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Telemedicine

By David Mendosa

Last Update: April 1, 1999

Diabetes and telemedicine are a natural match. By using the Internet, health care professionals can reach out to people with diabetes who need their services.

Somebody's watching and giving feedback.

For one thing, it's a more efficient way to use a very scare resource—the time available to endocrinologists. The United States has about 3,500 board-certified clinical endocrinologists, according to the American Association of Clinical Endocrinologists. There's no way they can see even a small fraction of the 10.3 million Americans diagnosed with the disease.

Seeing your endocrinologist on-line is also efficient for the patient. It lets you avoid the trip to the doctor's office and those long delays in what are appropriately called waiting rooms.

Yet few endocrinologists practice telemedicine. In fact, I've discovered fewer than a dozen endocrinologists who even have Web pages that I can link on On-line Diabetes Resources, Part 4: Universities, Hospitals, M.D.'s, and Research Web Sites.

One of these, Dr. J. Joseph Prendergast, is also one of the first to extend his practice into telemedicine. The medical director of the Endocrine Metabolic Medical Center in Atherton, California, a suburb of San Francisco, Dr. Prendergast has already enrolled more that 700 participants in the center's telemedicine program.

For the past seven months as I gathered material for this column I've been one of those participants. I've never met Dr. Prendergast or traveled to his office, which is about 50 miles from my home in Santa Cruz, California. While I do have a local endocrinologist/internist, lately I have seen him only for non-diabetes related conditions.

When I got into the program, I wondered if it would help me to control my type 2 diabetes. The big difference turned out that I now do my fingerstick tests much more religiously. Why? Simply because I know somebody's watching and giving me feedback.

The feedback comes mostly from Certified Diabetes Educators on Dr. Prendergast's staff. Currently, it's e-mail and comments on a summary report for the previous 14 days. By July, however, they hope that each participant will have their test results on password-protected pages on the center's DiabetesOneonOne site.

The first tangible result of participating in the program was getting a blood glucose meter capable of transmitting test results to Dr. Prendergast's office. The beauty of the set-up is that it doesn't require the participants to use any software. I simply connect the meter to a little device that contains a modem and send my test results every couple of weeks.

They also persuaded me to get a hemoglobin A1c test more often than my local doctor had done. Another benefit of participating in the program is receiving a daily e-mail message, called E-News, about the latest diabetes developments.

"Most people with diabetes either want to know a lot or don't want to know anything," Michelle Perrot, a registered nurse and one of the center's Certified Diabetes Educators, says. "And e-mail empowers people, who are more likely to ask questions via that way than by calling or asking in person."

She tells me that if and when I do go into the office they will give me four or more different tests. In one, a retinal photograph, she says that I could see my own eye. "It's a great teaching tool," Perrot says. The others include a vascular test, one for neuropathy, and an EKG.

Almost everything that they do is run by the Certified Diabetes Educators, Dr. Prendergast says. "They are the ones who do most of the work communicating with the patients, like changing doses, in a protocol-driven type of thing."

Where are the participants in the program located? Most of them are in northern California, but they do have people as far away as the Philippines, the southern United States, Arizona and New Mexico, he says.

But wouldn't anyone practicing telemedicine have a problem practicing in states where he didn't have a license? "You can't do that," Dr. Prendergast replies. "It's illegal. So we have primary care physicians or specialists in those states, and we work directly with the patients and the physicians in informing them of what we are doing."

So is telemedicine the wave of the future? "I think so," Dr. Prendergast replies. "Diabetes is an information-rich disease, and when people have problems with it is usually just because of lack of knowledge. We have some other unique things in the way we approach the disease, but it's basically to apply the national standards to everybody and make sure that everybody gets their Hemoglobin A1c where it should be."

His goal is to have all his patients to do all their own testing at home or at work. "Ultimately we don't want to ever see anybody in the office," Dr. Prendergast says. If that's the future, then I'm ready to forgo those waiting room waits. 


The American Diabetes Association originally published this article on its Web site as one of my “About the Internet” columns.


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