Abstract
Patients will decide whether to adopt remote digital monitoring (RDM) for diabetes by weighing its health benefits against the inconvenience it may cause. To identify the minimum effectiveness patients report they require to adopt 36 different RDM scenarios. This survey study was conducted among adults with type 1 or type 2 diabetes living in 30 countries from February to July 2019. 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. 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). 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. 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.
Highlights
The findings of this study suggest that patients require greater health benefits to adopt more intrusive remote digital monitoring (RDM) modalities, food monitoring, and real-time feedback by a health care professional
RDM consists of using prescribed sensors to capture patients’ physiological and behavioral data, which can be transmitted to their physician to complement in-person consultations or be used to offer real-time feedback provided by artificial intelligence (AI) or a clinician.[4,8,9,10,11,12,13]
Intrusiveness can lead to nonadherence to RDM among some patients,[15,16] but others may decide to adopt RDM despite its intrusiveness to obtain superior health benefits than those offered by the traditional care model.[20]
Summary
As with other treatment decisions, patients decide whether to adopt RDM by weighing its benefits against its costs and inconveniences.[14] Previous studies have identified the costs of RDM, including disruptive alerts and social stigma,[15,16,17] which represent the intrusiveness of RDM in patients’ private lives.[18,19] Intrusiveness can lead to nonadherence to RDM among some patients,[15,16] but others may decide to adopt RDM despite its intrusiveness to obtain superior health benefits than those offered by the traditional care model.[20] The magnitude of health benefits patients require to adopt RDM and the association of this requirement with the perceived intrusiveness of RDM has not been explored.
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