Diabetes and Depression: How Telemedicine is Successfully Treating Both
With commentary from Thomas Miller, PhD, ABPP, professor emeritus and senior research scientist at the University of Connecticut, Center for Health, Intervention, and Prevention.
Managing type 1 and type 2 diabetes demands a steadfast commitment to blood sugar monitoring, healthy eating, regular exercise and sometimes medication or insulin injections. The rigors of managing the condition can get overwhelming. So it may come as no surprise that people with diabetes are at least two times more likely to suffer from depression as non-diabetics, according to the Joslin Diabetes Center.
The link between diabetes and depression may be twofold, according to the National Institutes of Health. Low blood sugar can make you feel depressed and lethargic, but depression can also trigger low blood sugar due to a lack of proper self-care.
The Risks of Untreated Depression and Diabetes
When left untreated, clinical depression causes a whole host of symptoms, including chronic headaches, aches and pains, low energy, insomnia, fatigue, appetite changes, and in serious cases, suicidal thoughts. Depression also affects your behavior, which can impact your ability to think clearly and stay motivated about proper self-care.
Unfortunately when diabetes is not managed, people also face serious health problems such as kidney failure, blindness, skin infections (leading to amputation), heart failure and stroke.
“These [health problems] are often avoidable outcomes of a controllable illness, which are possibly made more complex because of depression,” says Thomas Miller, PhD, ABPP, professor emeritus and senior research scientist at the University of Connecticut, Center for Health, Intervention, and Prevention.
How Telemedicine Can Help Diabetes and Depression
Seeking in-person medical treatment for diabetes and depression is critical to successfully managing both diseases. As an added layer of support, telemedicine, also known as telehealth, is showing great promise in helping patients stay on top of their self-care, says Miller. Telemedicine involves the exchange of medical information from one site to another via electronic communications (such as two-way video with a healthcare provider, email, texting and apps like One Drop).
“In many respects, diabetes is particularly well-suited to the advantages of technology, says Miller. “The daily tasks of counting carbs and monitoring blood glucose levels can be eased through the use of a smartphone app. A nurse can observe a diabetic taking his medication and administering injections remotely through the use of a video telephone. This can increase the patient’s compliance and improve the management of the condition.”
Additionally, says Miller, if a patient knows that every time he tests his blood glucose levels they will be read by a health care practitioner, he may be more motivated to comply. “If you don’t have anyone to answer to, your compliance rates will be lower every time,” he says.
Just as encouraging, some early research suggests that telemedicine is also effective for helping people with diabetes suffering from depression.
“Spencer” (not his real name) who was diagnosed with type 2 diabetes 20 years ago became depressed over time. He stopped exercising and paying attention to his diet, and started gaining weight. Through a program offered by his insurance company (Aetna), and a New York-based health company called AbilTo (which specializes in providing at-home support to medical and behavioral health management), Spencer participated in an 8-week program conducted entirely by phone. Twice a week he received one-on-one support from a team consisting of a therapist charged with identifying his emotional challenges, and a behavior coach who helped him find ways to make and maintain necessary lifestyle changes. (Note: Spencer was also given the option of using a secure video link but opted to use the phone.)
Spencer admits he didn’t understand the importance of frequent (three or four times daily) blood glucose testing levels, but says the support was empowering and helped him stay focused on the important task. “I’m keeping a log and seeing positive results,” he said adding, that he’s lost 50 pounds in the five months following his participation in the program.
Getting Access to Telemedicine
Telemedicine is still in its infancy in the U.S., but as testament to its growth, an increasing number of insurance companies are including the option in employee benefit packages. Telemedicine is not a separate medical specialty, but rather its related services and products are usually distributed under the umbrella of a larger institution like a hospital, home health agencies or private physician office.
Similar to a visit to your practitioner, a conference call with your diabetes care team or a video session with a therapist, would be billed the same way as if you did in-person and require no more than a co-pay.
There are, however, companies that function independently of insurance companies. MDLive, for instance, is a telehealth company that claims to offer “24/7/365 on-demand access to affordable quality healthcare anytime, anywhere.” According to the MDLive.com, it’s best used for non-emergency medical issues when your doctor isn’t available, or it’s not convenient to leave your home or office. In this case, if your health insurance company is not a participant, there would be a fee for service payable at the time the services are used. In other cases, a particular service you need may not be offered in your state, or participating practitioners may not be licensed to practice medicine in the state you live in.
Before You Hop On the Virtual Couch
Consider these tips before telecommunicating with a therapist:
- Establish a good in-person relationship first. Miller has been relying on telecommunications as an adjunct to in-person therapy since 1993 to treat some of his patients with depression. He says talking with patients being treated for depression via a two-way video camera can be a helpful supplement to therapy, but should never be the primary source of treatment. He recommends first establishing a good relationship with a therapist in-person before introducing any type of technologically enabled communication.
- Make sure your privacy is protected. One of the big concerns with treating patients remotely is privacy. “I never use Skype because it’s not secure,” Miller explains. “I only use a firewall protected video telephone through a university based medical center. Telephones can be tapped so there’s no assurance of security with data and information. And a mobile phone is even less secure than a landline—it’s a computer.
- Be sure your practitioner has experience with therapy and technology. Determining a practitioner’s competency is another challenge of telemedicine. “Not every online therapist delivers a good standard of care, but the same can be said about therapists who use face-to-face therapy, too,” says Miller. Additionally, "a clinician who treats patients using technology also requires a working knowledge of the operation, management, and equipment. Miller recommends asking for referrals from your primary care physician.
Given the current emphasis on cost-saving and preventive medicine, he believes telehealth will continue to grow. “When technology meets healthcare in the best sense, the benefits can be tremendous. It can be cost saving, and provide convenience and answers when you need them, and offer extra human contact that can make a positive difference in your health."