THE COVID-19 pandemic has disrupted almost every aspect of conventional health care delivery. As an endocrinologist, I was initially concerned that the lockdown would be the perfect environment for previously well managed patients with diabetes to lose their trajectory. However, it has provided a unique opportunity to see what technology has to offer in the real world for the management of diabetes.
More than 1.7 million Australians are living with diabetes and were included among those most at risk of severe COVID-19 complications. As people around Australia were encouraged to stay at home between March and May 2020, this new way of life presented a bigger challenge to those living with diabetes, a chronic and lifelong condition.
The pandemic inspired the rise of telehealth, which became an attractive option for health care professionals when a face-to-face appointment was not possible. Telehealth is a powerful alternative and there is growing interest in technologies that support remote appointments.
Living with diabetes involves regular monitoring of blood glucose levels and recording these data. These records help health care professionals make informed decisions about their patients’ treatment and care. Without these data and without seeing the patient in person, it can be tricky to update their treatment plan or offer personalised advice.
Technology such as flash glucose monitoring kept health care professionals and patients with diabetes connected while apart during the first lockdown. The technology supports telehealth appointments by giving the health care team the full picture of their patients’ diabetes thanks to cloud-based glucose data sharing. I noticed a jump in the number of my patients living with diabetes who turned to these devices to help manage their condition during this period. There is an element of reassurance in being able to communicate with your health care professional and sharing glucose data accurately from a distance. My patients were happy that technology was there to assist them with their glucose measurements.
Flash glucose monitoring allows people with diabetes to monitor their glucose level by hovering a smartphone over a small sensor on the back of their arm. The dedicated smartphone application collects the reading after scanning and uploads it in real time to a cloud-based platform that health care professionals can access securely to review the glucose data.
There is certainly a recognition by people who have diabetes that health care professionals need to access their data. If they scan using a smartphone, we can access the data without them having to do anything. They do not need to send us the data as an email attachment or manually log the numbers as the cloud takes care of sharing them. Living with diabetes should not mean more time spent doing “life administrative tasks”.
Flash glucose monitoring provides important information that leads to greater awareness of glucose patterns, driving insulin and dietary changes as well as reducing hypoglycaemia risk (here, here, here and here). It assists with remote medical consultations and reduces the need for emergency care and hospitalisation.
A study conducted in Great Britain looked at the impact of the lockdown on the glycaemic control of people with type 1 diabetes using flash glucose monitoring. Glucose data gathered on cloud-based platform LibreView was analysed for 572 subjects, the largest cohort size for a study of this type. Although the researchers expected the impact of the lockdown to be negative, they found that this 2-month stay-at-home phase was not associated with a significant deterioration in glycaemic control. The results were compared with the same period in 2019: there were statistically significant improvements for some glycaemic variables, and modest but significant improvements for other variables. The findings in Great Britain reflect what I have seen in my role as an endocrinologist in Melbourne: in general, my patients kept similar blood glucose levels to those they had before the lockdown, which was encouraging.
The first stay-at-home phase was an opportunity for people with diabetes and clinicians to educate themselves on how to use technology to manage their condition. With the recent implementation of stage 4 restrictions in Melbourne, staying at home is back on the cards. Hopefully, people with diabetes will feel better prepared to manage their condition independently with the help of technology this time around.
I anticipate that remote glucose monitoring technology will remain in use once our lives have returned to some normality. COVID-19 is likely to be an ongoing issue. While people with diabetes still require face-to-face appointments for check-ups and pathology testing, the pandemic has woken the world up to things that can be done remotely.
Associate Professor Neale Cohen is Director of Clinical Diabetes at the Baker Heart and Diabetes Institute; Adjunct Clinical Associate Professor Monash University, School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences; Associate Professor, School of Pharmacy, University of Queensland. He is part of the Advisory Board for Abbott Diabetes Care.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.