COMMENTARY

Control and Monitoring of Type 1 Diabetes With a Mobile App

Alfred Penfornis, MD, PhD

Disclosures

June 27, 2014

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Telemedicine Applications in Diabetes

My name is Freddy Penfornis. I am a diabetologist. I practice in Besançon, which is a small city near the eastern part of France, where I head the Department of Diabetology.

I am going to talk about telemedicine in the field of diabetes, which has several applications. Already being applied in clinical practice is screening for diabetic retinopathy by taking pictures of the retina with a nonmydriatic fundoscopic camera. The picture is taken by orthoptists or nurses and is then sent to be reviewed by an ophthalmologist. This application of telemedicine has been devised to compensate for the lack of diabetologists.

A second telemedicine application that is currently in development in diabetes is a follow-up of patients with diabetic foot ulcers. This is a growing complication; all diabetes centers are having to cope increasingly with patients with foot ulcers. It is a very important issue for the future.

Challenges in Managing Diabetes

I would like to talk about the application of telemedicine to follow up patients with type 1 diabetes. Many patients with type 1 diabetes are not very well controlled. They have an A1c levels > 8%, and the main reason for that is the difficulty of coping with the constraints of this disease. At least twice a day, they have to adjust their prandial insulin dose according to carbohydrate intake and premeal glycemia, and if appropriate, according to their physical activity. It is quite a difficult task for some patients, and that's why most often they have either hypoglycemia or hyperglycemia, primarily after meals.

There is a correlation between A1c concentration and the number of contacts between patients and diabetes healthcare professionals. However, it is difficult for young patients to comply with the numerous visits they must have with their diabetes healthcare professionals. Most of these visits are not very useful because the patient gives up. The paper or the notebook in which they are told to write down all of their results of blood glucose testing, insulin doses, and so on, is often incomplete. Without these data, it is very difficult for the healthcare professional to give good advice to patients.

Diabeo: Simpler Control on a Smartphone

That is why Dr. Guillaume Charpentier, of the Corbeil-Essonnes Hospital in France, and his team have created a device called Diabeo®, which is software that can be downloaded into smartphones.[1] The software has several very interesting functions. The first is a bolus calculator that takes into account the carbohydrate intake, the premeal gylcemia, and physical activity level as reported by the patient.

The second function is automatic algorithms, which adjust the carbohydrate/insulin ratio and the insulin pump's basal rate if the postprandial glycemia or the fasting glycemia are off target. The third function is the transmission of the data to a secure Website where the healthcare professional can see the patient's data at any time, and they can communicate by telephone with their patient with data in front of them.

Remarkable Results With Diabeo

A few years ago, we conducted a trial[2,3] with this device, including 118 patients with type 1 diabetes whose A1c concentrations were > 8%. The patients had been divided into 3 groups by random assignment. The first group was the control group. The patients were seen every 3 months at the hospital and the study lasted 6 months -- a very conventional follow-up. The second group of patients had the Diabeo device but without teleconsultations. They went to the hospital for follow-up, as did group 1, at 1 month, 3 months, and 6 months.

The last group of patients had both the diabetic device and teleconsultations with their diabetes healthcare professional every 2 weeks, and they didn't have follow-up at the hospital before the end of the study at 6 months. With the diabetic device in the third group, we were able to show a very important reduction in the A1c of 0.9% compared with the control group, and the reduction of A1c in the second group without teleconsultations but with Diabeo alone was 0.7%. It is quite an amazing improvement in metabolic control because in trials with continuous glucose monitoring, the average reduction of A1c is about 0.5%.

We are now conducting a larger trial, recruiting 700 patients with either type 1 or type 2 diabetes who were being treated with multiple daily insulin injections or insulin pump. The patients were recruited from more than100 hospitals or clinical private-practice sites in France. We hope that at the end of this study, we will be able to confirm these very good results and that this diabetes device will be reimbursed by the French Social Security. We hope that at the completion of this study, we will be able to offer this device to all of our patients with type 1 or type 2 diabetes who are being treated with multiple daily insulin injections or an insulin pump to improve their metabolic control and make their lives easier.

So, I give you an appointment in 2 to 3 years from now to hear the results from this very large study.

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