Technology is evolving quickly. Its currents cut across all aspects of our lives, including healthcare. Fast-moving technological advances help explain why the mHealth (mobile health) industry is growing so rapidly.
Mobile technology is proving useful for a broad range of new applications, and it has inspired a rethinking of many aspects of healthcare. According to several studies, the modern technology behind the new discipline of remote patient monitoring has helped patients maintain independence, minimize personal costs, prevent complications, and participate more effectively in their own care, sometimes in their own homes.1
Remote patient monitoring has progressed in tandem with precision medicine, a field based around leveraging new cascades of data to provide more personalized care. Industry leaders are currently engaged in pioneering studies that measure the effectiveness of precision medicine for a growing array of purposes.
Precision medicine and remote patient monitoring technologies represent significant breakthroughs for healthcare providers and also for patients, who have access to an increasing range of options that provide greater comfort, convenience, and agency.
In the management of diabetes and screening for HbA1c, the challenges of point-of-care (POC) blood collection are well-documented.2 Quickly and comfortably drawing small volumes of blood, in the range of 10 μl, has often entailed a tradeoff in quality and reliability of results.
To be fair, modern point-of-care testing has come a very long way in terms of quality. But concerns remain about reliability over time; the test has a +/- 6 percent tolerance. When POC tests aren’t properly QCed, results can slip out of a lab’s control. And there are other practical limitations. Ten uL is about all that standard analyzers can absorb at one time. HbA1c analyzers can detect much more than just HbA1c. A better sample can generate more detailed information—for example, it can show whether a person is heterozygous for sickle cell anemia—so there is a demand and a purpose for more robust sampling solutions.
From a patient-centric perspective, other practical concerns have persisted. Effective diabetes management and screening requires lab visits; many patients must show up to clinics for this purpose as often as four times per year. This has the potential to negatively impact patient adherence and compliance with treatment, and it has definite impacts on convenience and economics. It makes it more difficult for patients to engage actively in their own care, which impedes the pursuit of a more patient-centered lab.
A more value-based approach to HbA1c monitoring can lead to the rethinking of entire systems of care. Medicine will shift away from decision-making based on tactical averages and toward more personalized planning. The future of care will be predictive, preventative, personalized, and participatory (sometimes called the P4 model). To achieve widespread adoption, emerging healthcare technologies will integrate this approach into their design. Diabetes management cuts across populations and affects millions, which makes it an ideal area in which to see new ideas in action.
The implementation of remote patient monitoring technologies and a philosophical gravitation toward a more patient-centric approach offer the potential to improve the treatment and lives of those who suffer from diabetes, and those who want to prevent it. But how do these big ideas translate into practice? A crucial and often neglected element in this equation is the sampling event itself.
The sampling event
Larger and larger amounts of data can now be generated from smaller and smaller amounts of blood. However, problems still exist at the moment when human skin is pricked and blood is drawn or absorbed. Venipuncture remains painful, and results generated from dried blood spot (DBS) cards still suffer from certain drawbacks. It’s problematic for many patients and participants, and it’s costly and cumbersome for many labs.
Newer microsampling technologies are designed to collect quantitative, volumetrically accurate specimens. Results from these methods correlate to those associated with wet blood, eliminating much uncertainty and concern, and creating a smarter sampling event. These technologies have the potential to catalyze innovation in precision medicine and remote monitoring, and to allow clinical labs to adopt more patient-centric approaches.
A recent study was conducted to examine the use of microsampling collection devices that allow patients to self-collect their capillary samples.3 The procedure requires minimal training, and can be conducted in a patient’s home or at a remote clinical site. The study’s findings indicate that most patients were at ease with self-collecting a capillary sample at home rather than going to a clinic, laboratory, or other phlebotomy collection site.
Remote monitoring for HbA1c
Compared to older methods, remote sampling and monitoring for HbA1c is convenient and saves time and costs. Most important, it has demonstrated effectiveness through improved outcomes for patients.
Scientists from Belgium’s Ghent University Hospital recently conducted a study in which they looked into the user-friendliness of various sampling techniques as well as the techniques patients preferred to use in the future.4 Remote and at-home sampling techniques, in which patients manage their blood samples by themselves, stood out as most popular. The future of remote monitoring for patients with diabetes opens new options and facilitates greater choice for people with diabetes and those who care for them.
Through such interventions as remote sampling, remote patient monitoring, and precision medicine, management of chronic illnesses could become a less taxing challenge for healthcare systems. The use of technology to implement cost-effective healthcare management is an increasingly realistic possible alternative for diabetes management.
1. Tep S. 8 studies that prove the value of remote monitoring for diabetes.
2. Broderick JA. Point‐of‐care haemoglobin measurement – state of the art or a bleeding nuisance? Anaesthesia. 2015;70(11):1225-1229.
3. Jannetto P, Mbughuni M, Stevens M, et al. Capillary versus venous therapeutic drug monitoring of tacrolimus and cyclosporine A. Mayo Clinic poster presentation.
4. Verougstraete N, Lapauw B, Van Aken S, Delanghe J, Stove C, Stove. V. Volumetric absorptive microsampling at home as an alternative tool for the monitoring of HbA1c in diabetes patients. Clin Chem Lab Med. 017;55(3):462-469.