Promising findings may help boost the global telehealth market

With an ever ageing population the prevalence of chronic disease worldwide is increasing. In the UK alone at least 15 million people are thought to be living with at least one long term condition. Telehealth, defined as “the remote exchange of data between a patient and healthcare professional as part of the patient’s diagnosis and healthcare management” has been earmarked as one potential approach to the treatment of these patients.

Telehealth utilises technology to help patients self-manage their condition and live more independently, therefore improving quality of life for the patient and potentially reducing costs of secondary healthcare. However, historically, a lack of economical and long term clinical data has meant many have been reluctant to invest.

The Department of Health has estimated that in the UK at least 3 million people with long term conditions could benefit from telehealth services, and hence initiated the “Three Million Lives” campaign. Preliminary findings from their Whole System Demonstrator (WSD) programme, the largest global randomised control trial of telehealth and telecare, demonstrate that successful delivery of telehealth can significantly reduce mortality rates and emergency admissions, which just could be the justification the market is waiting for.

The WSD trial involved a total of 3,230 patients in the UK with chronic obstructive pulmonary disease, heart failure and diabetes; all chronic conditions associated with high prevalence and high healthcare costs. Half of patients acted as a control group receiving treatment through traditional methods, and the other half were delivered telehealth.

Patients receiving telehealth were taught how to monitor their condition at home and transmitted data to their health care professional. Although the specific telehealth device used by patients varied, all chronic obstructive pulmonary disease patients used a pulse oximeter, all diabetic patients used a glucometer, and all heart failure patients used weighing scales.

Results from the trial indicate when compared to the control group, telehealth patients experienced:

·         a 45% reduction in mortality

·         a 21% reduction in emergency admissions

·         a 15% reduction in A&E visits

·         a 14% reduction in elective admissions

·         14% fewer bed days

·         an 11% reduction in hospital admissions

Small differences in hospital costs (£188 per head lower for telehealth patients) were noted, however given that the actual cost of the telehealth treatments were not taken into account, this reduction is not considered significant enough to conclude that telehealth can reduce secondary care costs over 12 months. Cost-effectiveness will be assessed as a separate part of the WSD trial.

Despite this, these findings from the WSD programme provide the strongest evidence yet that telehealth can be linked to improved patient outcomes and the reduction of reliance on (costly) secondary care. According to InMedica forecasts, the impact of the 3 million lives campaign could potentially push the UK ahead in the global telehealth market, accounting for 74% of worldwide telehealth patient numbers by 2016, compared to 4% in 2010. These initial clinical results, and hopefully the impending economic benefits could provide the evidence base that many have been waiting for, and become a tipping point for wider adoption of telehealth worldwide.

Find the full BMJ article on the WSD findings at http://www.bmj.com/content/344/bmj.e3874

Find the InMedica article at http://in-medica.com/news-events/press-template.php?pr_id=2463&from=all_pr

Getting the needle with GLP-1 treatment

Whichever way you put it, it seems that many people with type 2 diabetes are getting the needle when it comes to their GLP-1 agonist therapy.


This is a very useful treatment in terms of its efficacy in lowering blood glucose levels and lack of association with weight gain, maybe even achieving weight loss, an important benefit for people with type 2 diabetes.
However, when we spoke to HCPs at our stand at EASD in October it was evident that the devices associated with it currently are far from ideal.

CMR’s John Reynard commented: “GLP–1 products for type 2 diabetes are clearly the new frontier in treatment and, if used correctly, can help a patient manage their diabetes and possibly avoid insulin injections but this is highly dependent on the patient being compliant with their medication.”
People with type 2 diabetes are not used to self-injection and the process has to be made as easy as possible for them. Furthermore taking a GLP-1 is the step taken when oral treatments like Metformin have not been successful for diabetes management, which suggests a history of non-compliance in either medication, diet, exercise, or all of the above.

Currently we have a trade off between a once a week injection with Amylin’s Bydureon, that involves a complicated 15 piece kit with a large needle capable of dispensing a higher viscosity; and the more convenient, prefilled, disposable smaller injection pens offered by Novo Nordisk’s Victoza or Amylin’s Byetta, which have to be injected daily or twice daily.

“We discovered that healthcare professionals frequently encounter concerns that patients either fear the idea of becoming drug dependent through daily injection or can be intimidated by the complexity of the 15 piece kit.”, added John.

“Through our own research with patients we understand the conflicting needs of managing diabetes – a disease that takes over a person’s life and takes a considerable amount of time and effort to manage properly, and a reluctance to embody the thought that they are different from their peers - and this requires devices that are both simple and discreet.”
Any comment would be welcome on the above from both manufacturers and HCP’s, this is very much the new frontier in diabetes and the more discussion and exchange we have the better.

Who is being left behind by the march of technology?

The ever onward march of technology is discriminating against large numbers of the global population as we discovered from questions we posed of healthcare professionals visiting our stand at EASD in Berlin last October.


When it comes to diabetes, a disease that predominantly affects people with low incomes and other disadvantages, the ability to self manage their disease could be a major factor in slowing down the epidemic.

According to latest figures from the IDF: “It is now recognized that it is the low- and middle-income countries that presently face the greatest burden of diabetes, where there is substantial evidence that diabetes is epidemic”

The problem is that manufacturers are in constant competition to develop ever more sophisticated devices, and often little thought is given to the presentation of educational materials for patients.
Kylene Ross, CMR’s US Development Manager, believes that manufacturers need to pay more attention to cultural nuances as well as issues of literacy and poverty that exist in many areas where diabetes is now taking hold.

“We asked a basic question of healthcare professionals every day during the conference: Who is not being considered (in technological development)?

“There was a range of answers: from illiteracy, lack of accessibility in more remote areas, to the physically disadvantaged, the aging population and people on low incomes not being considered.

“Because diabetes is such a far reaching disease it’s incredibly important for patients to be able to understand the nature and processes involved in their treatments and to have access and support regardless of their ability to use technology.

“From talking to HCPs from many different nations at EASD it’s also clear to us that there’s a big disparity in the availability of diabetes devices across the world, which reinforces just how different populations have such differing experiences of treatment,” added Kylene.

Now, more than ever, the way the industry communicates to people with diabetes must become more inclusive. Diabetes is now becoming a major issue in populations and cultures which were previously unaffected.

Again, from the IDF: “Within ethnic groups, high rates of type 2 diabetes are usually found in migrant or urbanized populations that may have experienced a greater degree of lifestyle change. The lowest rates are generally found in rural communities where people have lifestyles incorporating high levels of physical activity.”

It is time we in the West, take responsibility for having given our western lifestyle changes to the less developed nations, and do our part in helping to widen the access to treatment and devices by giving proper thought to their needs.