122
VOLUME 10 NUMBER 4 • NOVEMBER 2013
REVIEW
SA JOURNAL OF DIABETES & VASCULAR DISEASE
‘Digital diabetes’– looking to the future
Deborah J Wake, Scott G Cunningham
Abstract
In theUK, 85%of adults use the internet, yet digital technology
and web-based applications have been slow to realise their
potential within healthcare. Diabetes, a chronic disease
requiring extensive self-management, could particularly
benefit from an e-health approach. While there are a number
of independent on-line diabetes communities, mobile apps,
websites and networking opportunities, these operate in
silos rather than integrating with mainstream healthcare.
This review will explore the political drivers and barriers to
e-health, and review current digital opportunities for patients
and healthcare professionals within diabetes care.
Keywords:
diabetes, digital, technology, social networks,
internet, care records, information governance
Introduction
In the UK today, many people spend more time communicating
through computers than through face-to-face contact; 67% of
adults use a computer every day. This trend is not exclusive to
the younger generation; 85% of all adults (and at least 80% of
households) in the UK have internet access, with further growing
trends in access through mobile devices.
1,2
Whilst low socioeconomic
status may associate with marginally lower technology access, still
92% of lowest earners (<£200/wk) use the internet. The internet
can be accessed almost anywhere in the world through a variety of
handheld devices, and computers. It has influenced the way people
learn, consume, buy, socialise and support one another.
One of the biggest rises in the last 5 years has been through social
networking sites such as Facebook, which has recently announced
reaching 1 billion users worldwide (equivalent to the third largest
country in the world!).
3
Twitter, a free networking and blogging tool,
has seen massive growth across the personal and corporate world.
Social networks are not just transforming our social lives, but have
been shown to support knowledge transformation, communication
and understanding, and can lever change, promote the uptake of
beneficial behaviours, and encourage ownership.
4–10
Despite its potential benefits,
5
the healthcare sector has been
slow to embrace the digital revolution, in comparison to industry,
Correspondence to: Dr Deborah Jane Wake
Medical Education Institute/Medical Research Institute, Level 5, University
of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK.
Email:
Scott G Cunningham
Clinical Technology Centre, University of Dundee, Ninewells Hospital,
Dundee, UK
Originally in:
Br J Diabetes Vasc Dis
2013;
13
(1): 13–20
S Afr J Diabetes Vasc Dis
2013;
10
: 122–126
particularly banking and retail. Chronic diseases like diabetes could
potentially benefit from technology driven approaches to care.
Background
The recorded prevalence of diabetes in the UK is around 2.9 million
and rising,
11
andis expected to double over the next 15 years.
11-14
This will place considerable strain on the National Health Service
(NHS).
15
There is an urgent need to develop and test innovative
methods to address the gap between demand for and availability
of services.
A recent report in Diabetic Medicine
15
predicts NHS annual
spending on diabetes will increase from £9.8 to £16.9 billion
over the next 25 years (17% of the entire NHS budget). Taking
into account indirect wider society costs this rises to £23.7
billion currently (£39.8 billion by 2035). A large percentage goes
into treating complications. A focus on early management and
complication prevention could therefore have a huge economic
impact.
Political drivers
In 2008, the Technology in the NHS report outlined a vision to
transform care and interaction in the NHS through technology,
including web-based communication.
6
A subsequent review made
promotion of innovation a legal duty for health authorities. Engaging
Patients in their Health concluded that the use of technology is
“underdeveloped and poorly deployed” in the NHS.
16
The internet and electronic patient held records have the
potential to change the balance of power from healthcare providers
to healthcare users and reduce the burden of care by engaging
patients in managing their own health and illness.
16,17
NHS England
has pledged through ‘The Power of Information’ strategy to allow
all patients access to their GP records by 2015.
18
NHS Scotland’s “Delivering for Health”, promotes a focus on
care delivery which is quicker, more personal and closer to home,
in addition, to promoting wellness, and decreasing costly acute
care necessitated by illness events.
19
The Scottish Diabetes Action
Plan
20
and the Healthcare Quality Strategy (2010) emphasise the
importance of “putting people at the heart of the NHS”, with
high quality, evidence based and patient-focused care.
21
In reality,
healthcare provision is organised around healthcare staff availability
with little support between infrequent clinic appointments.
Significant and innovative changes to healthcare delivery are
required to improve diabetes care in the current climate.
16
Self-
management, education and empowerment are key to good
glycaemic control and “Interactive behaviour change technology”
and on-line tools could be a cost effective option for the
management of people with diabetes.
4,5,22
Diabetes digital healthcare systems (health
informatics)
Clinical Management Systems including unified electronic patient
records and clinical portals are becoming increasingly mainstream in
