Enhanced 911/Global Position System Wizard: A Telemedicine Application for the Prevention of Severe Hypoglycemia—Monitor, Alert, and Locate

Abstract

Intensive insulin therapy has an inherent risk of hypoglycemia that can lead to loss of consciousness, cardiac arrhythmia, seizure, and death ("dead-in-bed syndrome"). This risk of hypoglycemia is a major concern for patients, families, and physicians. The need for an automated system that can alert in the event of severe hypoglycemia is evident. In engineering systems, where there is a risk of malfunction of the primary control system, alert and safety mechanisms are implemented in layers of protection. This concept has been adopted in the proposed system that integrates a hypoglycemia prediction algorithm with a global position system (GPS) locator and short message service such that the current glucose value with the rate of change (ROC) and the location of the subject can be communicated to a predefined list. Furthermore, if the system is linked to the insulin pump, it can suspend the pump or decrease the basal insulin infusion rate to prevent the pending event. The system was evaluated on clinical datasets of glucose tracings from the DexCom Seven system. Glucose tracings were analyzed for hypoglycemia events and then a text message was broadcast to a predefined list of people who were notified with the glucose value, ROC, GPS coordinates, and a Google map of the location. In addition to providing a safety layer to a future artificial pancreas, this system also can be easily implemented in current continuous glucose monitors to help provide information and alerts to people with diabetes.

Improved Outcomes from Diabetes Monitoring: The Benefits of Better Adherence, Therapy Adjustments, Patient Education, and Telemedicine Support

“…The system was named the Knowledge of Loop Operations Necessary System to Assist Repairs, whose acronym was Klonstar. 24 Dassau and associates 25 later proposed a specific telemedicine system based on Klonstar that was called an enhanced 911/global positioning system (GPS) wizard to prevent hypoglycemia, which integrated CGM with a hypoglycemia-predictive algorithm, with a GPS position locator and a short message service to monitor and alert for hypoglycemia. Furthermore, this system would be integrated with the patient's insulin pump to decrease or suspend insulin infusion in the event of impending hypoglycemia.…”

“…Furthermore, this system would be integrated with the patient's insulin pump to decrease or suspend insulin infusion in the event of impending hypoglycemia. 25 Currently, no closed-loop system is approved for use in the United States by the FDA. The first system with automatic control of insulin delivery, Veo, manufactured by Medtronic Diabetes, Northridge, CA, is available in Europe and Canada but has not yet been approved for use in the United States.…”

Continuous Glucose Monitoring: Professional and Real Time

“…7). If none of the alerts facilitate a response from the user, the E911 may suspend insulin delivery to provide further protection from hypoglycemia [23]. Integration of the E911 system with CGM would improve the risk of hypoglycemia unawareness and provide a safety net at times when hypoglycemia is not avoided.…”

Clinical Hurdles and Possible Solutions in the Implementation of Closed-Loop Control in Type 1 Diabetes Mellitus

“…A prototype global-positioningsystem-equipped continuous glucose monitor has been designed that can alert family and medical staff of the location and glucose concentration (absolute and rate of change) in the event of profound or impending hypoglycemia. 16 Another area that needs to be explored is redundancy, especially of the continuous glucose monitor. One could conceive of using an array of sensors and voting algorithms to minimize the weakness of any individual sensor or sensing method.…”