P2037 Télémédecine et Coopération interprofessionnelle médecin/infirmier, qu’en est-il en pratique ?

Franc, Sylvia; Juy, O.; Chaillous, Lucy; Benhamou, Pierre‐Yves; Penfornis, A.; Sonnet, E.; Mounier, S.; Petit, M.; Boscus, O.; Tarle, S. F.; Laroye, H.; Canipel, L.; Charpentier, G.

doi:10.1016/s1262-3636(13)71947-5

Cited by 1 publication

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“…The third program was developed to help and define tasks for nurses to whom work has been entrusted by the doctor, within the context of a 'personalized training plan'. This program has already undergone preliminary assessment [19].…”

Section: Fourth Level: Decision-support Systemsmentioning

confidence: 99%

Devices to Support Treatment Decisions in Type 1 Diabetes: The Diabeo System

Franc¹,

Charpentier²

2014

Frontiers in Diabetes

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Blood glucose control in type 1 diabetes has improved considerably since the DCCT due to general diffusion of 'physiological' basal-prandial therapeutic schedules, generalization of therapeutic educational programs, functional insulin therapy, insulin analogues, and insulin pumps. However, glycated hemoglobin (HbA 1c ) averages 8% within various studies, which is still unsatisfactory. The creation of new technological tools could lead to new levels of success, as attested by the Diabeo system. This system comprises three programs. The first program automatically calculates basal and prandial insulin doses while taking account of blood glucose levels, carbohydrate intake, and physical activity, and is equipped with algorithms that allow automatic adjustment based on the results obtained. The entire system must first of all be configured by the doctor according to the patient's characteristics, and then it has to be downloaded to a smartphone from a secure website. All of the patient's results and data are then made available for consultation at all times by authorized caregivers, enabling remote monitoring to be performed. The second program analyzes the results and automatically generates coaching messages for the patient and messages for the caregiver in the event of underuse, unsatisfactory results, or inadequate operation of the system. The caregiver may then intervene in a timely fashion via a telephone consultation or modification of the patient's treatment profile. The third program optimizes the doctor's available time by delegating tasks and allowing action to be undertaken by a specialized telemedicine nurse working in conjunction with the responsible diabetologist. An initial version of the system, comprising only the first of these three programs, resulted in a mean reduction in HbA 1c of 0.9% at 6 months versus the control group in a population of patients with chronic glycemic control problems and treated with multiple injections or insulin pump. Analysis of individual patient data shows that the most compliant patients derived the greatest benefit from the dose calculation function, while less compliant patients benefited considerably from the telemonitoring function, which allowed short but repeated consultations at opportune moments. A large-scale national study is currently being initiated in France to confirm these favorable metabolic results at 1 year and to assess the medicoeconomic impact of this system after 2 years of use. Ultimately, the results may lead to granting of reimbursable status for the Diabeo system by the French national social security authorities, followed by widespread use of the system in France and international availability.

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Section: Fourth Level: Decision-support Systemsmentioning

confidence: 99%