Mobile health and diabetes

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Mobile health and diabetes

  1. 1. The Application of Mobile Health to DiabetesManagement: Opportunities and Challenges. William E. Winter, MD Departments of Pathology & Pediatrics University of Florida Gainesville, FL 32610-0275 winter@pathology.ufl.edu
  2. 2. What disease is becoming epidemic in developed and developing countries? Diabetes mellitus - A family of disorders characterized by chronic hyperglycemia and the development of chronic complications Pathophysiology Decr. insulin action -- > hyperglycemia Insulin action = [Insulin] x Ins. sensitivity Type 1 DM 10% Absolute decr. Type 2 DM 90% Relative decr. Decr.William E. Winter, MD winter@pathology.ufl.edu
  3. 3. How common is diabetes mellitus throughout the world? World Health Organization (WHO) - Key facts (August 2011) - Worldwide cases: 346 million - Deaths from incr. glu. ~3.4 million (2004) - Diabetes deaths. >80% in low- and middle-income countries -WHO projection. By 2030, deaths will incr. 2 fold c/w 2005http://www.who.int/mediacentre/factsheets/fs312/en/index.html
  4. 4. How common is diabetes mellitus in Egypt? International Diabetes Federation (IDF, for 2010) - 11.4% of Egyptians have diabetes. Diabetes frequency in MENA (Middle East and North Africa): Algeria: 8.5% Iran: 8.0% Iraq: 10.2% Jordan: 10.1% Lebanon: 7.8% Morocco: 8.3% Saudi Arabia: 16.8% Tunisia: 9.3% United Arab Emirates: 18.7%http://www.novonordisk.com/images/about_us/changing-diabetes/PDF/Leadership%20forum%20pdfs/MENA%20Forum/Diabetes%20in%20the%20Middle%20East%20and%20Northern%20Africa%20+%20DAS.pdf
  5. 5. How common is type 1 diabetes in Egypt? Incidence is intermediate: 8-16 cases/106William E. Winter, MD winter@pathology.ufl.edu
  6. 6. Why is T1DM so difficult to treat? Plasma glucose is highly regulated: Excess --- > Diabetes/complications Deficiency --- > CNS impairment/death Plasma glucose pool turns over 4 x/hr (~100 fold per day) Glucose intake is episodic (meals) Glucose utilization can be highly variable (acticity) Balance: maintained by insulin (2ndly by glucagon) Islets: 1-2 grams!William E. Winter, MD winter@pathology.ufl.edu
  7. 7. Glucose input - Gut - Liver Incretins [Glucose] Glu/protein Beta cells Glucose clearance ANS - Brain - Skeletal muscle - Hormonal control Insulin - Activity - Adipose tissue - LiverWilliam E. Winter, MD winter@pathology.ufl.edu
  8. 8. What are the goals in treating T1DM? - Avoid hospitalization - Maintain daily health and activities avoid symptoms & hypoglycemia children: normal growth & development women: normal pregnancy - Maintain ideal or near ideal glucose target A1c: <7% - Delay/prevent long term complications - “Cure” diabetesWilliam E. Winter, MD winter@pathology.ufl.edu
  9. 9. How can mhealth be applied to improving diabetes care? Information collection Disease education Disease-related alerts and reminders Integration of social media functions Disease-related data export Synchronization w/ PHR (personal health record)William E. Winter, MD winter@pathology.ufl.edu
  10. 10. How can mhealth be applied to information collection? Self-monitoring data collection Information w/ immediate effects – recent & historic data Blood glucose Ketones (urine, blood) Medications Diet Activity Hypoglycemic events Information w/ longer term effects – recent & historic data Weight Blood pressureWilliam E. Winter, MD winter@pathology.ufl.edu
  11. 11. How can the data be acquired? Patient acquires data and inputs data - SMBG - Diet recording – touch screen; +/- labor intensive - Activity recording – touch screen – accuracy (?) Device acquires data and inputs data - Glucose - Device interfaces w/ mobile device - CGMS: continuous glucose monitoring - Diet – photo recognition? - bar-code scanning? - Activity - Accelerometer - compensation for transportation (?)William E. Winter, MD winter@pathology.ufl.edu
  12. 12. What can be done with the data? Patient decides on management - Variable ability of patients to - to make the right decisions Patient & medical team or computer decide on management Monitor progress between visitsWilliam E. Winter, MD winter@pathology.ufl.edu
  13. 13. How can mhealth be applied to disease education? Disease education Generic Blood glucose Diet Activity Medications Hypoglycemic events Weight Blood pressure Complications Pregnancy Personalized Specific to the patientWilliam E. Winter, MD winter@pathology.ufl.edu
  14. 14. How can mhealth be applied to alerts and reminders [e.g., SMS (short message service)]? Disease-related alerts and reminders Generic Blood glucose goals A1c goals BP goals When to screen for retinopathy When to screen for nephropathy When to screen for diabetes in pregnancy Personalized Specific to the patientWilliam E. Winter, MD winter@pathology.ufl.edu
  15. 15. How can mhealth be used to integrate social media functions? Facebook, Twitter Finding individuals or groups w/ similar challenges - Advice on treatment - Support groupWilliam E. Winter, MD winter@pathology.ufl.edu
  16. 16. How can mhealth be applied to data export? Disease-related data export Data sent to --- > central locale for storage / retrieval Data sent to --- > physician, nurse, physician assistant, diabetes educator, dietician, psychologist, etc. Interface w/ patientWilliam E. Winter, MD winter@pathology.ufl.edu
  17. 17. How can mhealth be applied to improving diabetes care? Synchronization w/ PHR (personal health record) Patient takes a role in their PHR and directly contributes to their PHRWilliam E. Winter, MD winter@pathology.ufl.edu
  18. 18. Concerning diabetes, what software (apps) for mobile devices are available? Chomutare et al. Features of mobile diabetes applications: review of the literature and analysis of current applications compared against evidence-based guidelines. Journal of Medical Internet Research. 2011, 13(3). University of North Norway, Tromso, Norway; University of Tromso; Northern Research Institute, Tromso, NorwayWilliam E. Winter, MD winter@pathology.ufl.edu
  19. 19. iTunes diabetes apps Numbers of apps: N 2009 60 2011 260 (>400% incr.)William E. Winter, MD winter@pathology.ufl.edu
  20. 20. iTunes diabetes apps Studied 137 apps: Features Insulin or medication tracking 65% Diet tracking 50% Activity tracking 40% Weight tracking 39% Synchronization 29% Education module 20%* Low Social media integration 15% Disease-related reminders 12% * Only 7/27 (26%) - personalized LowWilliam E. Winter, MD winter@pathology.ufl.edu
  21. 21. Examples of diabetes apps ------ > Cost Glucose Buddy Free Carb Counting with Lenny Free Diabetes Companion $0.99 Blood Sugar Diabetes Control $0.99 Vree for Diabetes $1.99 BGluMon $1.99 Track 3 $5.99 Diabetes Buddy $2.99 Diabetes Sugar Level Tracker $1.99 Glucose Tracker $0.99William E. Winter, MD winter@pathology.ufl.edu
  22. 22. Can a glucose meter be attached to the mobile device?William E. Winter, MD winter@pathology.ufl.edu
  23. 23. Can a glucose meter be attached to the mobile device?William E. Winter, MD winter@pathology.ufl.edu
  24. 24. What are the challenges in achieving improved glycemic control in people w/ T1DM diabetes? Treatment -- > complex - Insulin - Diet (total calories, composition, timing of meals) - Activity Balance must be achieved between hypo & hyperglycemia Possible “cure” artifical closed loop pancreasWilliam E. Winter, MD winter@pathology.ufl.edu
  25. 25. Closed loop system “artificial pancreas” - Description: continuous glucose sensor linked to insulin-delivery device Glu. meter Insulin infusion pumpWilliam E. Winter, MD winter@pathology.ufl.edu
  26. 26. What are the knowledge deficits regarding the use of mobile devices in the treatment of diabetes? Little data that mobile devices improve outcome (EBM) ~Almost all apps -- > no outcome data Professional organizations (e.g., ADA) are just beginning to provide apps Unclear: Qualifications of the app author Review of app by scientific body Other issues: - Privacy - SecurityWilliam E. Winter, MD winter@pathology.ufl.edu
  27. 27. THANK YOUWilliam E. Winter, MD winter@pathology.ufl.edu

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