Virtual care changing the game in diabetes management

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As an early adopter of digital health solutions, for the last several years, Dr. Ilana Halperin has offered video appointments to her patients with diabetes and looked at their glucose monitoring data electronically.

The COVID-19 pandemic has vastly increased the availability of such virtual care, while the use of sensor-based technology that checks, records and relays blood-sugar readings is growing. For Dr. Halperin, an endocrinologist at Toronto’s Sunnybrook Hospital who specializes in type 1 diabetes in high-risk cases, such as pregnancy and the tricky transition from pediatric to adult care, it’s a welcome kickstart to a new era in “high-frequency low-touch” diabetes management.

“This is a game-changer for people living with diabetes,” says Dr. Halperin, who currently sees some two-thirds of her patients virtually. She feels that with the COVID-19 crisis, finally health care “has caught up with the rest of society” and joined the digital world.

Sensor technologies are “reducing the burden of living with diabetes,” Dr. Halperin says, and the diabetes online community allows people to communicate with and learn from peers via social media. “There are no borders.”

This sharing of information has made a difference for Maria Smith-Williams, 51, who has lived with type 2 diabetes for the last eight years. Her passion is mentoring and encouraging followers on Instagram and Facebook to manage their diabetes through means such as self-checks, exercise and healthful eating.

“I’m living my best life,” says Ms. Smith-Williams, who does paralegal work for a Toronto law firm and appreciates being able to visit her endocrinologist virtually. However, she laments that “it can be pretty isolating, so it’s nice to see people online who are also struggling with this particular disease.”

Smitha Pradhan, a registered dietitian who is part of the Diabetes Education Program in the Academic Family Health Team of St. Michael’s Hospital in Toronto, says that while in-person visits remain important, attendance has actually improved through virtual appointments. In the past, about 20 per cent of scheduled office appointments ended up being “no-shows”; that has fallen to less than 10 per cent with virtual visits.

“It has a really positive impact,” she says, although the vast majority of appointments are by phone versus video, which limits the ability of practitioners to read the body language of patients. On the plus side, people at home can reach for resources like package labels when they’re speaking with Ms. Pradhan about certain foods. And it can improve the power dynamic “when they’re in their space and not in our space.”

Dr. Halperin says it’s critical that diabetes management technologies are more widely available through government-funded programs. According to Diabetes Canada, a number of jurisdictions do not publicly fund glucose monitoring devices. The organization advocates for greater access to glucose monitoring devices through more comprehensive coverage policies. Dr. Halperin hopes ongoing access to virtual care in the post-pandemic period and better coverage programs for sensor-based technologies will help reduce health-care inequities among different populations and regions, such as in rural and remote settings.

For example, one of her patients with type 1 diabetes lives on Manitoulin Island and now communicates with her entirely remotely, in video appointments and by secure email messages, with the ability to do blood work and in-person care with her local family doctor.

Advertising feature produced by Randall Anthony Communications with Diabetes Canada. The Globe’s editorial department was not involved.