Design, Methods, and Evaluation Directions of a Multi-Access Service for the Management of Diabetes Mellitus Patients

Abstract

Recent advances in information and communication technology allow the design and testing of new models of diabetes management, which are able to provide assistance to patients regardless of their distance from the health care providers. The M2DM project, funded by the European Commission, has the specific aim to investigate the potential of novel telemedicine services in diabetes management. A multi-access system based on the integration of Web access, telephone access through interactive voice response systems, and the use of palmtops and smart modems for data downloading has been implemented. The system is based on a technological platform that allows a tight integration between the access modalities through a middle layer called the multi-access organizer. Particular attention has been devoted to the design of the evaluation scheme for the system: A randomized controlled study has been defined, with clinical, organizational, economic, usability, and users' satisfaction outcomes. The evaluation of the system started in January 2002. The system is currently used by 67 patients and seven health care providers in five medical centers across Europe. After 6 months of usage of the system no major technical problems have been encountered, and the majority of patients are using the Web and data downloading modalities with a satisfactory frequency. From a clinical viewpoint, the hemoglobin A1c (HbA1c) of both active patients and controls decreased, and the variance of HbA1c in active patients is significantly lower than the control ones. The M2DM system allows for the implementation of an easy-to-use, user-tailored telemedicine system for diabetes management. The first clinical results are encouraging and seem to substantiate the hypothesis of its clinical effectiveness.

The use of high-definition video technology on diabetes management

“…[10] A growing body of literature suggests that information technology (IT), such as computer, Internet and cell phone technology, holds great promise in enhancing diabetic care. [11][12][13][14] …”

Clinical Evaluation of an Automated Artificial Pancreas Using Zone-Model Predictive Control and Health Monitoring System

“…The difficulty of controlling blood glucose for subjects is evident in the lack of good control experienced by most people with type 1 diabetes: in a study of 25,833 people with type 1 diabetes by the T1D Exchange Clinic Registry, it was shown that the average glycosylated hemoglobin (A1C) was 8.3%, 3 above the recommended limit of 7% set by the American Diabetes Association. 4 In addition, 7% of those studied had experienced severe hypoglycemia with seizure or coma, and 8% had experienced diabetic ketoacidosis within the last year.…”

Smart Telemedicine Support for Continuous Glucose Monitoring: The Embryo of a Future Global Agent for Diabetes Care

“…27,28 This "global agent for diabetes care" would be based on wireless communication of first-tier devices (biological variables monitors, hormone infusers) with a smart assistant equipped with dual-mode low energy Bluetooth, 29 which communicates remotely with the diabetes center. Its structure would be defined as a three-layer approach (Figure 1…”