This study from Jothydev’s Diabetes Research Center was an oral presentation by Dr.Jothydev Kesavadev  at the IDF World Diabetes Congress, Dubai. The study looks into the reasons of failure of our tele-medicine based multidisciplinary approach Diabetes Tele Management System(DTMS®) in a minority of patients, which has otherwise proven to be cost effective in treatment of diabetes. The study gains a social perspective in the context that the reasons quoted for failure can be projected to a wider canvas of general population where diabetes treatment miserably fails in majority.

DTMS® involves multi-disciplinary team, softwares, 4-5 point sugars reported via telephone/email & modifications in dosages, diet and exercise carried out frequently.We have previously reported DTMS effective in >86% patients in achieving HbA1c ≤6.5%. Despite this, some are lost to follow up or show poor compliance.

A cross-sectional survey was conducted among poorly compliant patients to assess satisfaction with and perceived success rates of DTMS, and reasons for lack of follow up. Questionnaires were administered to such patients, based on convenience sampling. It assessed satisfaction with DTMS, effectiveness in controlling glucose & other metabolic parameters, reactions to high blood sugars & reasons for lack of regular follow-up. Difference in scores between males and females were assessed using chi-square test for proportions and t-test for differences in means.

A majority of patients  expressed overall satisfaction with DTMS (92%) and thought it effective in reducing blood sugars(88%). Assessment of reactions to high sugars on SMBG showed only infrequent prevalence of fear, guilt, anger, frustration, upset, or fear of being blamed for diet in response to high SMBG. There were no significant differences (p>0.05) except females showing more test score for being upset than males (p=0.01). The major reason for DTMS non compliance reported was being busy by males followed by cost of strips, while females attributed cost of strips followed by difficulty in checking 4 SMBG values.

Hectic life-styles and cost of strips appear most significant barriers, despite the belief in DTMS of its cost-effectiveness & in averting long-term complications of T2DM. Though the non-compliant group is a minority, counseling patients and their caretakers may further help reach targets of metabolic control.