since the COVID-19 crisis began to unravel Many hospitals have begun to adapt by bringing in more technology. One of them is “Telemedicine” or seeing a doctor remotely especially patients with stable symptoms Or sick with symptoms or diseases that are not very complicated, enter the care system and follow up the symptoms through talking through the application. or video call instead of seeing a doctor face-to-face.
For symptom monitoring via Telemedicine, it can save patients from having to travel to the hospital. No need to pay for multiple trips And some people don’t have to pay daily wages because they have to take time off work to see a doctor as scheduled.
for Phutthasothon Hospital e.Chachoengsao It is another hospital that uses such a system to take care of diabetic patients since the COVID-19 crisis. until it was seen that the introduction The use of “Telemedicine” can help monitor patients’ symptoms more often. more than that yet “Reduce the risk” in the journey of “Pregnant woman”
Especially “pregnant women with diabetes” who need intensive follow-up so as not to affect the baby who is about to be born.
“The Coverage” get a chance to talk to Ph.D..Ornicha Amornriyakul Internal Medicine, Endocrinology and Metabolism Phutthasothon Hospital about the use of Telemedicine in caring for diabetic patients in pregnant women. Including efforts to expand services to patients with thyroid disease. and obesity as well
“Diabetes in pregnant women” It’s a risk for both mother and child.
Ph.D..Ornicha Explain that when diagnosed with gestational diabetes If there is no attempt to control it, both mother and child will be punished. which may cause “Pregnancy toxicity” is fearful that it may cause seizures. and is life-threatening Including the child may be affected by the condition. whether premature birth Hypoglycemia, jaundice, seizures, etc. In addition, children born in the future may be at risk of obesity. and diabetes than children whose mothers did not have gestational diabetes
“Past research has found that diabetic mothers have a higher incidence of caesarean sections than those without gestational diabetes. This caesarean section was not voluntary. but because there are complications”
therefore Therefore, it is necessary to have good control of gestational diabetes. must be serious and fast
Dr. Ornicha further stated that when COVID-19 occurred At that time, the management had a policy to limit the number of non-emergency patients. Therefore making an MOU with a private company that is ‘Dietz’ (Dietz.Asia) to introduce the Telemedicine system in 2020, because in addition to the first group of gestational diabetes patients who use it, there are also type 1 diabetes patients (lacking the hormone insulin to reduce blood sugar levels) because the body’s immune system destroys the pancreas, resulting in inability to produce hormones) and followed by patients with type 2 diabetes, which is the most common type (caused by heredity in conjunction with food consumption behavior and the body has insulin resistance) as well
“The COVID period is quite heavy. Pity the patient where he can’t come. Maybe he drew our blood, we can only see the blood results. So I felt that at that time taking care of patients with type 2 diabetes 2 Mostly not so good”
However, with the introduction of telemedicine, it does not mean that all patients will be able to receive follow-up treatment. Because the doctor must first assess readiness. Because patients must be ready to use technology. Including ensuring that the patient can use the drug correctly. (Because you will have to bring drugs that are mostly injections) to use at home.
Dr. Ornicha explains the steps in follow-up care that The first thing to look at is the need for close follow-up. and can use technology or not If they are confident that the patient needs and is able to use the technology, a consent form will be signed. and introduce basic information such as prescribing treatment set food for each meal Complications, etc. After that, you will see a nurse who will advise you on how to self-check your blood sugar at home. Writing and recording information on sugar levels and meals eaten each day.
Then sent to a nutritionist who will recommend the right type of food. including counting carbohydrates and meet the pharmacist in the next checkpoint To learn types and methods of self-injection of insulin.
However, once the patient enters the telemedicine system, the doctor will track the symptoms through the Diet app that is safe in terms of data collection. It will look at the sugar level measured from the fingertip examination. Eating at each meal Some people may need to look at the pressure and weight as well.
“Pregnant women with diabetes must be strict. He would have to do a sugar punch 7 times a day, before 3 meals, after 3 meals, and 1 time before bed to see each time. together with the food that you eat in each meal how much And then have to write down how much injection, which type of injection, and then the doctor will look at the information in this section to make a decision for treatment whether to adjust the drug further Do you recommend food or not and how?”
However, the doctor will make an appointment for the patient to come to the hospital once a month to examine the body to see if the body is swollen or not. Including looking at the position where the patient injected Because some people inject and bruise. or bleeding a hard kidney If not changed or improved, it may cause poor absorption of the drug. Therefore, when the doctor meets the patient face-to-face, he can perform additional examinations in this section. Including having the patient come to pick up the medicine at the hospital as well
Motherhood” Miracles that make patients control their sugar better
Dr. Ornicha said that there were many patients who were impressed during the treatment. Personally, I have a lot of experience with gestational diabetes patients. therefore showing the motherhood in each person who tries and intended to control the accumulated sugar levels
For the first case, the patient with type 1 diabetes before pregnancy never came to the hospital. (Let relatives take medicine instead) I don’t inject regularly. causing inability to control sugar levels Resulting in a blood sugar level of 8.6%, which is above the threshold. But when the patient became pregnant, it changed. whether it is a visit to the doctor regularly try to take care of yourself Do as your doctor recommends. until prenatal can reduce the cumulative sugar level down to the goal of 5.4%, as in Case 2, a patient with type 2 diabetes and diabetes due to pancreatitis In the pre-pregnancy period, diabetes cannot be controlled. At that time, the patient’s blood sugar level was 9.2%, which was above the threshold. But when it was found that she was pregnant, she changed herself as in the first case until she was able to reduce the accumulated sugar level before birth to 6.2%.
“Doctors like to encourage patients that there is power in us if we intend to do it. and what day it can be done You will have pride in yourself. Next, if the baby is born and the baby is strong Let you know that your child is strong. because of your effort Make you proud of yourself.”
Dr. Ornicha went on to say that Blood Sugar Level Monitoring – Diabetes Control Isn’t Easy Because the blood sugar must be checked before and after eating each meal, injections must be taken to count carbohydrate foods. Therefore, I personally try to understand the patient a lot. keep sending encouragement and consulting In addition to taking care of the body, the mind of the mother during pregnancy will also take care of it.
Preparing for further patient care “Thairoid is toxic.–Obesity”
From the success in taking care of gestational diabetes patients And familiar with the use of the system that has been improved until it can be used well Dr. Ornicha also indicates that there is still a “thyroid” that is considered another disease that can be found as much as with diabetes At this point, there will be a type of thyroid poisoning where the disease is in a calm state that must be followed up by a doctor.
However, including obesity that affects health. which is required to gain weight In some cases, diet and exercise methods are required. Because patients may not have the power to buy weight loss pills. because there is currently no weight loss drug listed in the National List of Essential Medicines
“Most can be done within 1 first year good weight loss After that, it’s hard to do. weight will go up So the doctor felt that we had to be close to the patient. If we follow him away, he might accidentally. or dropped So let’s follow through. Telemedicine every week Take note of what you ate. how much exercise how is the weight to be sent every week The doctor will see what should be recommended. Including cheering up on exercise This is another disease that will expand further.”
However, Dr. Ornicha concluded that in addition to the Telemedicine system, it will help to monitor patients’ symptoms more often without the need for patients to travel to the hospital. Another thing that can be seen in concrete is that “Help reduce congestion” of the hospital.
“In 2021, we reduced the number of patients 183 times and in 2022 decreased by 204 times, i.e. reducing the number of people coming to the hospital. which this doctor did alone and only doing it in small groups So if we expand more people to do it, I think it will help.” she stated
