Study Weighs Perceived Benefits, Costs of RDM Adoption for Diabetes Management

In an effort to understand patients’ willingness to adopt remote digital monitoring (RDM) for diabetes, adults with type 1 (T1D) or type 2 diabetes (T2D) living in 30 countries completed a survey weighing its health benefits against the potential inconvenience.

Results, published in JAMA Network Open, indicate patients with diabetes require greater health benefits to adopt more intrusive RDM modalities, food monitoring, and real-time feedback by a health care professional, researchers wrote.

“RDM consists of using prescribed sensors to capture patients’ physiological and behavioral data, which can then be transmitted to their physician to complement in-person consultations or be used to offer real-time feedback provided by artificial intelligence (AI) or a clinician.”

The technology is currently used in some clinical settings, but previous research found RDM’s costs, like disruptive eating alerts and social stigma, are intrusive to some patients’ private lives, which may lead to nonadherence. Some patients, however, do prefer RDM for the superior health benefits it can offer compared with the traditional care model.

The researchers designed a vignette-based survey consisting of hypothetical scenarios that described potential applications of RDM. Participants assessed the scenarios based on key components (vignette factors) that are varied to take 1 of several prespecified options (factor levels), the authors explained.

Between February and July 2019, English- and French-speaking participants with T1D or T2D were recruited from multiple channels to complete the survey. Different levels were developed for monitoring tools, duration and feedback loop, and data handling; they were combined to develop 36 unique vignette scenarios.

As part of the survey, “each participant assessed 3 randomly selected vignettes by responding to 2 questions, indicating the minimum health benefit they would require to adopt the RDM as their usual care.”

A total of 1010 individuals assessed at least 1 vignette, the majority (57%) of whom were female. Nearly 3000 vignette assessments were completed in the study window, with a median of 78 assessments per vignette. Among the participants, 524 had T1D, 723 used insulin, and 687 considered their diabetes controlled.

Data showed:

• In 1025 (36%) vignette assessments, participants would adopt RDM only if it was much more effective at reducing hypoglycemic episodes compared with their current monitoring
• In 1835 (65%) assessments, participants would adopt RDM if was just as or somewhat more effective than their current monitoring in reducing hypoglycemic episodes
• The main factors associated with required effectiveness were food monitoring (β = 0.32; SE, 0.12; P = .009), real-time telefeedback by a health care professional (β = 0.49; SE, 0.15; P = .001), and perceived intrusiveness (β = 0.36; SE, 0.06; P < .001)
• Minimum required effectiveness varied among participants; 34 of 36 (96%) RDM scenarios were simultaneously required to be just as/less effective or much more effective by at least 25% of participants each

Despite patients’ concerns over the intrusiveness of RDM, the researchers noted technological developments could mitigate the effects of these features and reduce the magnitude of health benefits patients expect to adopt RDM.

“Our results show that acceptability of RDM is contingent on how it affects health outcomes that are important to patients and how patients perceive its psychological costs,” the authors wrote. “Therefore, physicians should first discuss the expected efficacy of RDM with patients and codefine treatment goals.”

Because the current study only assessed RDM adoption, future studies should examine the association of different RDM modalities, their intrusiveness, and their perceived effectiveness over longer periods of sustained use. Real-world experimental studies are also needed to test actual adoption of RMD, not just perceptions of the technology.

In addition, because many participants were familiar with the use of digital health tools, acceptability rates in the overall population of individuals with diabetes may be lower than study participants, marking a limitation.

Reference

Oikonomidi T, Ravaud P, Cosson E, Montori V, Tran VT. Evaluation of patient willingness to adopt remote digital monitoring for diabetes management. JAMA Netw Open. doi:10.1001/jamanetworkopen.2020.33115