|
Mobile Doctor - UK
Diabetes mellitus is a chronic and currently incurable condition in which the body is unable to regulate blood sugar levels. Diabetics have to monitor their own blood sugar levels by testing their blood and recording the results. A new technology is making this process easier. Using mobile phone technology, diabetics can record their blood sugar levels and remotely send them to a database run by the Department of Engineering Science at the University of Oxford. This provides the patient with detailed information on their health trends.
Diabetes
Under normal circumstances, the hormone insulin, which is made by the pancreas, controls how much sugar (or glucose) is in the blood. With diabetes, the body cannot use the glucose properly, either because of a lack of insulin (type 1 diabetes) or because the available insulin is not effective (type 2 diabetes). The prevalence of type 1 diabetes is about 1 in 500 in the UK and its incidence in childhood has more than doubled over the last two or three decades.
Unless they are managed properly, both type 1 and type 2 diabetes can cause serious long-term health problems such as heart disease, stroke, blindness, kidney damage and nerve damage. The overall result of these complications means that sufferers have a significantly reduced life expectancy. These complications are related to hyperglycaemia (high blood sugar levels) and generally occur from the second decade onwards after diagnosis.
Low blood sugar levels can lead to coma (hypoglycaemia) and if untreated this may result in death. The annual incidence of hypoglycaemia requiring hospital treatment is about 1 per 10 patients and the mortality of patients under 50 is about 1 in 500.
These complications are, however, potentially preventable. Unfortunately, many patients in their late teens and early twenties tend not to monitor their blood sugar levels and so have poor glycaemic control. They are therefore at substantially increased risk of long term complications. To optimise glycaemic control, patients need to alter their insulin dose to take account of their energy intake and anticipated physical activity. Diabetes UK currently recommends that people with diabetes aim to keep their blood levels at 4-7 mmol/l (millimoles per litre) before meals (preprandial) and at no higher than
10 mmol/l two hours after the meals (postprandial). Studies have shown that tight blood glucose control (and blood pressure control) could reduce the risk of developing diabetic complications. The target blood glucose level used in the studies, and backed up by previous epidemiological research, was the same as that for people without diabetes (about 4-7 mmol/l, regardless of food intake).
NOTE
To convert mmol/l measurements (used in countries such as the UK, Canada and Scandanavia) into mg/dl (milligrams per deci-litre) – the measurements used in the USA and Germany - simply multiply by 18 to reach a measurement in mg/dl. To convert from mg/dl to mmol/l, divide by 18. |
Self-monitoring of blood sugar levels can have considerable benefits:
· It allows patients to see the immediate impact of particular behaviours, such as dietary habits or physical activity, on their blood glucose levels.
· It allows people with other conditions to identify whether they are feeling unwell due to blood glucose levels or another cause.
· It gives people confidence about their blood glucose levels at critical times, such as before driving or at work.
· It provides reassurance and removes the fear of hypoglycaemia, which cannot be detected by urine testing.
The National Institute for Clinical Excellence (NICE) recommendations for self-monitoring:
· Self-monitoring should not be considered a stand-alone intervention.
· Self-monitoring should be taught if the need/purpose is clear and agreed with the patient.
· Self-monitoring can be used in conjunction with appropriate therapy as part of integrated self-care. |
e-San
e-San initially evolved by using electronic media to overcome health problems. e-San’s technology allows clinicians to use the web to review patient's feedback more frequently as well as build up an accurate historical log of symptoms and clinical readings. e-San’s health system allows greater patient care, by providing immediate feedback as well as greater convenience and flexibility due to the reduction in time spent visiting clinics and hospitals.
Over 500 patients have been part of trial programmes over the past two years. The trials have been run in conjunction with a number of clinical and business partners, including Aberdeen University, the Bristol Royal Infirmary, the Isle of Man DHSS, Oxford University and the Vodafone Group Foundation.
Glucose Trials
Blood glucose tests provide feedback, but the recognition and interpretation of patterns of test results is complex because they occur in the context of changes in diet and physical activity. To help resolve the complex process, e-San is providing technology in a trial run by the University of Oxford’s Department for Engineering Science, which is sponsored by Vodafone Group International. The integrated monitoring device for diabetics combines an electronic blood glucose meter and a special kind of mobile phone (GPRS).
 |
| Courtesy of e-San |
The technology is being evaluated in a randomised controlled trial in a group of 100 young adults with diabetes. The purpose of the trial is to determine how technology can be used to improve glycaemic control and enhance self-management for young adult patients. Within seconds of sending personal information to the e-San database, the patient receives feedback direct to the phone where specialist pre-loaded software turns it into a full colour graphical display. The patient can see the record of blood sugar levels over the past 24 hours, displayed between two horizontal lines. The upper line represents the recommended maximum blood sugar level. The lower line indicated the level below which there is a likelihood of a hypoglycaemic coma (a ‘hypo’). A two-week summary of the data is also available on the phone.
Think Positive
People wishing to use e-San’s technological solutions can purchase a pre-packaged measurement instrument and mobile phone. This includes e-San software for retrieving measurements and transmitting them to the e-San server. A secure web page can be accessed showing historical readings. Patients can then view their data online or on their mobile phone.
Think positive ('t+') products will be available on a range of phones and tariffs to allow consumers to pick the style of phone and contract that best suits them. |
The incoming readings are monitored on a remote server and intelligent software automatically informs a Diabetes Specialist Nurse when required. This allows the nurse to offer support to individuals at a time when blood glucose levels have moved outside the individual’s personal target zone (the area between the two horizontal lines, defined by the model of normality for that individual). Whenever this occurs, the software on the server alerts the nurse who checks the readings by accessing a secure web page on the e-San server. The nurse then contacts the patient on their GPRS phone, identifies the concerns and problems, and agrees on revised goals.
Lionel Tarassenko, Professor of Electrical Engineering at the Department of Engineering Science, believes that the technology represents a leap forward in the management of diabetes:
“An exceptionally diligent patient, who religiously records their blood glucose levels in a diary, will have access to the same information that we are providing via mobile to participants in the trial. But that diligent patient is very rare. Almost nobody bothers to fill in diaries. Many diabetes sufferers are young, feel healthy and think they’ve got better things to do with their time…. This is all about effective patient education. Our approach is unique because it delivers real-time feedback…the immediate response helps patients make better decisions as regards diet and exercise. We are not prescribing a change to a patient’s insulin regime…. If we were to rely on SMS messaging, there would be a delay of between 5 and 20 minutes before the patient received feedback. It would be far less effective.” |
Hugo Tewson, a patient taking part in the trial, has been amazed at how the technology has fitted into his lifestyle:
“I used to find controlling my diabetes very difficult, even though I know a lot about it, but using the Think Positive Diabetes system has really changed the way I manage everything. Using a normal blood glucose monitor and recording the results in a written journal didn’t give me the full picture of my condition because it was difficult to read and hard to see a true pattern, especially when I ended up missing out data, either because it was a tedious process or because I knew my levels were high and subconsciously left them out. The t+ System has turned what was a vicious cycle into a virtuous one and made the whole process easier and more rewarding for me.” |
The system is also beneficial for GPs. The main problem GPs face is getting patients to test their blood. Mobile phones are such a part of people’s lives that the t+ system can become a day-to-day activity. The system informs GPs whether their patients have done a blood test or not and gives them accurate figures to work with.
Conclusion
Average glucose levels in healthy individuals are about 5-6 mmol/l, while levels in a typical diabetic exceed 10 mmol/l. A reduction of just 1% in blood glucose levels has a significant impact on the severity of diabetes related illness. The technology offered by a partnership between e-San, the University of Oxford and Vodafone Group Foundation significantly helps monitor blood glucose levels. It therefore has the capability to lead to a significantly greater life expectation and enhanced quality of life.
Further Information
Reference Materials
National Institute for Clinical Excellence (2002). Management of Type 2 Diabetes: Management of Blood Glucose. London: National Institute for Clinical Excellence.
The National Collaborating Centre for Chronic Conditions (2004). Type 1 Diabetes in Adults: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care. London: Royal College of Physicians.
Participating Organisations
e-San Ltd
Magdalen Centre
Oxford Science Park
Oxford OX4 4GA
United Kingdom
Tel: +44 (0)1865 784 090
Email: enquiries@e-san.co.uk
Website: http://www.e-san.co.uk/index.html
University of Oxford Department of Engineering Science
Parks Road
OXFORD
OX1 3PJ
UK
Tel: +44 (0)1865 273000
Fax: +44 (0)1865 273010
E-mail: administrator@eng.ox.ac.uk
Website: http://www.eng.ox.ac.uk/
Donor and Supporting Organisations
Department for International Development (DFID)
1 Palace Street,
London
SW1E 5HE
Tel: +44 (0)20 7023 0000
Fax: +44 (0)20 7023 0019
E-mail: enquiry@dfid.gov.uk
Website: http://www.dfid.gov.uk/
Vodafone Group Foundation
Vodafone House
The Connection
Newbury
Berkshire RG14 2FN
UK
E-mail: groupfoundation@vodafone.com
Website: http://www.vodafonefoundation.org/
USAID
Information Centre
Ronald Reagan Building
Washington, D.C. 20523-1000
Tel: +1 202-712-4320
Fax: +1 202-216-3524
Website: http://www.usaid.gov/
Resources
Diabetes UK
10 Parkway, London NW1 7AA
Tel: +44 (0)20 7424 1000
Fax: +44 (0)20 7424 1001
E-mail info@diabetes.org.uk
Website: http://www.diabetes.org.uk/home.htm
Healthlink Worldwide
Cityside, 40 Adler Street
London E1 1EE
United Kingdom
Tel: +44 20 7539 1570
Fax: +44 20 7539 1580
Email: info@healthlink.org.uk
Website: http://www.healthlink.org.uk/
Practical Action Technical Information Service
Schumacher Centre for Technology Development
Bourton Hall
Bourton On Dunsmore
Warwickshire
CV23 9QZ
UK
Tel: +44 - 01926 634462
Fax: +44 - 01926 634401
Website: www.practicalaction.org/ technicalinformationservice
ITDG Publishing
Schumacher Centre for Technology Development
Bourton Hall
Bourton On Dunsmore
Warwickshire
CV23 9QZ
Tel: +44 (0)1926 634501
Fax: +44 (0)1926 634502
E-mail: marketing@itpubs.org.uk
Website: www.itdgpublishing.org
|
