Dr R M Anjana & Dr Ranjani HarishEvery aspect of life in India is witnessing a digital revolution, and healthcare is no exception. Use of digital healthcare tools is particularly relevant to the management of chronic noncommunicable diseases, where patients require lifelong follow-up and treatment. The numbers affected are huge — India has 101 million people living with diabetes, and more than 136 million with pre-diabetes. Accelerated by black swan events such as the Covid-19 pandemic, technology is increasingly becoming a part of diabetes management. From teleconsultations and mobile health applications to continuous glucose monitoring devices and artificial intelligence-powered health platforms, digital health tools span the entire gamut of diabetes care.However, we need to ask ourselves if everyone is benefiting equally from the digital healthcare revolution. This question is particularly relevant in India, where wide disparities exist with respect to internet access, affordability of devices and digital literacy. We did a study recently, published in BMC Public Health, which attempts to answer how, while technology is advancing rapidly, many may be left behind due to social, economic, educational and geographical barriers.Digital healthcare has the potential to revolutionise delivery of diabetes care. Through digital technologies, people with diabetes are able to consult doctors remotely. They can track their blood sugar levels through smartphone apps and other connected devices. They can also get reminders for periodic check-ups and medication refills and can access diet plans through mobile applications, and obtain educational support without visiting a hospital or clinic frequently. Especially during the Covid-19 pandemic, telemedicine became a lifesaver for many with diabetes. Online consultations helped people receive continuing care and stay connected to the healthcare team, even during lockdowns.Yet, technology alone is often not enough.Our DIG-EQUITY study explored the experiences of people with diabetes, caregivers, healthcare providers, policymakers, and community organisations in urban and rural Tamil Nadu, and identified reasons for the “digital divide”.One of the most important results of the study was the influence of age. While the younger population was comfortable using smartphones, health applications, and teleconsultation services, older people often faced difficulties navigating digital platforms. The elderly needed help from family members to book appointments, join online consultations, or get their reports online. Dependence on a caregiver has traditionally been the main challenge for older adults in accessing healthcare and digital health may not completely ameliorate this. Impaired vision and hearing and lack of dexterity also contribute to the inability of older people to fully utilise digital health solutions.Interestingly, many with type 1 diabetes, who are, in general, younger and would be expected to favour teleconsultations, expressed a preference for traditional in-person consultations, likely due to the need for physical assessments.Researchers noted that geographical location continues to play a significant role in determining who can benefit from digital health innovations. People living in urban areas benefit from good network connections, greater smartphone usage and access to digital health services. On the other hand, rural communities often encountered network issues, infrastructure limitations and limited access to digital devices. In some families, only a single smartphone was available and had to be shared among multiple family members, making regular access to healthcare applications difficult.Many digital tools are promoted as affordable solutions for digital healthcare. Yet, the study found many cannot afford smartphones, internet data packages, wearable devices and other digital monitoring systems. For low-income people in whom healthcare priorities most often compete with other essential expenses such as food, education, and housing, digital healthcare solutions may remain inaccessible. Ironically, these are some of the very populations that need such solutions the most.Having a smartphone does not mean that someone is able to use digital healthcare services effectively. Those who understood how to download applications, access teleconsultation platforms, navigate online forms, and interpret digital health information were more likely to benefit from these services. Hence, the study indicates the importance of digital literacy programmes alongside technological innovation.The study also highlights the important contributions made by caregivers. Children with type 1 diabetes often need their parents to support them in accessing digital monitoring systems. Similarly, elderly people also require help from family members. Researchers emphasised that future digital health programmes should be designed not only for patients but also for caregivers who often act as technology facilitators.Many people who benefited from digital health technologies also expressed issues related to privacy, data security, and reliability. Trust in digital platforms is always influenced by questions about who owns the data, who can access personal health information and how data is stored.Transparent policies, stronger cybersecurity measures, and clear communication regarding data protection are essential to encourage wider adoption. The introduction of the Digital Personal Data Protection Act in 2023 and the DPDP Rules in 2025 by the Union govt are an important step in this direction.Digital health has the potential to enhance diabetes healthcare in India, but its success depends on inclusivity. Targeted digital literacy programmes, improved rural internet infrastructure, affordable technology solutions and user-friendly application design will encourage wider and more effective use of digital health technologies.Digital healthcare can transform diabetes care, but only when inclusion becomes as important as innovation.(The writers work with Dr Mohan’s Diabetes Specialities Centre & Madras Diabetes Research Foundation in Chennai)
