Long-term Effects of Remote Patient Monitoring in Patients Living with Diabetes: A Retrospective Look at Participants of the Mississippi Diabetes Telehealth Network Study

Use of Cellular-Enabled Glucometer for Diabetes Management in High-Risk Pregnancy

Background

Type 1 and type 2 diabetes during pregnancy requires intensive glucose monitoring to ensure optimal health outcomes for mothers and infants. Standard practice includes patients monitoring their glucose four to six times a day using a standard glucometer and paper diary. Remote patient monitoring (RPM) offers an alternative method for diabetes management. This study aimed at measuring the patient's satisfaction with and feasibility of using a cellular-enabled RPM device for glucose management in pregnancies complicated by type 1 or type 2 diabetes.

Methods

In a mixed-methods pilot study, 59 pregnant women with type 1 or type 2 diabetes were given a cellular-enabled iGlucose glucometer. Participants completed a pre-survey, used the device for 30 days, and then completed a post-survey and semi-structured interview.

Results

Participants were divided into two groups based on duration of device use: high-use >50 days and low-use ≤50 days. A significant difference (p < 0.0001) in Appraisal of Diabetes scores was seen between the pre- and post-survey for both groups, which indicates that the use of iGlucose glucometer significantly improved participants' appraisal of their diabetes. There was a significant difference (p = 0.0409) in pre-post General Life Satisfaction in the high-use group, which indicates that iGlucose glucometer significantly improved participants' life satisfaction when used for an extended amount of time. Participants scored high on system usability for all groups and reported positive associations with iGlucose use.

Conclusion

The use of cellular-enabled RPM glucometers is a valuable tool for the management of type 1 diabetes mellitus and type 2 diabetes mellitus during pregnancy.

Framework for Evaluating and Developing Sustainable Telehealth Programs

During the COVID-19 pandemic and public health emergency, telehealth programs vastly expanded with strong support from various federal and state agencies. However, the uncertainty regarding future reimbursement policies for telehealth services has resulted in concerns about long-term sustainability of innovative health service delivery models beyond the financial support. Given the limited literature on creating telehealth programs with long-term sustainability in consideration, we have developed a framework for gathering appropriate data during various stages of program implementation to evaluate clinical effectiveness and economic sustainability that is applicable across various settings, with additional attention to health equity. Recognizing the difficulty of sustaining telehealth programs solely through a fee-for-service payment model, we encourage all telehealth stakeholders, especially payers and policymakers, to consider cost-effectiveness of telehealth programs and support alternate payment models for ensuring long-term sustainability.