A Telemedicine System Intervention for Patients With Type 1 Diabetes: Pilot Feasibility Crossover Intervention Study (Preprint)

Abstract

BACKGROUND Telemedicine systems have been proven to be a successful tool for the supporting patients in diabetes mellitus selfmanagement. Despite this, a large percentage of patients do not use of all available functions of telemedicine systems. And this is one of the reasons, why patients do not meet the target compensation of their disease. This paper presents the current features of the Diani telemedicine system and the evaluation outcomes of its use. Dani has been designed to provide the patients with a comprehensive overview of their collected data including carbohydrate intake, insulin doses, physical activity level (steps) and blood glucose. OBJECTIVE The objective of the study was to evaluate the benefits of the Diani telemedicine system for the treatment of type 1 diabetes patient. The obtained suggestions will lead to further verification and development of the system in order to better compensate for diabetes mellitus. METHODS Data were obtained on the basis of a 24-week, randomized, crossover, intervention study. Patients responded to the standardized WHOQOL-BREF quality of life questionnaire and the system evaluation questionnaire. Both the level of glycated hemoglobin and the patient's weight were examined. The patient's usage of the telemedicine system was monitored and daily physical activity was measured. All data were being sent from the device to the Diani server using a real-time diabetic diary application. Wilcoxon and Friedman tests and LME method were used for data analysis. This study involved 10 patients (5 men and 5 women) who participated in the Diani system evaluation. The mean age of the participants was 47.7 ± 19.3 years; the mean duration of diabetes was 10.5 ± 8.6 years; and the mean HbA1c was 59.5 ± 6.7 mmol/mol. RESULTS The median number of days during which the patients tested the system was 84. After the intervention the mean HbA1c decreased by 4.35 mmol/mol (p = 0.011). Patients spent 18.6 ± 6.8 minutes on average using the application daily. After the Diani system intervention, the number of patients who measured their blood glucose at least 3 times a day increased by 30%. The graphical display of measured quantities, automatic transmission of measured data from the glucometer, compatibility and interconnection of individual devices when entering data were evaluated by patients in a positive way. CONCLUSIONS Diani system is beneficial for type 1 diabetes mellitus patients in terms of controlling their disease. Patients perceive it positively; it strengthens their education in the field of diabetes and understanding the influence of measured values on the compensation of their disease. Its use has a positive effect on the HbA1C level.