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Richard Lane, former President of DUK, and a patient diagnosed with T2DM suggest that the biggest challenge for diabetes care is actually engaging people who are either at risk of the condition or living with diabetes. Only once people are engaged do you stand a chance to raise their awareness of the disease, and encourage them to change their diets and lifestyles in order to slow the progression of the condition and even prevent it.

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Structured educational courses to help people living with diabetes manage their condition are not working.
 
A few closed service providers dominate diabetes education in the UK, and according to the last National Diabetes Audit, less than 2% of the 3.8 million diagnosed with diabetes attend any form of structured education.
 
The non-dramatic, insidious and chronic nature of diabetes masks the fact that it has become a global epidemic with the potential to overwhelm national health systems, if education can't halt its progress. 
 
Although advances in diabetes research are significant, the horizon for a cure is still distant. At this moment in time, the best option to halt the progression of diabetes is convenient, fast and effective education.
 
 
Diabetes education and outcomes
Current providers of diabetes education fail to demonstrate how their offerings affect outcomes, and people are not interested in educational courses if they're not linked to outcomes. A 2012 London School of Economics study concludes that there's a lack of diabetes outcome data in the UK, and, "No one really knows the true impact of diabetes, and its associated complications."

The 2013 Annual Report of Diabetes UK (DUK) states that 50,000 people with diabetes used the Charity's blood glucose tracker app, 500,000 took its diabetes risk test, and DUK distributed 250,000 foot-guides, but the Report fails to mention what impact these important activities had on patient outcomes. 
 
Shift of power
Traditional providers of diabetes education have yet to appreciate that the information age has shifted the balance of power from health providers to patients.
 
Mobile devices are ubiquitous and personal. By 2018 smartphone penetration in the UK is expected to be 100%. The over 55s are projected to experience the fastest year-on-year smartphone penetration, and the difference of smartphone penetration by age is expected to disappear by 2020. Further, competition will continue to drive down prices of mobile devices, and increase their functionality. 
 
Over 70% of people living with diabetes regularly use their mobiles to search the Internet for healthcare information, and use social-media to share information about health providers, and educational courses.  This is carried out 24-7, 365 days a year.
 
Traditional providers of diabetes educational courses should be minded that 35% of all patients who use social-media say negative things about health providers, 40% of people who receive such negative information believe it, and 41% say it affects their choices. Social-media is the new frontier of reputation risk for providers of diabetes education.
 
Takeaways
Traditional providers of diabetes education must become more open to independent service providers, and enhance their digital strategies to make their education offerings smarter, faster, and better. 
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It's a travesty!

Health professionals don't effectively use mHealth strategies to proactively engage and support people living with diabetes. This failure destroys the lives of millions and unnecessarily increases healthcare costs by billions. This is a travesty.

Health information online
In the UK and US the majority of people living with diabetes and pre-diabetes have smartphones, which they use on a daily basis to send and receive information, purchase goods, bank, educate and socialize. Notwithstanding, 80% of health professionals still provide information for the management of diabetes in paper pamphlets, and the majority of diabetes care information on websites is digitalised paper pamphlets. Such communications strategies, cost millions, and fail to slow the progression of the condition.

Epidemic
Here's evidence, which suggests that current healthcare communications strategies are failing. Recent UK data released by the NHS show that people diagnosed with diabetes has increased significantly over the past decade. Today, 6% of UK adults are registered as diabetic, and an estimated 0.85 million people have diabetes without knowing it. In 2013 there were 163,000 new diagnoses: the biggest annual increase since 2008.

A 2014 study reported in the British Medical Journal revealed that the prevalence of pre-diabetes in England has tripled in eight years, from 11.6% in 2003 to 35.3% in 2011, which puts immense pressure on NHS finances. It's projected that by 2025, five million people will have diabetes in the UK.

The situation in the US is similar. Results of a 2014 study published in the Journal of the American Medical Association, show that there was a significant increase in diabetes between 2001 and 2009, and warns of a growing epidemic that could strain the American health-care system.
 
Diabetes UK report
Governments and charities are good at describing the burden of diabetes, but poor at introducing and promoting effective mHealth strategies to reduce the burden. In a 2014 Diabetes UK report, Barbara Young, the charity's CEO says, "The NHS is spending an eye watering amount on diabetes (£10 billion annually), but the money isn't being used effectively." Those who are diagnosed late or don't receive timely care can suffer complications such as kidney and nerve damage, which costs the NHS billions.

The Report emphasises the importance of better education on how to manage diabetes, and stresses that a staggering 80% of the £10 billion the NHS spends on diabetes goes on treating complications, which may have been prevented if patients had received more effective information about the condition.

If nothing changes, the Report suggests, by 2035 diabetes will cost the NHS £17billion a year, and thousands of diabetics will suffer unnecessary complications.

Online managed care systems
Where's the leadership to help change the situation?  There's evidence to suggest that when mHealth strategies are used in the management of diabetes, they slow the progression of the condition, propel self-management, and significantly reduce the costs of care.

For example, Professor Shahid Ali, a UK practicing GP and Head of Digital Health, University of Salford, has developed and implemented a mHealth system, which enhances the quality of diabetes care, while substantially reducing costs and increasing the efficiency of health professionals. 
 
In the US, Welldoc a successful technology company, founded in 2005 by an endocrinologist, provides  a mHealth solution for people living with diabetes, which coordinates diabetes care, propels self-management and achieves long-term adherence.
 
Professor Gordon Moore from Harvard University Medical School has developed a managed care system that embeds the clinical, behavioural and motivational aspects of diabetes care into any handheld device. It's like, Moore says, "having your doctor in your pocket".
 
Notwithstanding, governments and agencies responsible for enhancing the quality of care for people living with diabetes are failing to bring such tried-and-tested mHealth solutions to their attention.
 
Takeaways
According to Diabetes UK's, we, "know what needs to happen":
  • "More focus on ensuring that people know about diabetes
  • Provision and promotion of effective self-management
  • Integrated care planned around the needs of the individual
  • Effective promotion of lifestyle change."
But, how many more people living with diabetes have to endue unnecessary progression of their condition, and devastating complications, which cost health systems billions, before health professionals abandon their costly and ineffective communications systems and embrace cheaper and more effective mHealth strategies?  
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