Diabetes and Telemedicine
At Children’s National Medical Center we are in the process of translating architectural renderings of our future Washington Nationals Diabetes Care Complex into reality! The timing of the complex construction (projected to begin late summer to early fall) coincides with the Washington Nationals season. (They are currently in first place in the National League East! GO NATS!)
As we translate plans into reality, it is important to imagine and predict how diabetes care will be delivered in the future. As such, a teleconferencing center will be included as one of the spaces in our 6,500 square feet complex. Our goal is to care for as many children and adolescents in the Capital area and beyond, which will require remote connections in many cases. In addition to our teleconferencing center, we hope to add teleconferencing abilities to present diabetes and related multidisciplinary dietary concepts, and actual cooking lessons in our Black Bear kitchen. Telemedicine has become a reality to provide care to vast audiences that are unable to travel to a central medical complex. We, therefore, must bring the “show” to our families locally.
On May 24, at the AACE (American Association of Clinical Endocrinologists 21st Annual Scientific and Clinical Conference), a study highlighted the positive results applying telemedicine in the examination and treatment in diabetes that are located in remote regions. Dr E. Nyenwe et al. designed a study to evaluate the “effectiveness of examining and treating patients with endocrine diseases using telemedicine, and to analyze the ability of telemedicine-based endocrine consultative service to improve outcome measures in endocrine patients in rural communities.”
How was the study conducted?
During a 2.5-year period, a clinical endocrinologist located in a centralized urban medical complex connected via video teleconference with 66 patients in a rural location that actually enabled visual examination and real-time face-to-face doctor-patient communication. The equipment included video cameras, television monitors, and an Internet connection to transmit video, audio, and electronic records. It was a “virtual examination” room as defined by the authors of the study. A nurse in the rural, remote location facilitated the meeting between the endocrinologist and the patient and assisted with the physical examination.
What were the results?
The majority were type 2 diabetes patients. 97 percent of patients were comfortable with care provided by telemedicine. The next step will be to perform a follow-up study with a larger sample and determine the effectiveness of telemedicine with people with both type 2 and type 1 diabetes. Metrics will need to be rigorous to demonstrate improvement in care to justify coverage by insurance companies.
It should be noted that some insurance companies actually do cover care by telemedicine. Last year, I was involved in a pilot project at Children’s National to provide a follow-up office visit to four patients with type 1 diabetes via telemedicine at our outpatient site inVirginia. There were glitches; but, with experience, after we were able to coordinate medical records, telemonitors that demonstrated the same clinical data visualized by both care provider and child/adolescent/family (blood glucose downloads), and visual inspection (looking at injection sites), the visits progressed smoothly. Thus, it is my hope that by outfitting our teleconference center with the appropriate equipment our diabetes team will be able to provide care to patients who travel great distances for appointments.
As we know, access for pediatric diabetes care is often difficult due to a lack of pediatric endocrinologists/diabetologists. As such, any method by which we can improve access should be an effective means to disseminate care. Ideally, after the completion of the Washington Nationals Diabetes Care Complex at the Children’sNationalMedicalCenter, my vision for diabetes follow-up care would be to see all patients every 3 months using the following paradigm:
- Two to three follow-up visits/year at the regional outpatient center closest to home and/or
- One visit by teleconferencing if the patient lives many hours away from an outpatient center,
- One visit at the Care Complex yearly for comprehensive care by the entire diabetes team (physician, nurse educator, dietician, psychologist, and social worker, if needed) using the Joslin Model.
On a personal note, I would like to thank all our family members, corporate sponsors, and hospital staff who have and are continuing to contribute towards the construction of the Washington Nationals Diabetes Care Complex! This has been my dream for the past 10 years and it might actually come true!