Glucose control in type 1 and type 2 diabetes: the Auvergne experience on PDA phones
Topic of the practice
Telemedicine service for care and treatment of chronic patients with diabetes
Good Practice Information
For patients with type 1 diabetes receiving basal insulin (to live) once a day, and meal time insulin (to eat) three times a day, a decision has to be taken about the dose of insulin to inject each time. Intensification of treatment leads to improved control of diabetes and reduction of complications (DCC trial). An automatic support (Diabeo) using a PDA phone to decide which dose to inject is useful for patients.
Besides the practice is targeting type 2 patients. When introducing insulin to type 2 patients, the adaptation of insulin doses (initially basal insulin, later basal-bolus schedule) has to be individualized. An automatic support was developed for coaching and dose adaptation.
The use of a PDA phone compatible programme for adaptation of insulin doses and coaching support was developed in France by CERITD, Corbeil. The application of this tool was initially developed to optimize insulin doses in highly active patients with limited time to access health care practitioners. It was later suggested to apply the tool to isolated populations.
Seven days a week, the patient can record his/her blood glucose levels and the dose of insulin he/she plans to inject. The Diabeo program, via the PDA phone, will immediately send back a suggested dose of insulin to inject, based on data observed on the previous days. The development of the program in Auvergne region is ensured by the department of diabetes at the CHU de Clermont-Ferrand. National coordination is attributed to Corbeil-Essonne.
Evidence of success
The main aim is to determine changes in glucose control (by HbA1c). Other evaluation data include:
• cost of medical care (cost of transportation)
• time spent by patient and health care professionals for diabetes care
Success factors include:
• The possibility to stay at home and avoid forth and back transportation to the hospital is of great advantage to active patients - ambulances are not needed to transport patients
• The physician reduces his acts in the final report, and the collaboration between the patients and the physician increases
Contact details to obtain further information on the practice
Professor Igor TAUVERON
UHC Clermont-Ferrand, Medical Departement of the endocrinology and Diabetes
Annex completed on: 03-10-2011