The Use of eHealth for the Care of Patients With Diabetes in Connection to the COVID-19 Pandemic

In the late fall of 2019, Wuhan city, the capital of Hubei province in China, announced an outbreak of a respiratory infection of unknown cause, which was later designated coronavirus disease (SARS-2 CoV2 or COVID-19) by World Health Organization (WHO).^1,2 The coronavirus disease (COVID-19) was declared pandemic by WHO on March 11, 2020. ³ The clinical symptoms of Severe Acute Respiratory Syndrome-Coronavirus-2 infection are wide, varying from asymptomatic infection, mild upper respiratory tract illness, to severe viral pneumonia, which could be further complicated by respiratory failure and even death. However, the majority of infected individuals have mild or no symptoms. ³

I have learned that the large number of patients being admitted to hospitals with pneumonia stretched the hospital resources to its ultimate limit in many regions or countries.

Despite a shortage of resources, health care providers have to offer treatment to both those with acute diseases as well as to those with chronic diseases such as individuals with diabetes. This is to be done without reducing the quality of the care.

Senior citizens are, due to increased risk of more serious COVID-19 infection, encouraged by authorities to avoid unnecessary social contacts besides with those living in the same household. There could be a risk of being infected by COVID-19 when attending an outpatient clinic and for many patients’ public transportation is the only available means of travelling to their Health Care Providers (HCPs) at the diabetes clinic. This could become a hindrance for elderly with diabetes to attend to planned diabetes consultations with their HCP and thereby have a negative impact of their diabetes care.

mHealth or digital health is usually defined as the practice of medicine, public health, and clinical health psychology supported by mobile communication devices, such as mobile phones, tablet computers, wearable activity trackers, and other tools for health services and information.

mHealth has been shown useful for type 1 diabetes supporting the needs of often rigorous daily routines and improving self-management. A subset of digital health often called electronic health (eHealth) includes health information technology, telemedicine, and personalized medicine. ⁴

Within eHealth, many mobile apps incorporate connected blood glucose meters and are often developed by the device manufacturers. Also, real-time continuous glucose monitoring (rtCGM) and intermittently scanned flash glucose monitoring (isCGM) are increasingly used as adjuncts and alternatives to self-monitoring of blood glucose (SMBG) for making diabetes treatment decisions.

These systems can be downloaded via specific- or via more generic systems. By the use of a system able to download a variety of diabetes technology devices such as Diasend/Glooko (Diasend AB, Göteborg, Sweden/Glooko Inc., Mountain View, CA, USA), most of the different glucometers, rtCGM and isCGM systems, could be accessed through only one system. The ease of data flow from connected SMBG and CGM systems allow glucose patterns to be presented to patients for self-management and to clinicians for treatment adjustments.

However, attention is needed to ensure that the downloaded data are safely stored on a secure remote server or cloud and that data can be accessed and utilized by both the patient as well as the HCP.

Digital platforms where HCPs and patients can meet in a virtual meeting room and share downloadable data from glucometers, continuous glucose monitors, insulin pumps, and smart insulin pens. This can provide a very good alternative to the physical, and perhaps risky, routine outpatient meeting, where a patient could be accidently infected by COVID-19 during either transport to or at the visit at the diabetes clinic.

Furthermore, these digital platforms can be adapted to rapidly changing medical guidelines and translated across different conditions. They can also be quickly scaled to reach thousands of people and potentially increase the public access to health care. ⁵

There are examples of diabetes clinics that have successfully used virtual rather than face-to-face consultations. ⁶ eHealth using virtual meetings and connecting smartphones/tablets/computers of patients with HCPs has been studied. In a randomized controlled trial, in a pediatric setting, improvements in health, quality of life, and treatment satisfaction together with at least as good glucose control as regular visits has been shown. ⁷

In the future I predict far more use of eHealth and downloadable data from glucometers, sensors, pumps, and pens within the field of both type 1 and type 2 diabetes. These new technologies will further help clinicians in both motivating patients in maintaining significant lifestyle behavior changes and in improving health outcomes, quality of life, and well-being. This done in a fashion that ensures both functional patient empowerment and engagement. eHealth allows this to be done in a safe and most likely cost-effective manner and on top of it with less environmental footprint.