Diabeo: a tool forTele-Diabetes, Educating and supporting diabetic patients over distance

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5 Νοε 2013 (πριν από 3 χρόνια και 9 μήνες)

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Diabeo: a tool forTele
-
Diabetes,
Educating and supporting diabetic
patients over distance










IGOR TAUVERON







CHU Clermont
-
Ferrand








AUVERGNE








France










What is diabetes ?

high glucose (sugar) concentration in blood


OK , but what else?


HYPERglycaemia


is bad for diabetics


But HYPOglycaemia
is not good either

Call 112

Aim is balance

Auvergne








population

1
.
3

M








area

26

000
Km
2

























hilly

région

Diabetics # 5 % population

Diabetologists # 18 qualified diabetologists

Perspectives: Reduction in number of GP




until 2025 (rural medical deserts)

Increasing number of diabetics ( France reached its 2016 target)

For patients with intensified insulin
treatment, how can mobile and/or web
technology help to decide their proper
insulin dose ?

For patients with type 2 diabetes, how to
improve care when introducing insulin ?

For isolated patients (type 1 or 2) or health care professionals,

how to improve quality of care ?

The DIABEO System


A tool to improve the management and the monitoring of
patients with type 1 diabetes

Electronic
diary

Bolus
Calculator

Insulin dose
Adaptation

Remote access to the electronic
diary via internet

Physician

Patient

))))))

))))))

3.
Electronic

Systems
helping

decision

making

Primary efficacy outcome: the use of DIABEO
improves HbA1c at 6 months



8
8,2
8,4
8,6
8,8
9
9,2
9,4
< 1 an
M0
M3
M6
Suivi habituel
DIABEO + Suivi
habituel
DIABEO + Suivi
téléphonique
p < 0,002

Δ

=
-

0.9%

p = 0,022

Secondary safety endpoints:


better BG control without increased risk of
hypoglycemia with DIABEO.

4,5
5,5
4,4
5,6
5
1,8
0
1
2
3
4
5
6
Suivi habituel
DIABEO + Suivi
habituel
DIABEO + Suivi
téléphonique
Toutes hypo (n
moyen les 15 jours
précédent M6)
Sévères (entre M0 et
M6, % des patients)
All hypoglycemic

Events



Severe hypoglycemic

Events
(between M0
and M6, % of patients)

G1

G2

G3

No more time spent for physicians;


patients in G1 and G2
spent nearly five hours
more than patients in G3 attending hospital visits.


1,2
7,1
1,2
8,3
1,2
1,2
0
1
2
3
4
5
6
7
8
9
Suivi habituel
DIABEO + Suivi
habituel
DIABEO + Suivi
téléphonique
Temps de
consultation*
Prise en charge
totale**
p

0.001

Hours

-

No difference between the 3 groups for total time spent on follow
-
up

-

For participants in G1 & G2, an additional 274
±

178 minutes were spent by
participants in G1 and 288
±

218 minutes for G2 travelling to and from the hospital,
carrying out administrative procedures and waiting time, whileG3 participants did not
lose overtime.

For patients with Type 2 Diabetes, How
can mobile and/or web technology help ?

Hindrance :

1.
Older people vs technology ?

2.
Mass education ?

3.
Cost issue and lack of Health Care Professionnel?


The goals :

1.
To improve patients skill in diet, physical exercise,
BG monitoring and treatment adaptation

2.
To propose real time
Decision Support

Conclusion :

the ideal Mobile and
Web Diabetes Management Coaching Tool :

Either

Plug
-
in
Glucometer


Diet

Diectory

Or
Integrated

CGM

Decision
Support

Software

Real Time

Support Decision

Telemonitoring

Teleconsultation


Either

Plug
-
in
Glucometer


Or
Integrated

CGM

Decision
Support

Software

Real Time

Support Decision

Telemonitoring

Teleconsultation


Specialized Nurses

Diabetologist

Dietician

???

Teleexpertise

Teleassistance

Acknowledgements

Dr Béatrice ROCHE

Nurse team

Diabétologie



Dr Guillaume CHARPENTIER

Diabétologie

itauveron@chu
-
clermontferrand.fr