Diabetes Connected Health: A Diabetes Connected Health: A Pilot Study of a Patient- and Pilot Study of a Patient- and

Provider-Shared Glucose Provider-Shared Glucose Monitoring Web ApplicationMonitoring Web Application

Journal of Diabetes Science and Technology 20Journal of Diabetes Science and Technology 200909

Alice J. Watson,Joseph C. Kvedar,Basmah Rahman,AlexaAlice J. Watson,Joseph C. Kvedar,Basmah Rahman,Alexandra C. Pelletier,Gregory Salber,and Richard W. Grantndra C. Pelletier,Gregory Salber,and Richard W. Grant

OutlineOutline

BackgroundBackground Research Design and MethodsResearch Design and Methods ResultsResults DiscussionDiscussion Lessons LearnedLessons Learned Implications for Future ResearchImplications for Future Research

BackgroundBackground ““current standard of care” frequently fails to decurrent standard of care” frequently fails to de

liver on evidence-based recommendations for praliver on evidence-based recommendations for practice.ctice.

Requirements for more transparent reporting of oRequirements for more transparent reporting of outcomes and new payment systems that reimbursutcomes and new payment systems that reimburse based on outcomes rather than visit.e based on outcomes rather than visit.

AA remote blood glucose monitoring application remote blood glucose monitoring application [[““ DiabetesDiabetes Connected Health“Connected Health“ (DCH)](DCH)]

Allows patients to upload glucometer readings froAllows patients to upload glucometer readings from commercially available glucometers.m commercially available glucometers.

Research Design and Research Design and MethodsMethods

Both patients and providers had access to this Web Both patients and providers had access to this Web site, where the data could be viewed, analyzed, and site, where the data could be viewed, analyzed, and discussed.discussed.

Subjects were recruited from a primary care Subjects were recruited from a primary care practice. practice.

20(8 decline)→12(5 ineligible)→720(8 decline)→12(5 ineligible)→7

Prominently featured a graphic representation of Prominently featured a graphic representation of blood glucose readings.blood glucose readings.

A “journal” page allows patient to make notes and A “journal” page allows patient to make notes and comments about each reading.comments about each reading.

Provider can access to patient blood Provider can access to patient blood glucose glucose readings and notesreadings and notes..

One-way messaging allowed provider to send One-way messaging allowed provider to send comments to each patient. comments to each patient.

Each participant was asked to upload their Each participant was asked to upload their readings using the modem once per day.readings using the modem once per day.

ResultsResults

Participant Satisfaction:Participant Satisfaction: Five “Excellent” or “Good”Five “Excellent” or “Good” Remaining “Average” or “Satisfactory”Remaining “Average” or “Satisfactory”

Patients are motivated to improve self-Patients are motivated to improve self-management because they know their management because they know their provider is watching.provider is watching.

The DCH application facilitated greater The DCH application facilitated greater communication between patient and provider.communication between patient and provider.

The use of the product increased patients’ The use of the product increased patients’ general awareness of their blood sugar and its general awareness of their blood sugar and its changes.changes.

The application would be most useful for The application would be most useful for newly diagnosed patients or during times of newly diagnosed patients or during times of medication titration.medication titration.

DiscussionDiscussion The number of comments per month The number of comments per month

increased, indicating increased, indicating ongoing engagementongoing engagement..

Self-monitoring is likely to be of value when Self-monitoring is likely to be of value when test results are linked to educational or test results are linked to educational or behavioral advice and changes in clinical behavioral advice and changes in clinical management.management.

Lessons LearnedLessons Learned Limitations:Limitations:

Small sample size and short follow-up period.Small sample size and short follow-up period. DDemographyemography Not Not generalizgeneralizable.able.

Shortcomings: Shortcomings: Messaging was one-way.Messaging was one-way. Difficult to integrate the use of the Web site to provider's Difficult to integrate the use of the Web site to provider's

workflow.workflow. User wanted more flexibility in how the readings were dUser wanted more flexibility in how the readings were d

isplayed.isplayed. More flexibility in where and when patient could upload More flexibility in where and when patient could upload

readings.readings. More contextual information around high or low readinMore contextual information around high or low readin

gs.gs.

Implications for Future Implications for Future ResearchResearch

Primary outcome measure will be change in HbPrimary outcome measure will be change in HbA1c over the 6-month study.A1c over the 6-month study.

Improvements:Improvements: Two-way messaging.Two-way messaging. Integration of the program with other data sources.Integration of the program with other data sources. A summary page detailing all their patients along with A summary page detailing all their patients along with

key metrics.key metrics. Customize the appearance of the graph.Customize the appearance of the graph. NNew method of data upload via a computerew method of data upload via a computer.. Dates where medication changes were made are highlDates where medication changes were made are highl

ighted on the graph.ighted on the graph.