ABSTRACT
Pros and cons of telemedicine (TM) in diabetes have been debated during Covid-19. Diabetes Tele Management System (DTMS®) which include a disease specific EMR, customized targets integrated with remote monitoring capabilities supported 24/7 by a multidisciplinary team has been actively delivering patient care for more than 2 decades. We assessed long-term outcomes in patients adhering to DTMS® for 15 ± 3 years(y) [Treatment group(TG)] compared with those on conventional care[Control Group (CG)]. Patients having a Virtual Consultation(VC) ≥ 1 in 3 months, Physical Visit(PV) ≥ 1 in 3y, and attended group diabetes education ≥ 1 in 3y were included. T2D (n=451, age 62.91 ± 11.64 y, avg. duration of diabetes 8.41 ± 2.78 at baseline) were deidentified and their clinical characteristics were extracted from EMR. DTSQ and Eq-5D were administered to capture treatment satisfaction and QoL respectively. TG demonstrated sustained improvements and maintenance of glycemic and non-glycemic parameters over 15y. Subjects expressed significant level of satisfaction with TM(Table). Judicious use of TM with customized frequency for virtual consultations, counselling and coaching significantly averts the long term complications of diabetes and is superior to conventional care. Nonetheless connectivity issues and economic loss to hospital are among the foremost challenges observed with TM.
ABSTRACT
Telemedicine (TM) continues to play a critical role in ensuring continuity of care in diabetes patients during Covid-19. This study is based on Diabetes Tele Management System (DTMS®), a TM-based follow-up program consisting of decision support system aided by a multidisciplinary diabetes team since 1997 and its role during Covid-19. We retrospectively assessed the effectiveness of DTMS® and fortnightly delivered diabetes-specific Covid-19 webinars during lockdown period in our country. HbA1c of 848 consecutive T2D patients (age 55.68 ± 12.82 yrs, duration of T2D 13 ± 8 yrs) before and after lockdown were extracted from EMR and analyzed. Patients were also interviewed for their feedback using a structured questionnaire. Statistically significant reduction in HbA1c(baseline 7.81±1.76%, final 7.53±1.54%;t=5.601, p< 0.001*) was observed post lockdown. Among the patients who utilized telemedicine facility, 92.5% reported TM consultations during Covid-19 as a highly satisfactory experience (Figure 1). Since these patients were already familiar with the use of TM, no additional training was required other than reinforcing the necessity for maintaining treatment goals due to association of poor diabetes control with severity of Covid. SMS, audio video consults and counseling were found to be highly effective in those patients who were sensitized for a stricter control during COVID pandemic.
ABSTRACT
AIM: Amidst COVID-19 pandemic, the health care delivery in India faces major challenges owing to the overwhelming hospitals, exhausted healthcare workers, and shortage of crucial medical supplies such as ventilators and oxygen. The study aims to propose a novel successful interventional home care model, the Virtual COVID In-Patient (VCIP) care for effective COVID management. METHODS: The Covid-19 positive patients enrolled in VCIP were chosen for the study. A 24/7 active multidisciplinary WhatsApp group was created for each patient, for remote monitoring of temperature, blood pressure, blood glucose, respiratory and pulse rate along with the symptoms. Advice on sleep and exercises were given along with the medication via video-audio consultations. Lab facility was provided at the doorstep. Training on various devices, medications including steroids, delivering subcutaneous injections etc were given via video platforms. RESULTS: Among the 220 patients who availed the VCIP facility, only two were hospitalized, yielding a 99.5 % success rate in preventing hospitalizations and patients enrolled have been immensely satisfied with their experience. CONCLUSIONS: With similar pandemics anticipated in near future, VCIP model may be considered for successful domiciliary treatment and overcoming the challenges.