Telemedicine for diabetes care: The DIABTel approach towards diabetestelecare

Abstract

Telemedicine is modifying classical health care by providing effective solutions to an increasing number of new situations. This article summarizes the potential benefits made available by this technology in diabetes care, and describes in detail how the new DIABTel Telemedicine Service complements the daily care of diabetic patients. The basic functions of the telemedicine system include telemonitoring of patient's blood glucose data and self-management actions, and remote care from doctors to diabetic patients. The system's architecture comprises two main components: the Medical Workstation, a PC-based system to be used by physicians and nurses in Diabetes Day Centre units in hospitals, and the Patient Unit, a palmtop-computer to be used by patients in their day to day activities. Both components, in an integrated approach, offer tools to doctors and patients for data collection and management, viewing and interpretation modules, data/message exchange services and an interactive glucose/insulin simulator for educational purposes. The DIABTel telemedicine diabetes care procedure aims: (1) to improve communication of the patient with the hospital-based diabetologist, in between the patient's visits to the clinic; (2) to allow doctors to assess the patient's condition on a frequent basis (every week); (3) to help patients with management in the daily care of diabetes, and (4) to provide patients with a service of 'supervised autonomy', to increase patient's independence without decreasing the necessary continual support and supervision from the doctor. Finally, we discuss the practical problems, limitations and vital issues regarding implementation of the telemedicine service.

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

“…11 They designed a microcomputer that allowed data interchange between doctor and patient. The next system developed by this group was called DIABTel 12 and included a function of glucose data download from the glucometer, with subsequent versions that bring us to the present. Other TM experiences took further steps toward the model most of us recognize; the following ones are good examples: the TIDDM project, 13 using Internet and including a smart analysis for insulin dose counseling; the Computer-Assisted Meal-Related Insulin Therapy project, 14 one of the first to demonstrate a significant change in hemoglobin A1c; the Multiaccess Services for Diabetes Management project, allowing "multi-access" from many different devices; the Informatics for Diabetes Education and Telemedicine study, 15 which included more than 2000 patients in two cohorts from socially underserved areas of New York, obtaining a reduction in hemoglobin A1c; and finally the Intelligent Control Assistant for Diabetes project, 16 integrating, for the first time, CGM into a smart TM platform with positive results in terms of hemoglobin A1c and glucose variability.…”

The Promise of Technology in the Management of the Patient with Diabetes

“…Gomez et al 47 used DIABTel, a telemedicin e program that had both a hospital-based workstation and a palmtop carried by the patients. This allowed telephone support for diabetics who could obtain computer-based recommendations for adjustments of their blood sugars.…”

Bringing the Artificial Pancreas Home: Telemedicine Aspects

“…After the early work on the "Biostator" artificial pancreas 1 and the test of portable computerized systems for decision support, 2,3 the first telemedicine systems have been implemented and tested. [4][5][6][7] Such interest has been motivated by the inherent complexity of blood glucose control and caring for patients with diabetes. As a matter of fact, as reported elsewhere, [8][9][10] diabetes management can be seen as a hierarchical control system where day-by-day glucose control algorithms are implemented in accordance to a strategy that is revised on a visit-by-visit basis.…”