Subject(s)
Humans , Male , Female , Pancreas/anatomy & histology , Pancreas/enzymology , Diabetes Mellitus/pathology , Insulin/therapeutic useSubject(s)
Diabetes Mellitus/surgery , Insulin/therapeutic use , Pancreas, Artificial , Telemedicine/trends , Adult , Clinical Trials as Topic , Cross-Over Studies , Decision Making , Diabetes Mellitus/psychology , Ethics, Medical , Humans , Insulin/administration & dosage , Insulin Infusion Systems , Middle Aged , Pancreas, Artificial/trends , Patient Education as Topic , Social Support , Young AdultABSTRACT
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No disponible
Subject(s)
Humans , Pancreatic Extracts/therapeutic use , Pancreatic Hormones/therapeutic use , Diabetes Mellitus/drug therapy , Hypoglycemic Agents/historyABSTRACT
This paper presents the current features of the DIABTel telemedicine system and the evaluation outcomes of its use in clinical routine. This telemedicine system is designed to complement the daily care and intensive management of diabetic patients through telemonitoring and telecare services. The system comprises a patient unit (PU) used by patients in their day-to-day activities and a Medical Workstation used by physicians and nurses at hospitals. Both applications offer tools to collect, manage, view and interpret data and to exchange data and messages. The system was evaluated for usability, telemedical protocols, metabolic control and quality of life. This evaluation consisted in a 6-month cross-over pilot study with ten Type I diabetic patients. The results of the evaluation allowed assessment of the telemedicine protocols in terms of the number of communications/patient (21.6+/-7.7); days between communications (5.4+/-2.66); messages sent by physicians (118 text messages); and data and messages transmitted by patients (3524 blood glucose readings, 1649 day-to-day insulin adjustments, 24 exercise reports, ten diet modifications and 63 text messages). Physicians performed more therapeutic changes during the DIABTel period than in the control period. There was a trend towards HbA1c improvement during DIABTel use with no incidence in the number of hypoglycaemias. This pilot study demonstrates the feasibility of the DIABTel system in clinical routine use and its potential benefits for diabetes care: improving the availability of information necessary for therapy adjustments; offering new physician-patient communication tools; increasing patient empowerment and education; and showing a positive trend towards improving the metabolic control of patients. Further studies are needed to validate these findings and to promote telemedicine as an opportunity to better diabetes care.
Subject(s)
Diabetes Mellitus, Type 1/therapy , Telemedicine/methods , Cross-Over Studies , Diabetes Mellitus, Type 1/physiopathology , Disease Management , Humans , Patient Education as Topic , Patient Participation , Physician's Role , Pilot Projects , Telemedicine/instrumentationABSTRACT
In the context of the EU funded Telematic Management of Insulin-Dependent Diabetes Mellitus (T-IDDM) project, we have designed, developed and evaluated a telemedicine system for insulin dependent diabetic patients management. The system relies on the integration of two modules, a Patient Unit (PU) and a Medical Unit (MU), able to communicate over the Internet and the Public Switched Telephone Network. Using the PU, patients are allowed to automatically download their monitoring data from the blood glucose monitoring device, and to send them to the hospital data-base; moreover, they are supported in their every day self monitoring activity. The MU provides physicians with a set of tools for data visualization, data analysis and decision support, and allows them to send messages and/or therapeutic advice to the patients. The T-IDDM service has been evaluated through the application of a formal methodology, and has been used by European patients and physicians for about 18 months. The results obtained during the project demonstration, even if obtained on a pilot study of 12 subjects, show the feasibility of the T-IDDM telemedicine service, and seem to substantiate the hypothesis that the use of the system could present an advantage in the management of insulin dependent diabetic patients, by improving communications and, potentially, clinical outcomes.
Subject(s)
Diabetes Mellitus, Type 1/therapy , Telemedicine , Blood Glucose Self-Monitoring , Diabetes Mellitus, Type 1/physiopathology , Disease Management , Humans , Telemedicine/instrumentation , Telemedicine/methods , Therapy, Computer-AssistedABSTRACT
The medical record is central to the management of patients. For people with a chronic disease their many records, held at different locations, often pose a problem. Electronic patient records have been discussed for a long time. This article reports on the paradigm of a portable computer-based patient record on a smart card. It describes the development of the chip card based medical information system for chronic diseases in ambulatory and hospital care. The system has been implemented, tested and evaluated. DIABCARD could demonstrate that for a speciality patient record the capacity and functionality of the existing card is sufficient. Finally, the perspectives of chip cards in health care are discussed.