Diabetes mellitus is a chronic disease of which incidences are still increasing and related therapies bring many obstacles to patient´ daily lives, often accompanied by both acute and chronic complications. It is a group of metabolic diseases characterized by high blood glucose levels resulting from defects in insulin secretion, insulin action, or both. Many factors have an impact on the metabolic compensation of the disease. The most significant once are the amount of carbohydrate intake, injected insulin doses and intensity of physical activity. These parameters can be measured and supervised by multiple mobile devices thanks to which we can get more information about patients´ actual health state and more detailed data can be tracked and stored for potential further analysis. Moreover, nearly real-time tele-monitoring of patients’ detailed and daily behavioural and self-management information can allow patients and clinicians to identify problematic situations that would otherwise be unnoticeable.
Therefore, we are working on development of a telemonitoring system enabling to monitor patients´ diabetes. It includes the possibility to gather all the measured data from multiple mobile devices, to store them in one place, to visualize them and use them for further analysis and data mining for both patients and clinicians.
The Diani application is built upon the idea of a telemonitoring system that remotely control patients´ diabetes. The telemonitoring is a common tool in therapies for metabolic diseases: it can have a positive effect on improving patients’ health and increase the quality of medical care. In addition, it has the potential of reducing the need of using the health services, and thus, reduce treatment expenses. An important aspect of telemonitoring is increasing patients’ knowledge and education regarding the impact and progress of their illness. Patients are often motivated to be more interested in their disease.
Online supervision of the patients by either clinicians or their family members increases safety of the patients and enables immediate reaction on situations patients are hardly to control on their own. In order to prevent mainly the long-term complications patients or clinicians can make adequate steps for changes in patients´ daily regimen upon the problematic situations discovered in the data.
The platform stores all the parameters measured with multiple mobile devices patients use, and displays them in a form of diagrams and tables.
In the graphical interpretation section there are two graphs for visualizing patients’ data. The upper graph shows the blood glucose data measured either by glucose meter or CGM system, and the lower diagram indicates food and drug registrations, physical and sleeping activity.
Following devices are used for data collecting:
Dexcom G4 or Medtronic Enlite sensor
These sensors are commonly used in medical practice in the Czech Republic for continuous glucose monitoring, in connection with corresponding receiver or insulin pump. Both are able to register and record blood glucose values in 5-minutes interval.
FORA Diamond Mini glucose meter
This device is used for self-measurement of patients´ blood glucose and is capable of transferring measured data via Bluetooth either to a special application or, in our case, automatically to the Diabetesdagboka mobile application described below. This functionality ensures that all BG registrations are registered to the Diary and that untruthful and omitted registrations are eliminated.
Fitbit Flex activity tracker
For physical activity monitoring, patients can be equipped with the Fitbit activity tracker. In addition to other functions (calories burnt, distance walked, etc.), this sensor can track the number of steps taken per minute, and also detect movements in bed when set to sleep mode.
Thanks to the Fitbit API, which allows developers to interact with Fitbit data in their own applications , we are able to automatically transfer all the data to the Diani web server.
Diabetesdagboka mobile application
This diabetes app was developed by the Norwegian Centre for E-health Research, and its further
development and Czech version is supported also by the Research Centre Albertov in the Czech
Republic. As a self-management tool, it enables patient to track their most important parameters. Users can make registrations about their daily food and insulin intake, blood glucose values and physical activity, including the possibility of adding notes to particular logs. The app enables all registrations to be automatically uploaded to the Diani web server.
For easier and faster registration to the Diabetesdagboka app it is possible to use the Pebble smartwatch app that enables users to log each parameter to the diary app with just a few button pushes on the watch. This tool can also help to increase both the adherence of our testers to use the diary and the number of registrations they made. Also, a function that reminds patients to check their blood glucose can higher the frequency of post-meal blood glucose measurements.
In order to adapt the current system to medical practice, a function from a generation of the paper-based diabetes diary was implemented to this system as well. Patients can print out the report from individually selected time periods to show it during a personal consultation with their doctor.