Management of Patients with Diabetes Through Information Technology: Tools for Monitoring and Control of the Patients' Metabolic Behavior

Bellazzi, Riccardo; Arcelloni, Marco; Ferrari, P; Cata, Pasquale De; Hernando, M. Elena; García, Ángel Hernández; Gazzaruso, Carmine; Gómez, Enrique J.; Larizza, Cristiana; Fratino, Pietro; Stefanelli, Mario

doi:10.1089/dia.2004.6.567

Cited by 40 publications

(15 citation statements)

References 16 publications

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“…We reviewed the literature on PWP-delivered interventions and disease management support targeting persons with diabetes and or enhancing diabetes care and found that PWP systems enhance patient-provider communication [20, 22, 24, 25], increase overall satisfaction with care [9•, 23••, 26–28], expand access to health information [21, 24, 29, 30], and improve disease management [9•, 26, 27, 29, 31–36] and patient outcomes [29, 32–34, 36] in diabetes. The recent body of PWP evaluation studies has established the usefulness of PWPs for improving care and clinical outcomes, but many of the studied PWPs have unique functionalities.…”

Section: Discussionmentioning

confidence: 99%

Patient Web Portals to Improve Diabetes Outcomes: A Systematic Review

et al. 2010

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Patient web portals (PWPs), defined as the integration of electronic medical records and patient health records, have been related to enhanced patient outcomes. A literature review was conducted to characterize the design and evaluation of PWPs to improve health care processes and outcomes in diabetes. A summary of 26 articles revealed the positive impact PWPs have on patient outcomes, patient-provider communication, disease management, and access to and patient satisfaction with health care. Innovative and useful approaches included the evaluation of specific components of the PWPs, assessing the impact of PWPs on mediators of health behaviors, such as patient distress, identification of barriers to use, and patient willingness to pay for access. Future research should focus on relevant processes that mediate patient and provider use, impact on health care utilization, and a patient-centered approach to the design and integration of educational opportunities afforded through PWPs.

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Section: Discussionmentioning

confidence: 99%

Patient Web Portals to Improve Diabetes Outcomes: A Systematic Review

et al. 2010

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“…The mobile phone can also provide an additional link between the health care professional and the patient for personalized feedback (eg, reminders, statistics, or medical advices) [9,10,14,16], education [12,13], or motivation [23]. In addition to technical feasibility, several studies have already pointed out the impact on adherence to therapy [11,12] and self-management [10] when mobile phones are used.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of a Mobile Phone–Based Data Service for Functional Insulin Treatment of Type 1 Diabetes Mellitus Patients

Kollmann¹,

Riedl²,

Kästner³

et al. 2007

J Med Internet Res

118

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BackgroundPatients with type 1 diabetes mellitus (DM1) have to be active participants in their treatment because they are inevitably responsible for their own day-to-day-care. Availability of mobile Internet access is advancing rapidly and mobile phones are now widely available at low cost. Thus, mobile phones have the potential to assist in daily diabetes management and to enable a telemedical interaction between patients and health care professionals.ObjectiveThe aim of the study was to evaluate the feasibility and user acceptance of a mobile phone–based data service to assist DM1 patients on intensive insulin treatment.MethodsA software application called Diab-Memory (based on Java 2 Mobile Edition) has been developed to support patients when entering diabetes-related data with synchronization to the remote database at the monitoring center. The data were then processed to generate statistics and trends, which were provided for the patient and his/her health care professional via a Web portal. The system has been evaluated in the course of a clinical before-after pilot trial. Outcome measures focused on patients’ adherence to the therapy, availability of the monitoring system, and the effects on metabolic status. General user acceptance of the system was evaluated using a questionnaire.ResultsTen patients (four female) with DM1 participated in the trial. Mean age was 36.6 years (± 11.0 years) and prestudy glycated hemoglobin (HbA1c) was 7.9% (± 1.1%). A total of 3850 log-ins were registered during the 3 months of the study. The total number of received datasets was 13003, which equates to an average of 14 transmitted parameters per patient per day. The service was well accepted by the patients (no dropouts), and data transmission via mobile phone was successful on the first attempt in 96.5% of cases. Upon completion of the study, a statistically significant improvement in metabolic control was observed (HbA1c: prestudy 7.9% ± 1.1% versus poststudy 7.5% ± 0.9%;P= .02). While there was a slight decrease in average blood glucose level (prestudy 141.8 mg/dL ± 22.5 mg/dL vs poststudy 141.2 mg/dL ± 23.1 mg/dL;P= .69), the difference was not statistically significant.ConclusionThe results of the clinical pilot trial indicate that this proposed diabetes management system was well accepted by the patients and practical for daily usage. Thus, using the mobile phone as patient terminal seems to provide a ubiquitous, easy-to-use, and cost efficient solution for patient-centered data acquisition in the management of DM1. To confirm the promising results of the pilot trial further research has to be done to study long-term effects on glycemic control and cost-effectiveness.

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“…Even more advanced systems have been developed in which the data will be translated by the computer and dose adjustments are sent back to the patient with minimal interaction from the health care team. 3 This fully automated program is still being tested. Other web-based applications encourage patients to practice dose adjustments on a simulator, which accounts for insulin sensitivity, type of insulin, dietary intake, and physical activity (AIDIA2).…”

Section: Discussionmentioning

confidence: 99%

Analysis: Automated Messaging System for Diabetes: An Ounce of Prevention

Malasanos

2005

Diabetes Technology & Therapeutics

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T HE COMPLEXITY OF DIABETES CARE and the flood of newly diagnosed patients in the face of reimbursement cutbacks have created an almost unmanageable clinical load. Automation and self-management may be the most viable solution to this problem. For example, if the average endocrinologist cares for 400 patients with diabetes and if they attain the goal of checking their blood glucose (BG) four to six times per day and send them each to be reviewed by the health care team, that creates more than a half million data points to review each year. The current standard of care is to review BG data at clinic visits while relying on patients to call the health care team if there are "problems" or 911 if there are perceived emergencies. This system allows broad interpretation by the patient, potential long delays in contacting the health care team during illness, and more frequent emergency department and/or hospital usage rather than timely phone management. In addition this standard of care renders a huge portion of the data useless at analysis, since the review may be months after the collection.The logical solution then would be to encourage data collection and provide the knowledge and tools required to react independently to the data collected. When each data point is used to make a decision, this in itself motivates collection of the data and influences frequent dose adjustments and behavior changes and can lead to improved metabolic control. While the paper by Leu et al. 1 in this issue of DTT did not specifically discuss BG data management or dose adjustments, the program did generate alerts for out-of-range data sent by pager for review. The patient was not required to send data.The automated system in this paper is used as a reminder to perform scheduled tasks, such as exercise, to take medications, or to check BG levels, as preselected by the patients. The patient could then reply with a canned or typed response. The program sent approximately 500 automated messages to each patient, and generated (when the two high responders were excluded) a 14% response rate: 0.1% of all sent messages generated responses that were noncanned and therefore went directly to the investigator, and 14% of those required further action. For 21 patients in the pager group 114 calls requiring investigator attention over 5 months is fairly high. The ability to type messages increases the attention needed to maintain the system. This is especially evident by the two highresponding patients who each replied to over 85% of their messages. By restriction of the responses to more varied canned responses with acknowledged requests for investigator attention the time required by the health care team may have been reduced by this program. The majority of messages requiring attention were about technical problems.Though the authors conclude that the patients felt more supported in the pager group

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Management of Patients with Diabetes Through Information Technology: Tools for Monitoring and Control of the Patients' Metabolic Behavior

Cited by 40 publications

References 16 publications

Patient Web Portals to Improve Diabetes Outcomes: A Systematic Review

Patient Web Portals to Improve Diabetes Outcomes: A Systematic Review

Feasibility of a Mobile Phone–Based Data Service for Functional Insulin Treatment of Type 1 Diabetes Mellitus Patients

Analysis: Automated Messaging System for Diabetes: An Ounce of Prevention

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