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Journal of Diabetes Science and Technology 2009

Diabetes Connected Health: A Pilot Study of a Patient- and Provider-Shared Glucose Monitoring Web Application. Journal of Diabetes Science and Technology 2009 Alice J. Watson,Joseph C. Kvedar,Basmah Rahman,Alexandra C. Pelletier,Gregory Salber,and Richard W. Grant. Outline. Background

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Journal of Diabetes Science and Technology 2009

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  1. Diabetes Connected Health: A Pilot Study of a Patient- and Provider-Shared Glucose Monitoring Web Application Journal of Diabetes Science and Technology 2009 Alice J. Watson,Joseph C. Kvedar,Basmah Rahman,Alexandra C. Pelletier,Gregory Salber,and Richard W. Grant

  2. Outline • Background • Research Design and Methods • Results • Discussion • Lessons Learned • Implications for Future Research

  3. Background • “current standard of care” frequently fails to deliver on evidence-based recommendations for practice. • Requirements for more transparent reporting of outcomes and new payment systems that reimburse based on outcomes rather than visit. • A remote blood glucose monitoring application [“DiabetesConnected Health“(DCH)] • Allows patients to upload glucometer readings from commercially available glucometers.

  4. Research Design and Methods • Both patients and providers had access to this Web site, where the data could be viewed, analyzed, and discussed. • Subjects were recruited from a primary care practice. • 20(8 decline)→12(5 ineligible)→7 • Prominently featured a graphic representation of blood glucose readings. • A “journal” page allows patient to make notes and comments about each reading.

  5. Provider can access to patient blood glucose readings and notes. • One-way messaging allowed provider to send comments to each patient. • Each participant was asked to upload their readings using the modem once per day.

  6. Results • Participant Satisfaction: • Five “Excellent” or “Good” • Remaining “Average” or “Satisfactory”

  7. Patients are motivated to improve self-management because they know their provider is watching. • The DCH application facilitated greater communication between patient and provider. • The use of the product increased patients’ general awareness of their blood sugar and its changes. • The application would be most useful for newly diagnosed patients or during times of medication titration.

  8. Discussion • The number of comments per month increased, indicating ongoing engagement. • Self-monitoring is likely to be of value when test results are linked to educational or behavioral advice and changes in clinical management.

  9. Lessons Learned • Limitations: • Small sample size and short follow-up period. • Demography Not generalizable. • Shortcomings: • Messaging was one-way. • Difficult to integrate the use of the Web site to provider's workflow. • User wanted more flexibility in how the readings were displayed. • More flexibility in where and when patient could upload readings. • More contextual information around high or low readings.

  10. Implications for Future Research • Primary outcome measure will be change in HbA1c over the 6-month study. • Improvements: • Two-way messaging. • Integration of the program with other data sources. • A summary page detailing all their patients along with key metrics. • Customize the appearance of the graph. • New method of data upload via a computer. • Dates where medication changes were made are highlighted on the graph.

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