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Successful diabetes management depends on strict patient adherence to the regimen of blood glucose monitoring, medication use, skin care, diet and exercise. Attempts to apply telemedicine for diabetic care were begun in the early 1990s. The solutions used in the early phase were based on communication through a standard telephony network. The first experience from the application of telemonitoring systems in patients with diabetes showed that they can be helpful in reduction of the incidence and severity of complications of type 1 diabetes and probably also in patients with type 2 diabetes[51][57][67].

The main objective of blood glucose measurements in diabetics is achieving optimum therapy. The monitoring process is based on sampling blood glucose levels carried out by the patient or the caregiver. Blood glucose measurements usually should be accompanied by blood pressure monitoring. The measurements are entered into a personal computer connected to the Internet and sent to the monitoring centre. In early solutions standard telephone lines were used for data transmission. In this scenario patient involvement in the measurements is necessary. Another option relies on the use of transcutaneous biosensors making automatic measurements of blood glucose levels and then transmitting the results to a personal computer linked to the Internet. Web-based systems with telemonitoring designed for use by patients and health professionals bring new advantages like long-term management options, access to electronic patient record and decision support[65].

The support received by patients with diabetes through e-health platforms may take various forms. Patients appreciate the educational and self-management applications, opportunity to stay in touch with support groups, intervention focused on specific activities included in diabetes management, e.g. physical training or enhanced communication with health professionals [15] [49] [59] [78]. The results of trials on the use of telemonitoring systems in patients with diabetes showed favourable influence on monitored parameters (haemoglobin A1C level, body weight, blood glucose).

Within research and development programmes of the European Commission several projects focussed on telemonitoring of chronic patients were funded. The Multi-Access Services for the Management of Diabetes Mellitus (M2DM) Project was focussed on improvement of quality of diabetes management[4]. Its main objective was to provide patients and health professionals with around-the-clock support in order to improve quality of care. The service is accessible through the Web or interactive voice responder system. Data from the measuring devices may be sent due to use of smart modems. DIABtel Telemedicine Service described by Gomez et al. was based on the concept of "supervised autonomy"[30]. Such approach enables patients with chronic conditions to maintain an active professional and social life. The patient unit was developed as a handheld computer that can be used by the patient during daily activities. Telemedical systems addressing specific areas of diabetes care like pregnancy or foot care were also developed[43][50].

New York State financed one of the greatest projects in the field of home telemonitoring — the Informatics for Diabetes Education and Telemedicine Project (IDEATel)[34][68]. It is focused on patients with diabetes from urban and rural areas. The Project was initiated in 2000, and it is conducted as a randomized clinical trial. Its main objective is evaluation of how telemedical application can improve diabetes control. Patients were equipped with home telemedicine units with four functions: synchronous videoconferencing over standard telephone lines, electronic transmission of glucose and blood pressure readings, secure Web-based messaging and clinical data review as well as access to Web-based educational materials. The automatic alerts can be generated if the data entered by the patient exceed expected values. The concept of home telecare and remote monitoring is accompanied in this initiative with the notion of the patient's access to the electronic medical record. The home telemedicine unit gives patients numerous modes of interaction with their personal online charts.

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