Patients with diabetes perceive remote digital monitoring modalities intrusive if these modalities include food monitoring, real-time human feedback by their physician or another healthcare professional, and private-sector data handling, according to a French study published in Mayo Clinic Proceedings.

“The digital revolution has been considered a step toward reducing the treatment burden for patients with diabetes. Our findings imply that remote digital monitoring not simply add or subtract burdens but rather transforms them. As health care enters the private sphere, social aspects of the burdens that have been identified in the literature may become more pronounced,” wrote authors who were led by Theodora Oikonomidi, MSc, of Hôpital Hôtel-Dieu in Paris.

The findings of this study were based on an online vignette-based survey administered to 1,010 adults with type 1 diabetes (n=524) or 2 diabetes (n=411) or subtypes of diabetes (n=75). A total of 3 randomly selected vignettes that were assessed included hypothetical scenarios which combined different diabetes monitoring components and modalities.


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The monitoring tools remote digital monitoring component included glucose and physical activity monitoring only, a combination of glucose, physical activity, and occasional food monitoring, as well as glucose, physical activity, and regular food monitoring. A duration/feedback look component included 6 modalities, ranging from monitoring for a week prior a specific consultation with feedback in consultation to real-time and artificial intelligence-generated treatment and lifestyle feedback. Another vignette assessing data handling included 2 modalities, including public- and private-sector data handling.

Participants provided a total of 2,860 vignette-assessments. Based on the survey responses, the diabetes monitoring modalities most perceived as featuring increased intrusiveness included food monitoring compared with glucose- and physical activity monitoring alone (95% CI, 0.26-0.42; P <.001) and permanent monitoring with real-time physician-generated feedback as compared to monitoring for a week with consultation feedback (95% CI, 0.16-0.34; P <.001).

In terms of data handling, public-sector data handling was significantly associated with decreased intrusiveness compared with private-sector data handling (95% CI, -0.22 to -0.09; P <.001). Qualitative analysis identified 4 drivers of intrusiveness: practical/psychosocial burden caused by visibility of remote digital monitoring tools and monitoring behaviors, perceived lack of control (n=440), data safety/misuse (n=206), and dehumanization of care (n=34).

The investigators noted that a limitation of their study was that the included sample may not be generalizable across the overall population with diabetes.

The researchers concluded that “minimally disruptive remote digital monitoring design could help reduce intrusiveness, and shared decision-making could help patients identify the remote digital monitoring that best aligns with their lifestyle and values.”

Reference

Oikonomidi T, Ravaud P, James A, Cosson E, Montori V, Tran VT. An international, mixed-methods study of the perceived intrusiveness of remote digital diabetes monitoring. Published online January 19, 2021. Mayo Clin Proc. doi:10.1016/j.mayocp.2020.07.040