Clinical reporting and coaching systems can significantly reduce glycated hemoglobin levels without increasing the costs of care.
Clinical reporting and coaching systems can significantly reduce hemoglobin A1c levels without increasing the costs of care. The good news came from Guillaume Charpentier, MD, Center Hospitalier Régional Gilles de Corbeil, Corbeil, France, during a Sunday symposium, New Technologies for Diabetes Education.
There are 3 broad models for telecare, Charpentier said. The most basic is a downward model, with automated phone messages and calls from a diabetes specialist to the patient. The second adds data transmission, either by modem or, more recently, by cell phone, with feedback by phone, text message, or Web page. The last model adds decision-support software for both clinician and patient.
Early downward models showed some success, Charpentier noted, with one type 1 diabetes trial showing a 1.1% A1c reduction over 6 months.
Early decision-support systems showed marginal results. IDEATeL (Informatics for Diabetes Education and Telemedicine), a telemedicine system tested in New York State, showed a 0.18% A1c drop over 5 years but added $8,000 per patient to care costs.
More recently, Charpentier developed DIABEO, a smart phone-based system with an electronic diary, a patient-specific bolus calculator, and mealtime dose calculations based on glucose trends. A trial comparing standard care to DIABEO with weekly phone consults showed a 0.9% reduction in A1c over 3 months. There was no increase in physician time, Charpentier reported, and a sharp decline in hypoglycemic events.
“This system is free to all patients with diabetes in France,” Charpentier said. “We have adapted it to all of the popular smart phones, and we expect it to be fully reimbursed by the national health plan in the very near future.”
The system has also been adapted for type 2 diabetes. New features include automatic basal dose adjustments, coaching for food and activity based on recent blood glucose results, and food selection advice. Early results show a steady decline in A1c, Charpentier said, with more mature data due in 2011.