Study explores internet as a tool for care of diabetic patients

BMJ 2000; 320 doi: (Published 01 April 2000) Cite this as: BMJ 2000;320:892
  1. Scott Gottlieb
  1. New York

    A new study involving patients with diabetes in the United States will show doctors whether it can be beneficial and affordable to use the internet to make high tech house calls.

    Upstate Medical Center in Syracuse, New York, and Columbia University in New York City will use a $28m (£17.5m) federal grant to deliver health care through the internet into the homes of 750 rural and inner city diabetic patients over the next four years.

    The grant from the US Health Care Financing Administration will provide patients with free personal computers with programming based on Microsoft Windows, internet access, and health monitoring equipment.

    The study will recruit 1500 patients from New York, half of whom will receive the computers and diagnostic equipment. The other half will continue with only the usual care from their doctors. The project includes a control group so that doctors can compare healthcare costs and benefits in the two groups.

    “Up front, obviously tele-medicine is going to cost more than normal care,” said Dr Ruth Weinstock, director of the State University of New York's Joslin Center for Diabetes in Syracuse. “You have to compare that to the cost of renal failure, and going on dialysis, or the cost of having a stroke, or going blind. We hope to prevent blindness, strokes, and heart attacks. We hope it's obvious that telemedicine is better in the long run.”

    She said that telemedicine offers two advantages for patients: comprehensive information from an expanded American Diabetes Association website, and limitless chances for rural patients to receive treatment. “When the winter comes, and the snow comes, often the patients cannot see their healthcare providers as often as would be optimal,” Dr Weinstock said.

    “This way, if their blood sugar is very high, we can see that as soon as it happens and make adjustments. They can get ‘visits’ as often as necessary.”

    Under the pilot programme, patients with computers will have use of a blood sugar monitoring device, an automatic blood pressure cuff, and a camera hooked up to the computer. The camera will allow doctors to look at patients' skin lesions without requiring patients to leave their homes. The equipment will stay with the patients for at least two years.

    After receiving training, patients will check their blood sugar level, blood pressure, and other factors and enter the data into a secure website for analysis. Patients will receive information through their computers on how to manage their disease. If a patient's data fall outside an acceptable range, an automatic alert will be sent via the internet to a doctor or nurse.

    “Diabetes, more than most other chronic diseases, requires daily self management,” Dr Weinstock said. “One cannot take a vacation from diabetes. We want to give people greater access to information and offer more timely intervention.”

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    Each of Permindar Kaur's garments, displayed in glass display cases, suggests a way of providing solace for the wearer. The garments are part of an exhibition at the Chelsea and Westminster Hospital in west London, which includes new commissions from eight artists. Instead of works of art designed to take the mind off medical procedures, “Don't Worry,” which runs until 26 May, puts the spotlight on the hospital.

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