Use of the Internet to optimize self-management of type 1 diabetes: preliminary experience with DiasNet

Six patients with type 1 diabetes participated in a pilot trial. Their median age was 36 years (range 29-61) and the median duration of diabetes was 10 years (range 3-29). They were asked to enter, from their home or work PC, blood glucose values, insulin doses and a food diary. From the data entered, a computer model generated a simulation of the blood glucose concentration for the data collection period. It could then suggest alternative insulin doses (or regimes), or meal sizes, to reduce the risk of hypo- and hyperglycaemia. During a six-month study, patients entered a median of five sets of data (range two to eight). Feedback from participants revealed that while the system was helpful, difficulties with data entry hindered its use. Information gained from this exercise is shaping further development of the system.

Using the internet in patient-centred diabetes care for communication, education, and decision support

The New England Journal of Medicine 329 (1993) 977- The present paper describes two systems for communication, education, and decision support in patient-centred diabetes care. Both systems are developed under the assumption that while the clinical resources in the health care sector are limited, patients' resources and new information technology may be able to play a much more central role. With DiasNet patients can experiment with their own data. They can, retrospectively, adjust insulin doses or meals sizes, and thereby learn how to cope with various situations. DiabVision, brings together algorithms for detection of retinal lesions in digital images and for aligning time series of retinal images. While the former algorithms are aimed at automated procedures for screening for diabetic retinopathy, the latter can be used to enable motivated patients to see the actual retinal lesions in their own eyes, illustrating how the changes appear, and perhaps disappear, as a consequence of changes in lifestyle and glycaemic control. One of the long-term goals of our work is to assess the potential of integrating all health related information for patients with diabetes and other major chronic diseases. One solution to these problems would be to organise data and information as one virtual database, which then could be accessed by both health professionals and by patients. This structure would facilitate easy access, a clear overview, and quality control. A web site taking the first step in this process has been launched.

DiasNet--a diabetes advisory system for communication and education via the internet

Intensive diabetes treatment can lead to a substantial reduction of the rate of the complications associated with diabetes. However, a number of patients may have poor control despite specialist care, and this along with devolution of care to non-specialists suggests that alternative interventions should be developed. The present paper describes an Internet based system where more emphasis is put on patient empowerment, the keywords being education and communication. The DiasNet system is based on a well documented decision support system, Dias, designed for use by clinicians. The scope of DiasNet has been widened from being used by clinicians to give advice on insulin dose, to also being used by patients as a tool for education and communication. Patients can experiment with their own data, adjusting insulin doses or meal sizes. In this way different therapeutic and dietary alternatives can be tried out, allowing the patient to gain experience in achieving glycaemic control. DiasNet is implemented in JAVA according to the client/server principle, enabling a new way of communication between patient and clinician: in case of any problems, the patient simply phones the clinician, who immediately, using his or her office PC, can take a look at the data the patient has entered.

DiasNet--an Internet tool for communication and education in diabetes

Although studies have shown that intensive diabetes treatment with the goal of maintaining blood glucose concentrations close to the normal range lead to a substantial reduction of the rate of the complications (e.g. blindness, kidney failure, amputations and circulatory diseases), this can be difficult to achieve using conventional means. It is recognised that a number of patients may have poor control despite specialist care, and this along with devolution of care to non-specialists suggests that alternative interventions should be developed. DiasNet, which is used by patients as a tool for education and communication, is based on a well documented decision support system used by clinicians to give advise on insulin dose. In DiasNet the patients can experiment with their own data, adjusting insulin doses or meals sizes, and thereby learning how to cope with various situations. The system can run both as an ordinary application on a standard PC, and as an Internet application using a standard web browser. The latter enables a new way of communication between patient and clinician. DiasNet is currently being tested on a small group of diabetes patients.