There are two ongoing clinical trials to be aware of.
One is at the Univ of Maryland and is using the forementioned Telcare meter. This study is a 6-month pilot study taking 100 patients with diabetes (both types 1 and 2) and randomizing them to either typical glucose meter or the Telcare meter. The outcome measures will be to see if connecting the patients via the Telcare meter will improve self-monitoring of blood glucose (SMBG) compliance, to see if A1c is affected, and to see if patient satisfaction is improved.
The other is being sponsored by a company called Diabetech with a link to the trial information here. This study is using an investigational device designed by Diabetech that attaches a self-contained wireless accessory to a glucose meter, and then transmits data to a centralized data management system. The system then analyzes the data and either sends educational materials to the patient or alerts or reports to the healthcare team. The primary outcome measures in this study are glucose control and patient satisfaction. The secondary outcome measures are HbA1c, self-test frequency of glucoses, and standard deviation of HbA1c and SMBG.
1) The Joslin Diabetes Center at Harvard is creating a telemedicine platform so that they can start doing long-distance diabetes consultations.
I’ve been doing a lot of “VTel” (VA slang for videoconferencing) at the VA this past year for diabetes consultations. While they aren’t a perfect substitution for a face-to-face conversation, they do generally seem to get the job done and save our remote patients a lot of travel time.
2) Reviews by Marisa Moore of 10 iPhone diabetes apps.
I have not yet tried most of these applications, but my overall feeling is that the current generation of smartphone apps for diabetes are not going to take us very far. There are several reasons for this. The main reason, as I’ve discussed in previous posts about Glooko and the iBGStar, is that asking patients to manually enter blood sugars after doing a fingerstick is an unworkable workflow. Also, with the way data is currently displayed, the iPhone screen is too small to glean anything useful. A lot of apps have education modules, which may be useful, but I think to really gain traction, education will have to be personally targeted to the right patient at the right point in time.
When mentioning the West Wireless Health Institute, I also should have mentioned Qualcomm Life, their 2net wireless platform, and the $100 million dollars they are giving to accelerate new companies. They also look like they are going to be a major player and force in wireless health, and they have a head-start in that they already know how to do wireless.
They describe the 2net Platform as “a cloud-based system designed to be universally-interoperable with different medical devices and applications, enabling end-to-end wireless connectivity while allowing medical device users and their physicians or caregivers to easily access biometric data.” This should make it much easier for many start-ups who have a good idea but don’t know how to do wireless. I’m excited to see how this plays out.
I recently learned about the West Wireless Health Institute in San Diego, founded by philanthropists Gary and Mary West, and with vice-chair Eric Topol (author of recently released Creative Destruction of Medicine). This non-profit institute is focused on fostering innovation in the field of wireless health, specifically with an eye towards cost savings. I recommend browsing their website. I think they are going to be a major force for good and for future innovation in improving health care value using wireless technology.
On February 9th, Cellnovo, a company based in the UK, announced they were launching a new system comprised of an integrated insulin pump connecting wirelessly to a touch-screen handset which then connects wirelessly to their software, allowing remote monitoring of a patient’s diabetes. They also announced that they will be performing a clinical trial looking at their new system, as well as specifically focusing on the usability of insulin pumps and wireless diabetes technology
- Integrated pump with handheld and software: Everything looks to be well-designed and will work seamlessly together. In fact, the handheld will also serve as a glucose monitor.
- Wireless and automated: Anything that is going to succeed is going to have to be wireless. Patients already spend enough time managing their diabetes. Asking them to do more work and take extra steps is unfair and not going to work. This system will record your glucose values and your insulin doses without you doing any extra work. That is a big deal!
- Closed system: Though the products designed by Cellnovo should all work well together, they represent yet another closed ecosystem in diabetes. If you like one device from one company and one device from another, sorry. Your data won’t be shared between them.
The United Kingdom’s National Health Service, according to this Telegraph article, plans to start recommending that physicians start prescribing certain mobile health apps to their patients. Examples include electronic reminders to check blood sugar or take a medication. Though I’m not sure that the examples provided present the strongest use cases possible for mobile health apps, I think they’re certainly on the right track. An app that increases the probability that someone remembers to take their medications regularly should accomplish improved healthcare outcomes and improved value.
We have to find ways of building mobile applications that patients find engaging, that they are willing to use, and that will empower them to take charge of their health. Apps that do these things should save the system money and improve healthcare outcomes. The NHS clearly thinks that some of these apps are ready to start serving those functions. It will be a nice experiment to see if they’re right.