Telemedicine and Advanced Technology Research Center (TATRC

ABFI 2004ABFI 2004 Chronic Disease Management Chronic Disease Management

Medical Research & Materiel CommandMedical Research & Materiel Command

Telemedicine & Advanced Technology Research CenterTelemedicine & Advanced Technology Research Center

Ft Detrick, MDFt Detrick, MD

Colonel Ronald Poropatich,MDRobert Read, LTC (Ret) USA

The PortfolioThe Portfolio

Chronic disease management (CDM) is an approach to Chronic disease management (CDM) is an approach to health care that emphasizes helping individuals health care that emphasizes helping individuals maintain independence and keep as healthy as possible maintain independence and keep as healthy as possible through prevention, early detection, and management through prevention, early detection, and management of chronic conditions, such as congestive heart failure, of chronic conditions, such as congestive heart failure, asthma, diabetes, and other debilitating illnesses.asthma, diabetes, and other debilitating illnesses.

Chronic conditions impose challenges for those Chronic conditions impose challenges for those affected, their families and care providers. A patient's affected, their families and care providers. A patient's ability to follow medical advice, accommodate ability to follow medical advice, accommodate lifestyle changes, and access resources are all factors lifestyle changes, and access resources are all factors that influence successful management of an ongoing that influence successful management of an ongoing illness. illness.

The PortfolioThe Portfolio

In 2004, TATRC managed nearly $10.5M in Diabetes In 2004, TATRC managed nearly $10.5M in Diabetes research alone.research alone.

Joslin Diabetes Center, Children’s Hospital of Joslin Diabetes Center, Children’s Hospital of Pittsburgh and Marshall Island Diabetes Wellness and Pittsburgh and Marshall Island Diabetes Wellness and Reversal Program.Reversal Program.

Schematic of Joslin Vision Network System ArchitectureSchematic of Joslin Vision Network System Architecture

Diabetes Management andEducation on WWW

JVN Hub Site, FDDIRing, Intranet

INTERNET ACCESS

Central JVN Serverand Data Store (1Terabyte)

Central JVN Reading CenterEMRS and Automated Diagnosisand Treatment Plans

Central JVN ImagingWorkstations EMRS andEducation Modules

Remote Imaging Work StationEMRS and Education

Remote Imaging Work StationEMRS and Education

Remote ImagingWork StationEMRS andEducation

Remote Hub SiteDataStorage(50Gb)

Remote Reading CenterDiagnosis and Treatment

Comprehensive Diabetes Management Program Comprehensive Diabetes Management Program (CDMP)(CDMP)

Development of an Inexpensive Development of an Inexpensive Portable Retinal Imaging DevicePortable Retinal Imaging Device

Current commercially available non-mydriatic retinal imaging Current commercially available non-mydriatic retinal imaging systems are limited by high cost, lack of portability, high flash systems are limited by high cost, lack of portability, high flash intensities for exposure, and pupil diameter less than 4 mm impacting intensities for exposure, and pupil diameter less than 4 mm impacting image quality and ability to grade images. Diabetic patients and older image quality and ability to grade images. Diabetic patients and older non-diabetic subjects characteristically present with smaller pupilsnon-diabetic subjects characteristically present with smaller pupils

Developed a JVN retinal imaging prototype that will be portable, Developed a JVN retinal imaging prototype that will be portable, inexpensive, will image through a 2.8 mm pupil providing a 37 degree inexpensive, will image through a 2.8 mm pupil providing a 37 degree field of the retina, and will perform at lower light levels using a novel field of the retina, and will perform at lower light levels using a novel light diode strobing technique for retinal exposures.light diode strobing technique for retinal exposures.

An SBIR application in collaboration with Kestrel Corporation is in An SBIR application in collaboration with Kestrel Corporation is in preparation with the aim of developing a production model of this preparation with the aim of developing a production model of this retinal imaging system retinal imaging system

A patent for this system was filed in August 2003A patent for this system was filed in August 2003

Genetics Evaluation of inheritance patterns of specific loci and risk of developing diabetes or diabetic-complications.

Biomarkers Identification of molecular biomarkers in the proteome and transcriptome associated with islet function and microvasculature disease.

Education Telemedicine-based programs increasing patient and provider understanding of diabetes.

Children’s Hospital of PittsburghChildren’s Hospital of Pittsburgh

Diabetic and Diabetic-Diabetic and Diabetic-Nephropathy PedigreesNephropathy Pedigrees

Pedigree 0533

Pedigree 5507

RF ON

RF

Symbol DescriptionBlue UnaffectedBlack DiabeticRF Renal FailureON Overt Nephropathy

Morel et al. PNAS (1988) 85:8111-8115

Genetic Information for TestingGenetic Information for TestingType 1 Diabetes GIFT-DType 1 Diabetes GIFT-D

Developing and Developing and Evaluating a theory-Evaluating a theory-based web education based web education and counseling and counseling programprogram

PI proposes to adapt the NEWSTART wellness program PI proposes to adapt the NEWSTART wellness program (commercial program from the Weimar Institute) to a subset (commercial program from the Weimar Institute) to a subset population in the Marshall Islands. population in the Marshall Islands.

This program utilizes Diabetes Reversal and Wellness thru This program utilizes Diabetes Reversal and Wellness thru lifestyle change reflected in a more healthy diet and increased lifestyle change reflected in a more healthy diet and increased physical activity (felt more effective than medication) in the hopes physical activity (felt more effective than medication) in the hopes of decreasing the incidence of type II diabetes. of decreasing the incidence of type II diabetes.

Success of the intervention will be based on achieving a clinically Success of the intervention will be based on achieving a clinically and statistically significant improvement in diabetes self-and statistically significant improvement in diabetes self-management, evidenced as reduction in fasting glucose and HA1C management, evidenced as reduction in fasting glucose and HA1C levels. levels.

Also included will be a dental component that will assess baseline Also included will be a dental component that will assess baseline and dental health status after intervention in the wellness program.and dental health status after intervention in the wellness program.

Marshall Islands DiabetesMarshall Islands Diabetes

Future of the PortfolioFuture of the Portfolio Good Chronic Disease Management offers real Good Chronic Disease Management offers real

opportunities for improvement in patient care, opportunities for improvement in patient care, service quality and reduction on costs.service quality and reduction on costs.

Good Chronic Disease Management can make a Good Chronic Disease Management can make a real differencereal difference, helping to prevent crises and , helping to prevent crises and deterioration, and enable people living with deterioration, and enable people living with chronic conditions to attain the best quality of chronic conditions to attain the best quality of life.life.

It is anticipated that this portfolio will continue It is anticipated that this portfolio will continue to increase to $12M in 2005 and include other to increase to $12M in 2005 and include other chronic diseases .chronic diseases .

Questions: See Mr. Read Questions: See Mr. Read or feel free to email or call or feel free to email or call

Colonel Poropatich at Colonel Poropatich at 301-619-2829 or 301-619-2829 or

poropatich@tatrc.orgporopatich@tatrc.org