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T + Diabetes system.

T + Diabetes system shows how technology can help to manage chronic conditions. A mobile-phone-based diabetes management system is helping both patients and general practitioners to manage the condition. The Think Positive Diabetes system (known as T+ diabetes) allows patients to send their blood glucose results to a central server using their mobile phone and receive an immediate and accurate graph showing how they are managing their diabetes.

One diabetes system proves how technology can help to manage chronic conditions. A mobile-phone-based diabetes management system is helping both patients and general practioners to manage the condition.

The Think Positive Diabetes system (known as T+ diabetes) allows patients to send their blood glucose results to a central server using their mobile phone and receive an immediate and accurate graph showing how they are managing their diabetes.
The patient is supplied with an electronic blood glucose monitor and has software loaded on to their own compatible mobile phone.

The patient tests their blood glucose, and then the monitor transmits the results via a Bluetooth wireless link to the mobile phone.
The patient then answers relevant diary questions, such as recent food intake, and all the information is forwarded to a central computer.

The data is processed and a graph is generated and sent back to the mobile phone. This way, the patient can see how they are doing. If the data falls outside their personal target, the patient is alerted and so is their health professional, who can then offer advice.

Dr. Jeremy Wheeler, a general practitioner in Maidenhead, Berkshire, England helped develop the system. The project began three years ago and, with the support of the practice nurse, he has been using it for six of his diabetic patients since last November.

"I have been using it for initiating insulin in some of my patients, as well as monitoring diabetics who are already on insulin," he explains.

"Patients monitor their blood sugars as they would normally, but the blood sugar meter communicates through their mobile phone to give them immediate graphical feedback. So rather than just having a figure on a screen, they actually get a bar chart."

Dr. Wheeler believes that the system helps to give patients more understanding of their sugar control and, at the same time, it helps him to adjust the dosage of insulin accordingly.

"If you start someone on insulin, you don’t really know what doses they are going to end up on, particularly type-2 diabetics," he says. "They have a once- or twice-a-day dosage and even though this is fairly constant, it is quite difficult to find the exact figure that they need. The system helps me to know this because it is a bit of a worry at first to know how well they are going to react to the insulin."

The process also allows Dr. Wheeler to monitor the patient’s progress remotely.

"It is a good way of keeping an eye on things," he says. "I log in every morning and have a look at the patient’s results when they come up on my computer. I can see if they are testing, how much they are testing and how high or low their levels are.

"I can also communicate with the patient through their mobile,’ he continues. ‘I can send them a message to tell them, for example, that their sugars are too high and so on."

This ‘remote’ monitoring of his diabetic patients has saved Dr. Wheeler a great deal of time.

"I don’t actually have to see the patients as often in the surgery," he explains. "Before, I wasn’t even doing insulin initiation in the practice because of the amount of work it required.

"Also it would take our local hospital about a year to start patients on insulin. So this has been really useful to enable me to feel assured about putting people on to insulin, getting it controlled better and quicker, and keeping an eye on them without having to see them."

HbA1c Targets

A recent nine-month randomized trial of the system showed that using this kind of technology, together with nurse support, led to sustained levels of monitoring, improvements in blood glucose levels and attainment of HbA1c target. It also concluded that it could offer a cost-effective way to improve outcomes.

Dr. Wheeler says that the results so far have been very positive. "The diabetic control, as a result of this system, has been superb," he says. "The first patient who started on the system had a foot infection and his insulin requirement shot up. We were actually able to see this on his read-outs. We could see, about a week before he actually presented with the infection, that his sugar control was already going out.

"It is very user-friendly for patients too. My oldest patient is about 64 years old, and my youngest is 27, so any age group can use it. It is simple and does not require more than a few seconds of their time. When we designed the system, we wanted minimum interference with the patient’s everyday life otherwise it wouldn’t be used."

Compliance is another benefit of T+ diabetes, because test results cannot be altered. "You can tell if someone is being compliant with the treatment and you know that they are genuine results on the screen, rather than someone making them up before a clinic," says Dr. Wheeler.
http://www.thinkdiabetes.com/tpdiabetes/howdoesitwork.php

"Patients monitor their blood sugars as they would normally, but the blood sugar meter communicates through their mobile phone to give them immediate graphical feedback," said Dr. Jeremy Wheeler, who helped develop the system.