Diabetes and Digital Health
- Colin Pfeiffer
- Jul 31, 2020
- 2 min read
The Diabeo Software Enabling Individualized Insulin Dose Adjustments Combined With Telemedicine Support Improves HbA1c in Poorly Controlled Type 1 Diabetic Patients: A 6-month, Randomized, Open-Label, Parallel-Group, Multicenter Trial (TeleDiab 1 Study)
Summary: DIABEO is a diabetes management app developed by Voluntis that allows patients to calculate bolus insulin doses at home. 180 French diabetic patients, Type 1 diabetes and average A1C > 8%, were randomized to three parallel arms. Group 1 received usual care, Group 2 used DIABEO and visited physicians quarterly, and Group 3 used DIABEO and received biweekly telemedicine consults. After six months, Group 3 saw the greatest reduction in mean A1C, while the usual care group saw the least reduction. In addition, Groups 1 and 2 spent five more hours hospitalized due to diabetic complications than Group 3.
The Mobile Insulin Titration Intervention (MITI) for Insulin Adjustment in an Urban, Low-Income Population: Randomized Controlled Trial
Summary: In the United States, diabetes mellitus affects low-income areas at higher rates than other populations. 48.7% of Medicaid patients with diabetes are classified as poorly-controlled. 61 patients were enrolled in a randomized, controlled-trial evaluating text messaging on insulin control. The intervention group sent daily text messages containing their fasting blood glucose (FBG) readings to a nurse. The nurse then assessed the readings for emergency situations and titrated the patient’s basal insulin glargine weekly if needed. After 12 weeks, 85% of the intervention arm their reached optimal insulin dose. Average A1C in the intervention arm was reduced by 1.30%.
Diabetes Prevention and Weight Loss with a Fully Automated Behavioral Intervention by Email, Web, and Mobile Phone: A Randomized Controlled Trial Among Persons with Prediabetes
Summary: Intervention at pre-diabetic stages can prevent patients from progressing to full diabetes mellitus. Alive-PD is an algorithm-based behavioral intervention for pre-diabetic patients. The program involves goal-setting, healthcare professional contact, and personalized recommendations for exercise and eating habits. 340 patients were randomized into six months of either Alive-PD or usual care. At the end of the study period, Alive-PD patients achieved an average reduction in FBG of -7.36 mg/dL compared to usual care’s reduction of -2.19 mg/dL (p < 0.001). Alive-PD patients also saw a greater reduction in BMI and waist size.
Personalized Diabetes Management Using Electronic Medical Records
Summary: Electronic medical records of 10,806 Type 2 Diabetes patients were used to construct a decision-making algorithm. The algorithm evaluated different pharmacotherapy regimens and noted when a given patient switched from one treatment to another. After evaluating 48,140 patient visits, the algorithm recommended the regular standard of care in 68% of visits. When the algorithm recommended a different course of care, average A1C lowered from 8.37% to 7.93% (p < 0.001).
Telemedicine for Diabetes: Economic Considerations
Summary: Telemedicine visits can save time and money for patients, who may not have to spend hours driving to a specialty clinic or pay for lodging. Providers can also reduce costs associated with in-person visits, such as staffing, wait room cleaning, and electrical needs. However, telemedicine visits pay far less than an in-person visit under current fee-for-service models for providers.
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