Issue 40 Februay 2012
2. Geographical location and effectiveness of a simple telemedicine program (DTMS®) in diabetes

Another research paper from Jothydev’s Diabetes Research Center presented at ATTD February 2012, Barcelona, Spain discusses the benefits of Diabetes Tele Management System (DTMS®) in a subset of patients residing in Trivandrum Vs those residing in Middle East.

There is sufficient evidence in the medical literature to support the fact that achieving and sustaining metabolic targets in diabetes prevents long term complications, hospitalizations, thus cutting down the cost of future therapy by several folds. 90% of the diabetes patients get treated at general practitioners’ located near their houses, priority being saving time and money rather than getting head to foot evaluations carried out at comprehensive diabetes centers. Some diabetes patients who have already developed complications may prefer being treated by cardiologist, nephrologist or neurologist, again to save the resources visiting a diabetologist/endocrinologist. Diabetes Tele Management System (DTMS®) - a telephone and web based follow up mechanism in our center for chronic care in diabetes takes into consideration HbA1c, lipids, blood pressure, diet, lifestyle etc. for making treatment decisions. The diabetes subjects enrolled with this system follow up with the multidisciplinary team of doctors, dietitians, diabetes educators etc. irrespective of their geographical location thus utilizing the benefits of DTMS®. This study looks into the multitude of benefits of this simple cost effective tool among subjects in the nearby locations of a comprehensive diabetes centre Vs those in a distant country followed up via DTMS®.

Diabetes patients in our clinic are encouraged to participate in a SMBG based telemedicine program (Diabetes Tele-Management System - DTMS®). Patients report 4-point values at individualized frequency, based on which changes in dose, diet & exercise are advised. A1c, blood pressure and other targets are customized based on age, duration of diabetes and presence of other co-morbidities.

The current study was done to check whether distance and place of work were barriers to effect management via DTMS®. We collated places of latest residence of Indian citizens visiting our clinic between January and July 2011, then compared their HbA1c values, time since last visit to clinic, frequency of tele-follow-ups preceding latest visit, and other characteristics. From this, we selected only those who had enrolled in the DTMS® at least 3 months prior to latest visit. The HbA1c values in patients who had gone to Middle East for work (7.7±1.4%, n= 45) were not statistically significantly different from patients in Thiruvanathapuram district (7.6±1.5%, n=326). Analysis of age- and sex- matched controls from Thiruvanathapuram also showed there were no significant differences in BMI, duration of diabetes, or HbA1c in previous visit. However, patients who had traveled had significantly more time between two physical visits (0.9 vs 0.4 years) and also count of emails for tele- follow-ups (1.7 vs 0.3) when compared to patients living near the clinic.

Irrespective of the country of residence, telemedicine involving Diabetes Tele Management System (DTMS® ) via telephone or internet combined with Self Monitoring of Blood Glucose (SMBG), diet and exercise advices, is a cost effective model in achieving goals of therapy in diabetes.

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