Use of telemedicine in subjects with type 1 diabetes equipped with an insulin pump and real-time continuous glucose monitoring

Abstract

We evaluated a telemedicine system in patients with type 1 diabetes who had optimized treatment with an insulin pump and a real-time continuous glucose monitoring system. We conducted a prospective, one-year study of 15 subjects. Three medical visits took place: pre-baseline, baseline and at 6 months. Each month the subjects transmitted information from the glucose meter, glucose sensor and insulin pump. We adjusted the treatment and returned the information by email. We evaluated psychological and metabolic variables, including HbA(1c), hypoglycaemia, hyperglycaemia and glucose variability. At baseline the mean age of the subjects was 40 years and the mean duration of diabetes was 22 years. There was a significant reduction in HbA(1c) (7.50 to 6.97%) at 6 months, a significant increase in the number of self-monitoring blood glucose checks per day (5.2 to 6.2), and significant improvements in variability: MODD, mean of daily difference (67 to 53) and MAGE, mean amplitude of glycaemic excursions (136 to 102). There were significant improvements in quality of life (92 to 87), satisfaction with the treatment (34 to 32) and less fear of hypoglycaemia (36 to 32). Adult subjects with type 1 diabetes on treatment with a continuous insulin infusion system and a real time glucose sensor and who have acceptable metabolic control and optimized treatment can benefit from the addition of a telemetry system to their usual outpatient follow-up.

Human Factors and Data Logging Processes With the Use of Advanced Technology for Adults With Type 1 Diabetes: Systematic Integrative Review

“…Martinez-Sarriegui et al [ 33 ] analyzed patient behavior when using the intervention of telemedicine system combined with CGM to identify how the CGM data captured participant interactions with the mobile system. In 2 phases of the experiment (with and without the telemedicine system), participants were provided with tools for visualization, management of monitoring data, and wireless downloading of data from an insulin pump via a personal smart assistant running on a personal digital device.…”

“…Given that the inclusion criteria for the Tansey et al [ 27 ] study were prior high frequency of self-monitoring, it is not clear if the technology was a mediating factor for engagement. The Martinez-Sarriegui et al [ 33 ] study was limited by a small sample size (n=10) and did not include any details about how the study instrument was developed or how the participants valued the feedback from the telemedicine system. Furthermore, there was a possibility for margin of error with the Kamble et al [ 32 ] study as it was not clear how participants measured time costs.…”

Human Factors and Data Logging Processes With the Use of Advanced Technology for Adults With Type 1 Diabetes: Systematic Integrative Review (Preprint)

“…The 18 studies included in this review consist of 5 qualitative studies [40][41][42][43][44], 5 experimental studies [31][32][33][34][35], 3 observational studies [28][29][30], 4 cross-sectional studies [36][37][38][39] and 1 mixed methods [45]. Five of the studies were smaller samples drawn from parent clinical trials [29,32,38,40,41].…”

“…Gonzalez et al [34] evaluated the overall effect of adding a telemedicine system for adults with T1DM who were treated with an insulin pump and real-time CGM. This was a longitudinal study that measured the physical and psychological outcomes of the intervention.…”

Emerging Role of Digital Technology and Remote Monitoring in the Care of Cardiac Patients

“…Widespread adoption of many of these devices and resources has led to improved quality of life and survival in affected patient populations. [1][2][3][4][5][6][7][8][9] Heart disease remains the leading cause of death in the United States. 10 Despite progressive decline in deaths due to coronary artery disease and acute myocardial infarction attributed to the combination of public awareness, early treatment, and aggressive preventive strategies, a large percentage of health care spending is devoted to the management of patients with heart disease.…”