Despite advancements in health information technology (HIT), the prevalence of diabetes in the United States continues to be high and is the seventh leading cause of death. Diabetes management in underserved communities has challenges concerning health care access for high-risk groups, often resulting in debilitating health outcomes worsened by adverse socio-economic consequences. Optimal HbA1c levels, controlled for by risk reduction, are essential. If diabetics encounter barriers to health care services, this impacts their ability to self-manage their disease and results in high HbA1c glycemic levels, leading to micro- and macrovascular complications. Notable reasons for patients exhibiting non-adherence include failure to start and continue treatment recommendations due to poor understanding of the long-term implications of not taking care of their diabetes; missing medical appointments and biomarker testing, failure to comply with medication recommendations due to poor health literacy and indifference as it pertains to committing to lifestyle changes (i.e., diet and exercise) and self-monitoring blood glucose.
HIT has been utilized over the years to improve diabetes management. Since the advent of the COVID-19 pandemic, the typical in-person mode of care requiring patients to visit a provider’s office or clinic to manage their health care needs has transitioned to telemedicine encounters, allowing increased access to urgent and timely treatment for vulnerable populations. Despite questions on the effectiveness of interactive telemedicine, its utilization for diabetes management is valuable for those living in medically underserved areas. It shows promise for relieving health burdens and lowering medical costs. Remote-digital-monitoring (RDM) for diabetes management has been implemented in various clinical settings, and research has shown that patients with more frequent and regular participation (one biometric data upload per day) in remote monitoring had lower HbA1c levels in comparison to those who uploaded their data every two days or less frequently, patient activation and engagement with RDM technology remains a challenge for patients who are of lower-socio economic status and have limited health literacy. On a national and global scale, diabetes registries show the most promise regarding monitoring, surveillance, health care planning, improving patient outcomes, and generating real-world evidence for diabetes management; however, they are rarely integrated into the health system. These registries generally help measure and compare outcomes and highlight variations in care and quality improvement; however, data capture can be variable. Well-established registries report on a range of parameters and collate demographic data, as well as data on risk factors and biomarkers such as HbA1c, blood pressure, lipid levels, urine albumin-to-creatinine ratio, lifestyle data, comorbidities, data on microvascular/macrovascular complications, eye and feet examinations, and linkage to mortality.
Consideration should be given to utilizing diabetes registries in a small group of medical practices or institutions with a minimal dataset such as age, sex, ethnicity, key biomarkers, risk factors, prescriptions, medical visits, eye/feet examinations, and associated complications (i.e., chronic kidney disease). Once embedded in routine clinical practice, clinical outcomes can be improved by assessing the target population characteristics, risk factors, complications, treatment, and gaps in implementing evidence-based guideline recommendations. In addition, this patient database can utilize technology employed to help patients adhere to treatment plans (i.e., SMS text) to send reminders and alerts on recommended biomarker testing, eye and foot examinations, medical appointments, and support medication adherence. The latter technology is currently effective in alerting patients about medication refills, medication pick-ups, vaccination updates, and other preventative services.
The author is an anonymous physician.