SA JOURNAL OF DIABETES & VASCULAR DISEASE
REVIEW
VOLUME 10 NUMBER 4 • NOVEMBER 2013
125
Patient Opinion is a relatively new website for any patients, that
allow users to share healthcare experiences in an open and free
environment.
59
Twitter is a popular free social networking/blogging tool. It
focuses on following a specific activity/person for information rather
than supporting equal contributions and community development,
but can be of use in knowledge sharing. Although best recognised
for its use by celebrities and their followers, many businesses and
field experts now also use twitter for marketing, networking and
information dissemination.
Simple SMS text messaging has been shown to be successful
in behaviour change/motivation in diabetes and other areas of
healthcare,
41,60
but the benefits of using blogging and networking
tools like Twitter and Facebook in diabetes care is yet unknown.
Barriers to eHealth
Whilst technology has the potential to transform, it also has
the potential to divide and care should be taken in the design
of systems so they do not disadvantage certain users such as
those with physical or visual impairment, literacy problems, non-
native language speakers or patients from low socio-economic
backgrounds.
61,62
In addition, any data sharing through technology
needs to be grounded in good information governance to protect
patients and minimise security risks. The Caldicott principles go
some way to defining basic information standards for all, but
organisations need to carefully consider the implications of any
new data sharing project.
63
Conclusions
Internet-based technology has huge potential to transform diabetes
care. Most diabetes patients have access to the internet and most
are computer literate. Technology can improve care, particularly
for those currently disadvantaged by current service delivery (see
Fig. 4, case study) including hard-to-reach populations such as the
geographically remote, young adolescents, busy professionals,
patients with physical disabilities, patients with social phobias and
those with a record of poor engagement with traditional clinics.
Patients, social enterprises and commercial companies, rather
than the healthcare professionals are the current drivers of the
digital revolution, realising opportunities through development of
apps, programs, gadgets and software to aid care management.
One of the biggest challenges is focusing and linking this plethora
of technology and online activity with mainstream healthcare so
that patient really benefits. Many technology tools and systems
currently operate in silos; for example patients use glucose monitors
and diabetes apps to manage their diabetes at home but this
information is never fully shared with their healthcare providers thus
missing an opportunity for inaction and intervention. Technology
that allows individuals to contribute information to their care record
between appointments, leading to a much more complete picture
of their current health, may go some way to achieving this.
Technology development in healthcare has been hampered
by concerns around security, and lack of expertise. Digital health
will however play an increasingly important role in diabetes care
over the coming decades, and mainstream health providers need
to find innovative ways to overcome these barriers and work with
commercial and non-governmental partners to achieve the best
care for their patients.
Conflict of interest
The authors have no conflicts of interest to declare
Funding
This research received no specific grant from any funding agency in
the public, commercial, or not-for-profit sectors.
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We recently reviewed a man in his late 20s, with type 1 diabetes for 15 years
on the high dependence unit. He was requiring regular intensive care input,
having being admitted with severe diabetic ketoacidosis, profound acidosis
and reduced conscious state (GCS 3 on admission). Thankfully he made a full
recovery over the coming days, but had he presented any later, his chance of
survival would have been slim.
The emergency services had broken down his door, following a phone call
from a social networking friend from the USA (who he had never met in
person). The caller had become worried when the patient hadn’t been mes-
saging online for a few days. The patient who admitted a degree of social
phobia, hadn’t attended diabetes clinics for 3 years and spent several hours
a day socialising online.
Figure 4.
Case study: This is an anonymised real case highlighting a population
group who do not engage with mainstream care, but who may benefit from a
technology based approach to care.
