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- Title
Evaluation of Patient Willingness to Adopt Remote Digital Monitoring for Diabetes Management.
- Authors
Oikonomidi, Theodora; Ravaud, Philippe; Cosson, Emmanuel; Montori, Victor; Tran, Viet Thi
- Abstract
Key Points: Question: What is the minimum effectiveness at which patients would adopt different remote digital monitoring (RDM) modalities for managing diabetes? Findings: In this survey study of 1010 adults with diabetes from 30 countries, 65% reported that they would adopt RDM even if it offered no or modest health improvements compared with their current monitoring. Participants reported that they required RDM to be more effective when they perceived it as intrusive to their lives and when it included food monitoring or real-time feedback by a health care professional. Meaning: These findings suggest that physicians should help patients select RDM modalities that align with their preferences and are unobtrusive to their lifestyle to ensure RDM adoption. This survey study identifies the minimum effectiveness patients with type 1 and type 2 diabetes report they require to adopt 36 different remote digital diabetes monitoring scenarios. Importance: Patients will decide whether to adopt remote digital monitoring (RDM) for diabetes by weighing its health benefits against the inconvenience it may cause. Objective: To identify the minimum effectiveness patients report they require to adopt 36 different RDM scenarios. Design, Setting, and Participants: This survey study was conducted among adults with type 1 or type 2 diabetes living in 30 countries from February to July 2019. Exposures: Survey participants assessed 3 randomly selected scenarios from a total of 36. Scenarios described different combinations of digital monitoring tools (glucose, physical activity, food monitoring), duration and feedback loops (feedback in consultation vs real-time telefeedback by a health care professional or by artificial intelligence), and data handling modalities (by a public vs private company), reflecting different degrees of RDM intrusiveness in patients' personal lives. Main Outcomes and Measures: Participants assessed the minimum effectiveness for 2 diabetes-related outcomes (reducing hypoglycemic episodes and preventing ophthalmologic complications) for which they would adopt each RDM (from much less effective to much more effective than their current monitoring). Results: Of 1577 individuals who consented to participate, 1010 (64%; 572 [57%] women, median [interquartile range] age, 51 [37-63] years, 524 [52%] with type 1 diabetes) assessed at least 1 vignette. Overall, 2860 vignette assessments were collected. In 1025 vignette assessments (36%), participants would adopt RDM only if it was much more effective at reducing hypoglycemic episodes compared with their current monitoring; in 1835 assessments (65%), participants would adopt RDM if was just as or somewhat more effective. 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 RDM scenarios (94%) were simultaneously required to be just as or less effective by at least 25% of participants and much more effective by at least 25% of participants. Results were similar for participant assessments of scenarios regarding the prevention of ophthalmologic complications. Conclusions and Relevance: The findings of this study suggest that patients require greater health benefits to adopt more intrusive RDM modalities, food monitoring, and real-time feedback by a health care professional. Patient monitoring devices should be designed to be minimally intrusive. The variability in patients' requirements points to a need for shared decision-making.
- Subjects
ADAPTABILITY (Personality); BLOOD sugar; DIABETES; EYE diseases; HYPOGLYCEMIA; CASE studies; MEDICAL consultation; PATIENT monitoring; REGRESSION analysis; SURVEYS; TELEMEDICINE; PHYSICAL activity; DATA analysis software; PATIENTS' attitudes; DESCRIPTIVE statistics
- Publication
JAMA Network Open, 2021, Vol 4, Issue 1, pe2033115
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2020.33115