It can take days or even weeks to travel from some settlements in Greenland to a town with a doctor and healthcare facilities, with weather conditions often causing added delays. In this context, delivering diabetes care – and healthcare in general – is a major challenge, made worse by a growing shortage of doctors and healthcare workers. Steno Diabetes Center Greenland (SDCG) is pioneering several initiatives to reach patients in remote areas, with the benefits extending far beyond diabetes.
One such initiative focuses on eye screenings that are used to detect diabetic retinopathy (DR), a late complication of diabetes responsible for around 80% of vision loss in persons with diabetes worldwide. While the prevalence is lower in Greenland than elsewhere – a 2022 study found a 2% prevalence among people with diabetes and prediabetes – it remains crucial to catch cases early to prevent vision loss.
Until recently, however, there were just nine fundus cameras that could screen for DR across Greenland’s more than two million square kilometres. With 80% of the country covered permanently in a thick layer of ice, this meant a days-long journey by plane, boat, helicopter and/or dog sled for many patients, plus significant costs for the Greenlandic healthcare system (which covers patients’ travel expenses), simply for a routine eye examination.
The solution was the purchase of several much smaller, easily transportable and easily operable cameras that have nearly the same capabilities and allow care to be taken nearer to the patients, instead of vice versa. The centre has three so far.
“We’ve travelled with these 25kg cameras by plane, helicopter and boat to smaller settlements and towns, and it works really well,” says Stine Byberg, head of research at SDCG. “Every time we go on a coast visit where there’s no camera, we bring one with us and image the people who haven’t been imaged for a year or two.”
Patient benefits
Anecdotal evidence suggests patients are happy with the service.
“Sometimes they just say spontaneously, ‘it’s so nice that I could get my eye exam here, because it’s so tiresome to travel a long way’,” says Byberg.
Two of these smaller cameras are now located permanently in towns in the north and east of the country, with local people trained to perform the screenings and ophthalmological nurses in Denmark receiving and analysing the images, which they say are of consistently high quality.
The cameras can also be used to screen for or follow up on other eye conditions, such as other types of retinal lesion or even glaucoma, extending the benefits far beyond diabetes.
App-based appointments
A second SDCG initiative that is also expanding healthcare delivery possibilities is telemedical consultations through an app called “Puisa”, enabling patients to have routine appointments or initial consultations with a doctor via a secure online connection.
The app is primarily designed to be used by patients on their own smartphones, from home, at work, or while travelling. Those without a smart device or an internet connection can use the app at one of more than 50 health centres in small settlements around Greenland, which have been supplied with a tablet and basic point-of-care testing equipment, for example, a simple apparatus for measuring HbA1c. In each case, the local nurse or auxiliary healthcare worker has been trained in using the app and the equipment and can support the patient through their online appointment.
Since the launch of the app in 2022, it has been steadily gaining popularity among SDCG patients and staff. In 2024 alone, the numbers have increased significantly, with 5.1% of consultations carried out via Puisa in January, rising to 22% in June.
“It has huge implications for the amount of travel patients need to do and for speeding up their access to care,” says Byberg. “They no longer have to wait up to several days to get to the nearest healthcare centre with a doctor.”
By reducing travel, especially air travel, the app is also far more climate friendly than in-person appointments.
Puisa, which has been designed to work on minimal bandwidth, is also available for use by healthcare workers in other fields. For example, one dietician handles most of her consultations with patients living in coastal areas through Puisa. As more patients and healthcare professionals learn about the app, demand is growing and use is expected to increase significantly in the future.
Further information
Novo Nordisk Foundation, Judith Vonberg, Communications Specialist, +45 4172 7925, jvo@novo.dk