Skip to main content
Intended for healthcare professionals

Abstract

Background:

The coronavirus pandemic of 2019 (COVID-19) forced worldwide recognition and implementation of telehealth as a means of providing continuity of care by varied health care institutions. Diabetes is a global health threat with rates that continue to accelerate, thereby causing an increased need for clinicians to provide diabetes care and education to keep up with demand. Utilizing technology to provide education via phone/smartphone, video/audio, web, text message, mobile apps, or a combination of these methods can help improve patient access and clinical outcomes, cut costs, and close gaps in care.

Methods:

While numerous publications have summarized the various tools and technologies available for capturing remote clinical data and their relevance to diabetes care and self-management, this review focuses on self-educational telehealth tools available for diabetes self-management, their advantages and disadvantages, and factors that need to be considered prior to implementation. Recent relevant studies indexed by PubMed were included.

Results:

The widespread use and popularity of phones/smartphones, tablets, computers, and the Internet by patients of all age groups, cultures, socioeconomic and geographic areas allow for increased outreach, flexibility, and engagement with diabetes education, either in combination or as an adjunct to traditional in-person visits. Demonstrated benefits of using health technologies for diabetes self-management education include improved lifestyle habits, reduced hemoglobin A1C levels, decreased health care costs, and better medication adherence. Potential drawbacks include lack of regulation, need for staff training on methodologies used, the requirement for patients to be tech savvy, privacy concerns, lag time with technology updates/glitches, and the need for more long-term research data on efficacy.

Conclusions:

Telehealth technologies for diabetes self-education improve overall clinical outcomes and have come a long way. With increasing numbers of patients with diabetes, it is expected that more optimal and user-friendly methodologies will be developed to fully engage and help patients communicate with their physicians.

Get full access to this article

View all access and purchase options for this article.

References

1. Fortmann AL, Gallo LC, Garcia MI, et al. Dulce digital: an mHealth SMS-based intervention improves glycemic control in Hispanics with type 2 diabetes. Diabetes Care. 2017;40(10):1349-1355.
2. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html. Published 2020. Accessed April 6, 2022.
3. Bommer C, Sagalova V, Heesemann E, et al. Global economic burden of diabetes in adults: projections from 2015 to 2030. Diabetes Care. 2018;41(5):963-970.
4. Haas L, Maryniuk M, Beck J, et al. National standards for diabetes self-management education and support. Diabetes Care. 2012;35(11):2393-2401.
5. Ye Q, Patel R, Khan U, Boren SA, Kim MS. Evaluation of provider documentation patterns as a tool to deliver ongoing patient-centred diabetes education and support. Int J Clin Pract. 2020;74(3):e13451.
6. Carpenter R, DiChiacchio T, Barker K. Interventions for self-management of type 2 diabetes: an integrative review. Int J Nurs Sci. 2019;6(1):70-91.
7. Ramchandani N. Virtual Coaching to Enhance Diabetes Care. Diabetes Technol Ther. 2019;21(suppl 2):S248-S51.
8. Garcia JF, Fogel J, Reid M, Bisno DI, Raymond JK. Telehealth for young adults with diabetes: addressing social determinants of health. Diabetes Spectr. 2021;34(4):357-362.
9. Reid N, Bennett W, Coughlin J, Thrift J, Kachur S, Gudzune KA. Evaluating an insurer-based health coaching program: impact of program engagement on healthcare utilization and weight loss. Prev Med Rep. 2018;12:343-348.
10. Schmittdiel JA, Brown SD, Neugebauer R, et al. Health-plan and employer-based wellness programs to reduce diabetes risk: the Kaiser Permanente Northern California NEXT-D Study. Prev Chronic Dis. 2013;10:E15.
11. Vale MJ, Jelinek MV, Best JD, Santamaria JD. Coaching patients with coronary heart disease to achieve the target cholesterol: a method to bridge the gap between evidence-based medicine and the “real world”—randomized controlled trial. J Clin Epidemio Radjenovic D, Wallace FL. Computer-based l. 2002;55(3):245-252.
12. von Storch K, Graaf E, Wunderlich M, Rietz C, Polidori MC, Woopen C. Telemedicine-assisted self-management program for type 2 diabetes patients. Diabetes Technol Ther. 2019;21(9):514-521.
13. Telehealth and Telemedicine. The Use of Telehealth and Telemedicine in Public Health. https://www.cdc.gov/phlp/publications/topic/telehealth.html. Accessed April 6, 2022.
14. Chen RY, Huang LC, Su CT, et al. Effectiveness of short-term health coaching on diabetes control and self-management efficacy: a quasi-experimental trial. Front Public Health. 2019;7:314.
15. Harter M, Dirmaier J, Dwinger S, et al. Effectiveness of telephone-based health coaching for patients with chronic conditions: a randomised controlled trial. Plos One. 2016;11(9):e0161269.
16. Dennis SM, Harris M, Lloyd J, Powell Davies G, Faruqi N, Zwar N. Do people with existing chronic conditions benefit from telephone coaching? a rapid review. Aust Health Rev. 2013;37(3):381-388.
17. Oddone EZ, Gierisch JM, Sanders LL, et al. A coaching by telephone intervention on engaging patients to address modifiable cardiovascular risk factors: a randomized controlled trial. J Gen Intern Med. 2018;33(9):1487-1494.
18. Wilson MG, DeJoy DM, Vandenberg RJ, Corso P, Padilla H, Zuercher H. Effect of intensity and program delivery on the translation of diabetes prevention program to worksites: a randomized controlled trial of fuel your life. J Occup Environ Med. 2016;58(11):1113-1120.
19. Rutledge T, Skoyen JA, Wiese JA, Ober KM, Woods GN. A comparison of MOVE! versus TeleMOVE programs for weight loss in Veterans with obesity. Obes Res Clin Pract. 2017;11(3):344-351.
20. Radcliff TA, Bobroff LB, Lutes LD, et al. comparing costs of telephone vs face-to-face extended-care programs for the management of obesity in rural settings. J Acad Nutr Diet. 2012;112(9):1363-1373.
21. Terry PE, Seaverson EL, Grossmeier J, Anderson DR. Effectiveness of a worksite telephone-based weight management program. Am J Health Promot. 2011;25(3):186-189.
22. Rasu RS, Hunter CM, Peterson AL, Maruska HM, Foreyt JP. Economic evaluation of an Internet-based weight management program. Am J Manag Care. 2010;16(4):e98-e104.
23. Willis EA, Szabo-Reed AN, Ptomey LT, et al. Distance learning strategies for weight management utilizing online social networks versus group phone conference call. Obes Sci Pract. 2017;3(2):134-142.
24. Gimenez-Perez G, Robert-Vila N, Tome-Guerreiro M, Castells I, Mauricio D. Are YouTube videos useful for patient self-education in type 2 diabetes? Health Informatics J. 2020;26(1):45-55.
25. Alley S, Jennings C, Plotnikoff RC, Vandelanotte C. My activity coach—using video-coaching to assist a web-based computer-tailored physical activity intervention: a randomised controlled trial protocol. BMC Public Health. 2014;14:738.
26. Ohnigian S, Richards JB, Monette DL, Roberts DH. Optimizing remote learning: leveraging zoom to develop and implement successful education sessions. J Med Educ Curric Dev. 2021;8.
27. Brei BK, Neches S, Gray MM, et al. Telehealth training during the COVID-19 pandemic: a feasibility study of large group multiplatform telesimulation training. Telemed J E Health. 2021;27(10):1166-1173.
28. Williams CM, Chaturvedi R, Chakravarthy K. Cybersecurity risks in a pandemic. J Med Internet Res. 2020;22(9):e23692.
29. He Y, Aliyu A, Evans M, Luo C. Health care cybersecurity challenges and solutions under the climate of COVID-19: scoping review. J Med Internet Res. 2021;23(4):e29877.
30. Johnson KE, Alencar MK, Coakley KE, et al. Telemedicine-based health coaching is effective for inducing weight loss and improving metabolic markers. Telemed J E Health. 2019;25(2):85-92.
31. Talley MH, Ogle N, Wingo N, Roche C, Willig J. Kaizen: interactive gaming for diabetes patient education. Games Health J. 2019;)8(6):423-431.
32. Gupta U, Gupta Y, Jose D, et al. Effectiveness of a video-based lifestyle education program compared to usual care in improving HbA1c and other metabolic parameters in individuals with type 2 diabetes: an open-label parallel arm Randomized Control Trial (RCT). Diabetes Ther. 2020;11(3):667-679.
33. Hansen CR, Perrild H, Koefoed BG, Zander M. Video consultations as add-on to standard care among patients with type 2 diabetes not responding to standard regimens: a randomized controlled trial. Eur J Endocrinol. 2017;176(6):727-736.
34. McLendon SF. Interactive video telehealth models to improve access to diabetes specialty care and education in the rural setting: a systematic review. Diabetes Spectr. 2017;30(2):124-136.
35. Maltinsky W, Hall S, Grant L, Simpson K, MacRury S. Pilot project and evaluation of delivering diabetes work-based education using video conferencing. Rural Remote Health. 2013;13(1):2053.
36. Radjenovic D, Wallace FL. Computer-based remote diabetes education for school personnel. Diabetes Technol Ther. 2001;3(4):601-607.
37. Levin K, Madsen JR, Petersen I, Wanscher CE, Hangaard J. Telemedicine diabetes consultations are cost-effective, and effects on essential diabetes treatment parameters are similar to conventional treatment: 7-year results from the Svendborg Telemedicine Diabetes Project. J Diabetes Sci Technol. 2013;7(3):587-595.
38. Lehmann ED, Tatti P. Using the AIDA—www.2aida.org—diabetes simulator. Part 2: recommended training requirements for health-carers planning to teach with the software. Diabetes Technol Ther. 2002;4(5):717-732.
39. Frielitz FS, Dordelmann J, Lemke S, et al. Assessing the benefits and challenges of video consultations for the treatment of children with type 1 diabetes—a qualitative study among diabetes professionals. Exp Clin Endocrinol Diabetes. 2021;129(11):831-836.
40. Gibson B, Simonsen S, Barton J, et al. Motivation and problem solving versus mobile 360 degrees videos to promote enrollment in the national diabetes prevention program’s lifestyle change program among people with prediabetes: protocol for a randomized trial. JMIR Res Protoc. 2021;10(6):e28884.
41. van Vugt M, de Wit M, Hendriks SH, Roelofsen Y, Bilo HJ, Snoek FJ. Web-based self-management with and without coaching for type 2 diabetes patients in primary care: design of a randomized controlled trial. BMC Endocr Disord. 2013;13:53.
42. Painter SL, Lu W, Schneider J, James R, Shah B. Drivers of weight loss in a CDC-recognized digital diabetes prevention program. BMJ Open Diabetes Res Care. 2020;8(1).
44. Smith MB, Albanese-O’Neill A, Yao Y, Wilkie DJ, Haller MJ, Keenan GM. Feasibility of the web-based Intervention Designed to Educate and Improve Adherence Through Learning to Use Continuous Glucose Monitor (IDEAL CGM) training and follow-up support intervention: randomized controlled pilot study. JMIR Diabetes. 2021;6(1):e15410.
45. Majithia AR, Kusiak CM, Armento Lee A, et al. Glycemic outcomes in adults with type 2 diabetes participating in a continuous glucose monitor-driven virtual diabetes clinic: prospective trial. J Med Internet Res. 2020;22(8):e21778.
46. Siegel KR, Ali MK, Zhou X, et al. Cost-effectiveness of interventions to manage diabetes: has the evidence changed since 2008? Diabetes Care. 2020;43(7):1557-1592.
47. Hansel B, Giral P, Gambotti L, et al. A fully automated web-based program improves lifestyle habits and HbA1c in patients with type 2 diabetes and abdominal obesity: randomized trial of patient e-coaching nutritional support (The ANODE Study). J Med Internet Res. 2017;19(11):e360.
48. Morrow RW, Fletcher J, Kelly KF, et al. Improving diabetes outcomes using a web-based registry and interactive education: a multisite collaborative approach. J Contin Educ Health Prof. 2013;33(2):136-144.
49. McMahon GT, Fonda SJ, Gomes HE, Alexis G, Conlin PR. A randomized comparison of online- and telephone-based care management with internet training alone in adult patients with poorly controlled type 2 diabetes. Diabetes Technol Ther. 2012;14(11):1060-1067.
50. Gal RL, Cohen NJ, Kruger D, et al. Diabetes telehealth solutions: improving self-management through remote initiation of continuous glucose monitoring. J Endocr Soc. 2020;4(9):bvaa076.
51. Greenwood DA, Gee PM, Fatkin KJ, Peeples M. A systematic review of reviews evaluating technology-enabled diabetes self-management education and support. J Diabetes Sci Technol. 2017;11(5):1015-1027.
52. Heinemann L, Klonoff DC. An opportunity to increase the benefit of CGM Usage: the need to train the patients adequately. J Diabetes Sci Technol. 2020;14(6):983-986.
53. Shah VN, Garg SK. Managing diabetes in the digital age. Clin Diabetes Endocrinol. 2015;1:16.
54. Myers A, Presswala L, Bissoonauth A, et al. Telemedicine for disparity patients with diabetes: the feasibility of utilizing telehealth in the management of uncontrolled type 2 diabetes in Black and Hispanic disparity patients; a pilot study. J Diabetes Sci Technol. 2021;15(5):1034-1041.
55. Smartphones in the U.S.—Statistics & Facts. https://www.statista.com/topics/2711/us-smartphone-market/#dossierKeyfigures. Accessed April 6, 2022.
57. Fischer HH, Fischer IP, Pereira RI, et al. Text message support for weight loss in patients with prediabetes: a randomized clinical trial. Diabetes Care. 2016;39(8):1364-1370.
58. Huo X, Krumholz HM, Bai X, et al. Effects of mobile text messaging on glycemic control in patients with coronary heart disease and diabetes mellitus: a randomized clinical trial. Circ Cardiovasc Qual Outcomes. 2019;12(9):e005805.
59. Arora S, Peters AL, Burner E, Lam CN, Menchine M. Trial to examine text message-based mHealth in emergency department patients with diabetes (TExT-MED): a randomized controlled trial. Ann Emerg Med. 2014;63(6):745-754.e6.
60. Zhuang R, Xiang Y, Han T, Yang GA, Zhang Y. Cell phone-based health education messaging improves health literacy. Afr Health Sci. 2016;16(1):311-318.
61. Newton KH, Wiltshire EJ, Elley CR. Pedometers and text messaging to increase physical activity: randomized controlled trial of adolescents with type 1 diabetes. Diabetes Care. 2009;32(5):813-815.
62. Tamban C, Isip -Tan IT, Jimeno C. Use of Short Message Services (SMS) for the management of type 2 diabetes mellitus: a randomized controlled trial. J ASEAN Fed Endocr Soc. 2014;)28(2):143.
63. Watterson JL, Rodriguez HP, Shortell SM, Aguilera A. Improved diabetes care management through a text-message intervention for low-income patients: mixed-methods pilot study. JMIR Diabetes. 2018;3(4):e15.
64. Abroms LC, Whittaker R, Free C, Mendel Van Alstyne J, Schindler- Ruwisch JM. Developing and pretesting a text messaging program for health behavior change: recommended steps. JMIR Mhealth Uhealth. 2015;3(4):e107.
65. Capozza K, Woolsey S, Georgsson M, et al. Going mobile with diabetes support: a randomized study of a text message-based personalized behavioral intervention for type 2 diabetes self-care. Diabetes Spectr. 2015;28(2):83-91.
66. Nelson LA, Greevy RA, Spieker A, et al. Effects of a tailored text messaging intervention among diverse adults with type 2 diabetes: evidence from the 15-month REACH randomized controlled trial. Diabetes Care. 2021;44(1):26-34.
67. Buis LR, Hirzel L, Turske SA, Des Jardins TR, Yarandi H, Bondurant P. Use of a text message program to raise type 2 diabetes risk awareness and promote health behavior change (part I): assessment of participant reach and adoption. J Med Internet Res. 2013;15(12):e281.
68. Douglas N, Free C. “Someone batting in my corner”: experiences of smoking-cessation support via text message. Br J Gen Pract. 2013;63(616):e768.
69. Byambasuren O, Beller E, Glasziou P. Current knowledge and adoption of mobile health apps among Australian general practitioners: survey study. JMIR Mhealth Uhealth. 2019;7(6):e13199.
70. Doyle-Delgado K, Chamberlain JJ. Use of diabetes-related applications and digital health tools by people with diabetes and their health care providers. Clin Diabetes. 2020;38(5):449-461.
71. El-Gayar O, Timsina P, Nawar N, Eid W. Mobile applications for diabetes self-management: status and potential. J Diabetes Sci Technol. 2013;7(1):247-262.
72. Aoki N, Ohta S, Okada T, Oishi M, Fukui T. INSULOT: a cellular phone-based edutainment learning tool for children with type 1 diabetes. Diabetes Care. 2005;28(3):760.
73. Quinn CC, Shardell MD, Terrin ML, Barr EA, Ballew SH, Gruber-Baldini AL. Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control. Diabetes Care. 2011;34(9):1934-1942.
74. Pradal-Cano L, Lozano-Ruiz C, Pereyra-Rodriguez JJ, et al. Using mobile applications to increase physical activity: a systematic review. Int J Environ Res Public Health. 2020;17(21).
75. Bingham JM, Black M, Anderson EJ, et al. Impact of telehealth interventions on medication adherence for patients with type 2 diabetes, hypertension, and/or dyslipidemia: a systematic review. Ann Pharmacother. 2021;55(5):637-649.
76. Zhai Y, Yu W. A Mobile app for diabetes management: impact on self-efficacy among patients with type 2 diabetes at a community hospital. Med Sci Monit. 2020;26:e926719.
77. Kim EK, Kwak SH, Baek S, et al. Feasibility of a patient-centered, smartphone-based, diabetes care system: a pilot study. Diabetes Metab J. 2016;40(3):192-201.
78. Arsand E, Tatara N, Ostengen G, Hartvigsen G. Mobile phone-based self-management tools for type 2 diabetes: the few touch application. J Diabetes Sci Technol. 2010;4(2):328-336.
79. Hamine S, Gerth-Guyette E, Faulx D, Green BB, Ginsburg AS. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review. J Med Internet Res. 2015;17(2):e52.
80. Fleming GA, Petrie JR, Bergenstal RM, Holl RW, Peters AL, Heinemann L. Diabetes digital app technology: benefits, challenges, and recommendations. A consensus report by the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) diabetes technology working group. Diabetes Care. 2020;43(1):250-260.
81. Kim MS, Khan U, Boren SA, Narindrarangkura P, Ye Q, Simoes EJ. Transforming AADE7 for use in an evaluation framework for health information technology in diabetes mellitus. J Diabetes Sci Technol. 2021.
82. Ciemins E, Coon P, Sorli C. An analysis of data management tools for diabetes self-management: can smart phone technology keep up? J Diabetes Sci Technol. 2010;4(4):958-960.
83. Drincic A, Prahalad P, Greenwood D, Klonoff DC. Evidence-based mobile medical applications in diabetes. Endocrinol Metab Clin North Am. 2016;45(4):943-965.
84. Eberle C, Lohnert M, Stichling S. Effectiveness of disease-specific mHealth apps in patients with diabetes mellitus: scoping review. JMIR Mhealth Uhealth. 2021;9(2):e23477.
85. Ye Q, Khan U, Boren SA, Simoes EJ, Kim MS. An analysis of diabetes mobile applications features compared to AADE7: addressing self-management behaviors in people with diabetes. J Diabetes Sci Technol. 2018;12(4):808-816.
86. Contreras I, Vehi J. Artificial intelligence for diabetes management and decision support: literature review. J Med Internet Res. 2018;20(5):e10775.
87. Ellahham S. Artificial intelligence: the future for diabetes care. Am J Med. 2020;133(8):895-900.
88. Li J, Huang J, Zheng L, Li X. Application of artificial intelligence in diabetes education and management: present status and promising prospect. Front Public Health. 2020;8:173.
89. Block G, Azar KM, Romanelli RJ, et al. Diabetes prevention and weight loss with a fully automated behavioral intervention by email, web, and mobile phone: a randomized controlled trial among persons with prediabetes. J Med Internet Res. 2015;17(10):e240.
90. Jakicic JM, Davis KK, Rogers RJ, et al. Effect of wearable technology combined with a lifestyle intervention on long-term weight loss: the IDEA randomized clinical trial. JAMA. 2016;316(11):1161-1171.
91. Nundy S, Dick JJ, Chou CH, Nocon RS, Chin MH, Peek ME. Mobile phone diabetes project led to improved glycemic control and net savings for Chicago plan participants. Health Aff (Millwood). 2014;33(2):265-272.
92. Smith AC, Thomas E, Snoswell CL, et al. Telehealth for global emergencies: implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare. 2020;26(5):309-313.

Cite article

Cite article

Cite article

OR

Download to reference manager

If you have citation software installed, you can download article citation data to the citation manager of your choice

Share options

Share

Share this article

Share with email
EMAIL ARTICLE LINK
Share on social media

Share access to this article

Sharing links are not relevant where the article is open access and not available if you do not have a subscription.

For more information view the Sage Journals article sharing page.

Information, rights and permissions

Information

Published In

Article first published online: April 29, 2022
Issue published: January 2024

Keywords

  1. diabetes
  2. education
  3. telehealth
  4. self-management
  5. coaching

Rights and permissions

© 2022 Diabetes Technology Society.
Request permissions for this article.
PubMed: 35485769

Authors

Affiliations

Vidya Sharma, MA, RD, LD, CDCES
Department of Nutrition & Dietetics, College for Health, Community and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
Marie Feldman, RD, CDCES, CHC
Independent Scholar, Ladera Ranch, CA, USA
Ramaswamy Sharma, MS, PhD
Department of Cell Systems and Anatomy, Joe R. & Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA

Notes

Ramaswamy Sharma, MS, PhD, Associate Professor, Department of Cell Systems and Anatomy, Joe R. & Teresa Lozano Long School of Medicine, UT Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA. Email: [email protected]

Author Contributions

R.S. and V.S. conceptualized the idea for this article; V.S. and M.F. wrote the article; R.S. reviewed and edited the article.

Metrics and citations

Metrics

Journals metrics

This article was published in Journal of Diabetes Science and Technology.

VIEW ALL JOURNAL METRICS

Article usage*

Total views and downloads: 2192

*Article usage tracking started in December 2016


Altmetric

See the impact this article is making through the number of times it’s been read, and the Altmetric Score.
Learn more about the Altmetric Scores



Articles citing this one

Receive email alerts when this article is cited

Web of Science: 0

Crossref: 3

  1. Family Caregiver Comfort with Telehealth Technologies: Differences by ...
    Go to citation Crossref Google Scholar
  2. A Nurse-Led Telehealth Program for Diabetes Foot Care: Feasibility and...
    Go to citation Crossref Google Scholar
  3. Use of a Smartphone-Based Medication Adherence Platform to Improve Out...
    Go to citation Crossref Google Scholar

Figures and tables

Figures & Media

Tables

View Options

Get access

Access options

If you have access to journal content via a personal subscription, university, library, employer or society, select from the options below:


Alternatively, view purchase options below:

Purchase 24 hour online access to view and download content.

Access journal content via a DeepDyve subscription or find out more about this option.

View options

PDF/ePub

View PDF/ePub

Full Text

View Full Text