Main characteristics of type 1 and type 2 diabetes patients interested in the use of a telemonitoring platform

Diabetes is one of the most challenging health problems of the 21st century. Using a telemonitoring platform could be beneficiary for persons with this condition. Such a platform could enhance the electronic communication between different actors in a private and secure way. Patients could receive timely (personalised) feedback; less transcription errors could occur and a higher reliability of direct transfer of blood glucose data into the system could be the result. Until now, it has however never been investigated whether those persons are actually interested in using such a platform. The aim of this study was therefore to investigate whether diabetes patients are interested in using a telemonitoring platform and if so, whether characteristics of interested users could be distinguished. Because no questionnaire existed to assess this interest, a Telemonitoring Health Effect and Readiness Questionnaire (THERQ) was developed and validated (Chapter 3). The preliminary findings suggest it is a valid, reliable, brief and easy to administer scale. In 2008, quite some patients were interested in the use of some services offered via a telemonitoring platform. In 2011, there was even a growing interest. Currently, patients recruited via a Community Health Centre (study 2011) do not use any electronic form (e.g. email) to communicate with their healthcare professional. However, also in this group of patients, about 40 percent of the patients was interested in using it. While the interest in 2008 especially was for using such a platform for communication from the home environment with their healthcare professional, in 2011 there was quite some interest in using such a platform during holidays. Even though these results cannot be compared with other studies, they seem promising. Another important question in this study was to look for characteristics of interested users of a telemonitoring platform. Because some telemonitoring studies already showed a link with empowerment, one of the aims of this study was to look for a link between empowerment and interest in the use of a telemonitoring platform. No Dutch version of the Diabetes Empowerment Scale (DES) existed, so the DES was translated into Dutch and the psychometric properties determined (Dutch-DES-20) (Chapter 4). The preliminary results suggest the Dutch-DES-20 is a valid and reliable instrument. To determine criterion validity, it was hypothesised that patients with high empowerment scores would have better metabolic control, thus lower HbA1c-levels. This study showed that patients with an insulin treatment and a better metabolic control were indeed more empowered. Also, patients being able to cope well and with good motivation (subscale 2) were more empowered, irrespective of the group. It was further hypothesised that patients with high empowerment scores also would have high scores on the Dutch-DES sub-questions. Indeed, patients on multiple daily insulin injections with high empowerment scores have a high self-rated understanding of diabetes and its treatment, feel themselves able to fit diabetes into their life in a positive manner and feel themselves capable to ask questions to their diabetes professional. Even though it was expected that diabetes would not prevent empowered diabetes patients from doing their normal daily activity, no significant correlations could be found. The interviews learned it was a quite difficult question to answer. Patients mentioned that it was not obvious to reflect on a life without diabetes while having it already for quite some time. In our sample, more than two thirds was already diagnosed for more than ten years. In Chapter 5, characteristics of interested users were described. The study in 2008 was performed in a hospital setting, while in the study performed in 2011, patients were recruited via a Community Health Centre (primary care setting), via the Flemish Diabetes Centre and via an online questionnaire. The most important results were found for patients with only insulin treatment and those with a combined treatment; interesting groups also from a clinical point of view. For those patients it was found, as expected, that younger patients, patients using a computer or searching on the Internet (making use of a forum or searching for diabetes-related information), and those already keeping data on computer are more interested in using a telemonitoring platform. In 2011, the use of a smartphone and the use of social media seemed to be very important characteristics as well. It was further found that patients with only an insulin treatment without adequate metabolic control seem to be more prone to use the telemonitoring platform. From a clinical point of view, having an adequate metabolic control is important, i.e. to diminish the risk to develop chronic complications. The present results suggest a link between eagerness to use a platform and those in need for a better control. For patients with a combined treatment regimen, a link was found with empowerment; i.e. those with lower empowerment scores seem to be more prone to use a telemonitoring platform. Even though further research is required, it could be hypothesised that this group of patients is entering a new stage in their disease and thus need to adapt their lifestyle to this new situation. CONCLUSION : The preliminary results of this study show that the Dutch Diabetes Empowerment Scale (Dutch-DES-20) as well as the Telemonitoring Health Effect and Readiness Questionnaire (THERQ) are valid and reliable instruments. The results further show that there is substantial growing interest in using a telemonitoring platform. For type 1 and type 2 diabetes patients with only insulin treatment it could be used to improve their metabolic control; for type 2 diabetes patients with a combined treatment regimen to improve empowerment. The selection of patients could be based on present Internet use, use of social media and on the fact they already log diabetes data