The role of distal technologies in type 1 diabetes management

A new review brings together the effectiveness, use and knowledge gaps relating to telehealth, mhealth, game-based support, social platforms and patient portals.

By Prof Jane Speight


In the past two decades, there have been many advances in the use of technology in our everyday lives. Such advances are now also available for the support and self-care of type 1 diabetes. But, are they making self-care and support more effective and/or more convenient? Are they improving both health and quality of life? A new review, co-authored by the ACBRD’s Prof Jane Speight, has been published in a recent issue of The Lancet Diabetes and Endocrinology.

‘Proximal’ technologies (i.e. insulin pumps, continuous glucose monitors, and closed-loop systems) have been the focus of several systematic reviews. However, ‘distal’ technologies have received much less attention. ‘Distal’ refers to several different types of technology that are designed to provide support or a service remotely, e.g.:

  • telehealth (e.g. consultations via videoconference)
  • mhealth (use of SMS/text messaging, or ‘apps’)
  • game-based support
  • social platforms (e.g. Facebook, Twitter)
  • patient portals (enabling access to results, making appointments, etc).

Such technologies can be used to provide healthcare consultations, medication/appointment reminders, peer support, education, and much, much more. In the review, Duke and colleagues, summarise the evidence about the effectiveness of available distal technologies for people with type 1 diabetes. They also discuss issues related to privacy, ethics, regulatory considerations, global adoption, knowledge gaps, and recommendations for the future.

The overall benefits of distal technologies vary by the type of technology, the people using them, and by technology adoption. Apps, messaging systems and web-based support remain under-evaluated. While medical science needs to be cautious, requires empirical evidence, and is slow to accept change, the free-market economy is driving the fluid and rapidly-evolving design and production of novel technologies. Consistent government guidelines, regulation, security policies and universal standards are needed to protect personal health information.

The daily self-care of type 1 diabetes is burdensome, frustrating, repetitive and ultimately prone to lapses in motivation and/or effectiveness. Technology has the potential to deliver accurate and important information and support, at the individual’s convenience. Until proximal technologies are able to fully automate type 1 diabetes management, further research is needed to better understand how distal technologies can support increased engagement in and support for self-care, and how/when it leads to improved outcomes. While the evidence remains limited, it clearly supports integration of conventional and novel methods of healthcare.

Duke D, Barry S, Wagner DV, Speight J, Choudhary P, Harris MA (2018). Distal technologies and type 1 diabetes management. Lancet Diabetes and Endocrinology, 6: 143-156.


To read more about the role of technology in diabetes check out previous blogs on this topic.
Diabetes and apps  Diabetes and apps
Is all that glitters really gold? Is all that glitters really gold?
The future is now: technologies are changing the face of diabetes  The future is now: technologies are changing the face of diabetes