetes outcomes through enhanced self-management of the complex behaviours so essential for good outcomes. Patients with diabetes often need a complex set of services and support ranging from glucose monitoring, insulin and other medication management, psychotherapy and social support, to physical activity promotion, nutrition counselling and more."

This is commonly something which is beyond the scale/scope of any single care provider, and often, most care facilities.

"Integrating these supports into a patient's therapeutic regimen presents challenges that need to be addressed through a variety of strategies. Patient self-management of diabetes enabled by information technology is becoming an important factor in the way providers deliver healthcare. Approaches using information technology to support clinical services are being dramatically altered by the confluence of several trends."

These trends and observations have lead to a few notable assumptions of what future technology assisted, diabetic health care must address appropriately.

  • Patients want an active role in managing their own health and a collaborative relationship with their healthcare providers.
  • Widespread, low-cost internet access is erasing existing geographic, economic and demographic barriers to obtaining health information online, and with advanced Web 2.0 technologies high levels of interactivity can engage the patient.
  • Clinicians and researchers now have a deeper understanding of how people learn and respond online, and that knowledge can be crafted into solutions that produce effective, long-term behaviour change. 
  • Technology enabled approaches that show great promise to improve outcomes use new models of service provision in which technology enabled self-management support (SMS) provides patients with just-in-time delivery of tailored messages and experience that speak to each person based on their unique characteristics, their performance on key behaviours and their needs at that moment in time.
  • Ways to easily and accurately keep track of their performance and use that knowledge to plan and implement new approaches to reaching their goals.
  • Ways to link directly to family and friends for critical support, and to link to their many providers to help integrate medical care with everyday life. 

By this, there is still a need for physician involvement.  However, this involvement will be different from traditional practice.  Undoubtedly, this will depend of a number of factors, such as insurance liabilities and payment fees, etc.

Online tools can extend health practices and provide this support through cost-effective programmes that help clinicians guide their patients to better manage their diabetes. The best internet self-management education and support programmes are rich in pertinent content, provide engaging interactive elements, and offer a tailored, personalised learning experience. They contain self-assessment tools and ways for the individual to monitor performance and changes in biological measurements such as blood sugar, insulin dosage, physical activity, weight, blood pressure and mood.

The patient will benefit most from self involvement.  Data logging and "opt-in" participation are means of permitting more personal means of health care application.

The patient can access their information, input their data, and receive support 24 h a day - at a time and place most convenient for them, and not limited to clinicians' office hours. Web-based learning and support technology benefits both clinician and patient; patients learn to overcome barriers and to self-document activities and interactions, permitting clinician review and feedback at any time. In addition to automating much of the educational content, this time shifting element is one of the keys to making the process efficient and low cost. The ability to perform an automated review of the patient's activities and performance also provides the clinician with a valuable tool that increases both effectiveness and efficiency.

Given the ubiquity of web enabled technology, automation services and "push" data can open a more sophisticated means of communication (human and/or automated)

As with online intervention, a 'virtual coach' can provide individualised guidance and support based on readily available analyses of each patient's characteristics and performance. In addition, the clinician can communicate frequently and efficiently, offering personalised email support to each patient without requiring in-person meetings, as well as monitor 'virtual support groups' where patients interact with others online via informational chat rooms and blogs. By incorporating web-based patient self-management and support into traditional treatment methods, one clinician can effectively support many patients - one patient at a time.