This article was presented at the 15th Advanced Technologies & Treatments for Diabetes Conference 2022 held in Spain by the diabetes team at Jothydev’s Diabetes Research Centre.

During the Covid pandemic, telemedicine (TM) has been more and more accepted by doctors and patients all over the world. Evidence-based research has found telemedicine-based management of type 1 diabetes efficient in delivering equivalent or better care and outcomes when compared to only face-to-face visits. Parents of kids with type 1 diabetes had access to WhatsApp and were part of the type 1 diabetes community in WhatsApp. This does not include all of those with type 1 diabetes in the state but included most of those who were economically compromised and didn’t have access to the premier hospitals and doctors.

There were a total of 4 WhatsApp groups, each consisting of 250 parents and children from all over the state of Kerala, receiving treatment from government hospitals or other private hospitals. The groups also included volunteering doctors, nurses, educators and dietitians who were assigned the job of guiding them in the right direction and providing advice rather than treating them. The team also provided economically disadvantaged families with free supplies including insulin, glucometers, strips and injection needles based on their needs. All the communications in the group were based on updated telemedicine guidelines in India. The diabetes team provided 24/7 advice and services free of cost to the entire community together with multiple online educational programs via the zoom. Some of these programs were with parents and children together and some other programs incorporated only parents so that counselling can be given to them to specifically address the psychosocial issues of these kids. Most frequently asked questions during the Covid pandemic were related to stress and anxiety of children including abnormal/aggressive behaviour, uncontrolled glucose, reluctance with insulin injections and glucose monitoring. Exclusive counseling sessions were also arranged with the psychologist to address the multiple emotional issues of the kids/caregivers. The study identified several merits and demerits which are described below.

Merits

1. All their concerns are addressed even during the middle of the night.
2. Could avoid multiple episodes of DKA.
3. Could successfully avert/treat multiple episodes of life-threatening hypoglycemia.
4. Dietitians in the groups could advise on diet, specific to individual requirements.
5. Diabetes nurses could retrain parents and children on injection techniques whenever found essential, multiple times.
6. Questions on stopping insulin or Complementary and Alternative Medicines (CAM), side effects of insulin were not only answered but also explained via videos.
7. Whoever is in short of glucometer strips or needles could get it from the community itself or from us without any delay.

Demerits

1. The patients in the WhatsApp groups are getting treated in different hospitals and not by the volunteering doctors and healthcare providers in the WhatsApp groups and hence the medical history and records are not with them.
2. Many a time, the patients with uncontrolled glucose might be on an insulin formulation or regimen not suitable for them but the team would not be able to commend on it.
3. Hundreds of parents will be messaging or calling via WhatsApp privately to doctors. However, due to legal implications, they are not replied to unless it is posted in the community group.
4. Though there is no hesitancy for the type 1 diabetes community members to open up about the disease in the group, there would be many concerns and questions which cannot be posted in a group.
5. Since it is an open community, whatever communications are exchanged; including lab reports are not secure or confidential.
6. The health care professionals (HCPs) will not get a remuneration and there is no funding for this activity; so those getting involved should volunteer out of their commitment to the society.
7. The HCPs may be under tremendous pressure since the patients will have easy and free access to the health care professional.