Telemedicine as a tool for intensive management of diabetes: the DIABTel experience

This paper presents the current features of the DIABTel telemedicine system and the evaluation outcomes of its use in clinical routine. This telemedicine system is designed to complement the daily care and intensive management of diabetic patients through telemonitoring and telecare services. The system comprises a patient unit (PU) used by patients in their day-to-day activities and a Medical Workstation used by physicians and nurses at hospitals. Both applications offer tools to collect, manage, view and interpret data and to exchange data and messages. The system was evaluated for usability, telemedical protocols, metabolic control and quality of life. This evaluation consisted in a 6-month cross-over pilot study with ten Type I diabetic patients. The results of the evaluation allowed assessment of the telemedicine protocols in terms of the number of communications/patient (21.6+/-7.7); days between communications (5.4+/-2.66); messages sent by physicians (118 text messages); and data and messages transmitted by patients (3524 blood glucose readings, 1649 day-to-day insulin adjustments, 24 exercise reports, ten diet modifications and 63 text messages). Physicians performed more therapeutic changes during the DIABTel period than in the control period. There was a trend towards HbA1c improvement during DIABTel use with no incidence in the number of hypoglycaemias. This pilot study demonstrates the feasibility of the DIABTel system in clinical routine use and its potential benefits for diabetes care: improving the availability of information necessary for therapy adjustments; offering new physician-patient communication tools; increasing patient empowerment and education; and showing a positive trend towards improving the metabolic control of patients. Further studies are needed to validate these findings and to promote telemedicine as an opportunity to better diabetes care.

[1]  B Pal,et al.  Internet helps communication between doctors and patients , 2000, BMJ : British Medical Journal.

[2]  Enrique J. Gómez,et al.  A broadband multimedia collaborative system for advanced teleradiology and medical imaging diagnosis , 1998, IEEE Transactions on Information Technology in Biomedicine.

[3]  M. Levy,et al.  SESAM-DIABETE, an expert system for insulin-requiring diabetic patient education. , 1989, Computers and biomedical research, an international journal.

[4]  W K Waldhäusl.  Finally we have arrived in a new millennium , 2001, Diabetologia.

[5]  F. del Pozo,et al.  Telemedicine for diabetes care: the DIABTel approach towards diabetes telecare. , 1996, Medical informatics = Medecine et informatique.

[6]  Luigi Portinale,et al.  Diabetic patients management exploiting case-based reasoning techniques , 2000, Comput. Methods Programs Biomed..

[7]  S. Genuth,et al.  The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. , 1993, The New England journal of medicine.

[8]  Enrique J. Gómez,et al.  Feasibility of diabtel use in the follow-up of type 1 diabetic patients , 2000 .

[9]  Ërodiabeta.  Information Technology for Diabetes Care in Europe: the EURODIABETA Initiative , 1990, Diabetic medicine : a journal of the British Diabetic Association.

[10]  P. Z. Zimmet.  Errata: Diabetologia (1999) 42: 499–518 , 1999, Diabetologia.

[11]  Francisco del Pozo,et al.  Telemedicine: a new model of health care , 1999 .

[12]  Ewart R. Carson,et al.  Computers in diabetes - an introduction , 2000, Comput. Methods Programs Biomed..

[13]  R A Rizza,et al.  Towards an optimal model for community-based diabetes care: design and baseline data from the Mayo Health System Diabetes Translation Project. , 2000, Journal of evaluation in clinical practice.

[14]  M. Marre,et al.  Telematic Transmission of Computerized Blood Glucose Profiles for IDDM Patients , 1991, Diabetes Care.

[15]  Waldhäusl Wk.  Finally we have arrived in a new millennium. , 2001 .

[16]  N. Farid,et al.  Telephone Modem Access Improves Diabetes Control in Those with Insulin-Requiring Diabetes , 1992, Diabetes Care.

[17]  E D Lehmann.  Application of information technology in clinical diabetes care--a special issue. Part 2. Models and education. , 1997, Medical informatics = Medecine et informatique.

[18]  A de Leiva,et al.  European Dimension of Diabetes Research. , 1996, Diabetologia.

[19]  F. del Pozo,et al.  A telemedicine distributed decision-support system for diabetes management , 1992, 1992 14th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[20]  A. Albisser,et al.  Diabetes intervention in the information age. , 1996, Medical informatics = Medecine et informatique.

[21]  Enrique J. Gómez,et al.  Evaluation of DIABNET, a decision support system for therapy planning in gestational diabetes , 2000, Comput. Methods Programs Biomed..

[22]  E H Shortliffe,et al.  Health Care and the Next Generation Internet , 1998, Annals of Internal Medicine.

[23]  L Abrams.  $28 million DHHS grant for diabetes care goes to Columbia University. , 2000, Telemedicine today.

[24]  E D Lehmann.  Application of information technology in clinical diabetes care--a special issue. Part 1. Databases, algorithms and decision support. , 1996, Medical informatics = Medecine et informatique.

[25]  C Seiboth,et al.  An evaluation of a network for professional development in child and adolescent mental health in rural and remote communities , 2000, Journal of telemedicine and telecare.