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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. 

Since the early 1970s, there's been significant progress in the survival rates of some cancers, in particular testicular, skin, breast, and prostate cancers where the 10-year survival rates in the UK have increased, on average from 46% to 86%.

However, the UK still lags comparable European countries in cancer survival, and for some cancers, particularly lung, esophagus, pancreas and brain, the 10-year survival rates are only about 10% or less.

Late diagnosis
In Britain 50% of cancer patients are diagnosed late. This is the result of GPs misdiagnosing, and patient's reluctance to visit their doctors.

In his book, Malignant, Stanford University professor S Lochlann Jain suggests cancer diagnosis is missed in young adults because, "doctors often work under the misguided assumption that cancer is a disease of older people." For example, 80% of lung cancers are diagnosed at advanced stages.

Cancer survival rates are expected to improve as technology, and self-education develop. This is expected to reduce the role of primary care doctors, increase patient-centered healthcare, and reduce late diagnosis.

 

British stiff-upper-lip
In emerging countries, cancer patients present late because of a lack of education and money. In the UK, where medicine is free at the point of care, the British stiff-upper-lip is often the cause of late diagnosis.
 
A 2013 comparative study published in the British Journal of Cancer found that there was little difference in the awareness of cancer symptoms among patients, yet the British were less likely to act on them. It concluded that the traditional British 'stiff-upper-lip' means cancer patients are dying unnecessarily because they don't want to waste their GP's time with their symptoms or are too embarrassed to seek help.

 

Genomic medicine
A number of studies suggest that doctor-patient relationships are sub-optimal and based on asymmetry of information.
 
Such relationships will change when patients have access to information on their own DNA. Genomic medicine is a game-changer because of its potential to personalize patient care.
 
It only takes a few hours to sequence a person's genome, and costs are low and falling. A recent survey suggests that 81% of all US patients would like to have their genome sequenced. Eventually, this will mean that most people will have their genome sequenced so they can be properly cared for if they get sick.

Already some scientists and clinicians have started taking advantage of genomic sequencing, to tailor their approaches to individual differences.  In this personalized, patient-centred healthcare environment, primary care doctors are less important, and patients more important.  As this transformation occurs, early cancer diagnosis and survival rates are expected to rise.