As National Diabetes Awareness Month brings the condition to the fore, a new telemedicine program is helping physicians at North Shore Medical Center more closely manage their diabetic patient population—promoting better health and the prevention of complications.
With eVisits, which are supported by Partners Population Health, Neelima Singh, MD, an endocrinologist practicing out of offices in Lynn and Danvers, says she is better able to track patient adherence to medication and lifestyle recommendations than regular office visits would allow. “We used to say, ‘Here’s your medication, eat healthy, exercise and come back in three-four months,’” says Dr. Singh. “But inevitably patients would come back the same, if not in worse shape.” During the eVisits, which are currently also available to patients at Massachusetts General Hospital, patients respond to a predetermined set of questions about their sugar levels, lifestyle patterns, medication changes, insurance issues, visits to other doctors, hospitalizations or ER visits and any other warning symptoms within the Partners Patient Gateway portal. The responses are monitored by Dr. Singh and her colleagues, who flag issues such as rising sugars and adjust patient protocols before warning signs become emergent complications.
Dr. Singh points to several barriers that typically stand in the way of good health when diabetic patients attempt to manage the condition on their own, without provider intervention. Diets get sidetracked by holidays and special events, and medication orders become held up by insurance complexities, money issues, sometimes simple miscommunication. Over email, Dr. Singh is able to step in and help patients avoid falling through the cracks, without the time and transportation constraints involved with more regular in-person appointments.
“With eVisits, patients have greater accountability and I’m armed with the information I need to provide more hands-on care. It’s really been a game-changer.”Neeli Singh, MD, endocrinologist, North Shore Medical Center
Among gestational diabetes patients, who typically require very close management, the eVisit approach has had strong patient adherence and resulted in patient satisfaction, tight sugar monitoring, helpful in avoiding complications, with A1C—average blood glucose—levels following suit. “This happens just with the constant surveillance enabled by the remote monitoring,” Dr. Singh notes.
She points to Metformin being the first choice for the type 2 diabetes, along with newer drug classes such as GLP-1 analog injectables and SGLT-2 inhibitors as helping to enhance type 2 diabetes care by treating the disease with accompanying cardiac benefits, and without unwanted side effects, such as weight gain, typically carried by traditional diabetes drugs. In addition to the medications, Dr. Singh also recommends basic moderation as key to diabetes prevention and management. “Patients will say, ‘What about this keto diet, or a no-carb diet,’” she says. “And I tell them, you’re human. Paying attention to portions is much more likely to keep you healthy for the long haul. Make it a one-day holiday, not a one-week celebration! Good old diet and exercise is and always will be your friend.”