Effects of remote care of patients with poorly controlled type 1 diabetes included in an experimental telemonitoring programme

Evaluating usability of and satisfaction with mHealth app in rural and remote areas-Germany GIZ collaboration in Bosnia-Herzegovina to optimize type 1 diabetes care

Background

Type 1 diabetes mellitus (T1DM) management in children and adolescents requires intensive supervision and monitoring to prevent acute and late diabetes complications and to improve quality of life. Digital health interventions, in particular diabetes mobile health apps (mHealth apps) can facilitate specialized T1DM care in this population. This study evaluated the initial usability of and satisfaction with the m-Health intervention Diabetes: M app, and the ease of use of various app features in supporting T1DM care in rural and remote areas of Bosnia-Herzegovina with limited access to specialized diabetes care.

Methods

This cross-sectional study, performed in February-March 2023, evaluated T1DM pediatric patients who used the Diabetes: M app in a 3-month mHealth-based T1DM management program, along with their parents and healthcare providers (HCPs). All participants completed self-administered online questionnaires at the end of the 3-month period. Data were analyzed by descriptive statistics.

Results

The study population included 50 T1DM patients (children/parents and adolescents) and nine HCPs. The mean ± SD age of the T1DM patients was 14 ± 4.54 years, with 26 (52%) being female. The mean ± SD age of the HCPs was 43.4 ± 7.76 years; all (100%) were women, with a mean ± SD professional experience of 17.8 ± 8.81 years. The app was reported usable in the domains of ease-of-use and satisfaction by the T1DM children/parents (5.82/7.0), T1DM adolescents/young adults (5.68/7.0), and HCPs (5.22/7.0). Various app features, as well as the overall app experience, were rated positively by the participants.

Conclusion

The results strongly support the usability of mHealth-based interventions in T1DM care, especially in overcoming care shortage and improving diabetes management and communications between HCPs and patients. Further studies are needed to compare the effectiveness of apps used to support T1DM management with routine care.

Multi index evaluation method of pathological weight loss effect of aerobic exercise based on telemedicine monitoring

INTRODUCTION: Pathological obesity seriously endangers human health. OBJECTIVES: A multi index evaluation method of pathological weight loss effect of aerobic exercise based on telemedicine monitoring is proposed to evaluate the pathological weight loss effect of aerobic exercise by using telemedicine monitoring system. METHODS: According to the indexes of aerobic exercise affecting weight loss effect, a multi index evaluation system of pathological weight loss effect of aerobic exercise was established. The medical sensor of the telemedicine monitoring system is used to collect the index data in the multi index evaluation system of pathological obese personnel. The medical sensor uses the wireless node to transmit the collected data to the remote monitoring center. The evaluation module of the remote monitoring center uses the collected data and selects the fuzzy comprehensive evaluation method to evaluate the pathological weight loss effect of aerobic exercise. RESULTS: The experimental results show that this method can effectively use the telemedicine monitoring system to collect the physiological parameters of pathological obese people, and use the parameter collection results to evaluate the effect of aerobic exercise on pathological weight loss. CONCLUSION: The proposed methods can provide basis for human aerobic exercise pathological weight loss.

Hybrid closed Loop improved glucose control compared to sensor-augmented pumps in outpatients with type 1 diabetes in real-life conditions with telehealth monitoring

OBJECTIVES

The study aims at evaluating glucose metrics and HbA1C values after pump initiation in outpatient settings.

RESEARCH DESIGN AND METHODS

This single center observational study enrolled 121 subjects with type 1 diabetes between September 2020 and May 2021 initiating sensor-augmented pump therapy with stand-alone CGM (n = 26) or pump users who only changed their device (n = 51), with predictive low glucose management (n = 8) or with Hybrid Closed Loop using Medtronic 780G (n = 36) systems. Changes in HbA1C levels and glucose metrics were analyzed after 3 months. All subjects received diabetes and carbohydrate-counting education if needed at time of initiation and were proposed a telehealth monitoring by a diabetic nurse educator.

RESULTS

There was no episodes of severe hypoglycemia or diabetic ketoacidosis nor serious pump-related adverse events despite outpatient model of care. While only 18/121 (14.8%) participants reached initially the recommended HbA1C levels, 23/85 (27%) in the conventional group and 33/36 (91%) subjects in the Hybrid Closed Loop group reached target levels after 3 months of follow-up. Time in target range 3.9-10 mmol/L (70-180 mg/dl) also improved and was optimal with closed loop with 30/36 (83%) subjects with time in range above 70%.

CONCLUSIONS

Initiation of insulin pump therapy for outpatients is safe with a dedicated facility. Telehealth monitoring after outpatient initiation provides tools for improvement in glucose control with an insulin pump. Outpatient pump initiation is compatible with Hybrid Closed Loop systems which provide the largest improvements in glucose control.