DIFFICULT DIABETES

Intensive insulin therapy is the only type of treatment currently available for most of the type 1 diabetic patients that makes it possible to keep normal daily activities and to slow down a progression of the late complications of diabetes, which otherwise might cause serious disabilities and a premature death.

At the initial phase of the treatment in case of the newly diagnosed diabetic patients and in patients with unstable course of the metabolic control (i.e. difficult diabetes) it is very difficult to stabilize patient’s state and to bring glucose concentration to normoglycemic range in a short period of time. Therefore, in case of the unstable course of diabetes, an expensive few-weeks-long hospitalization might be necessary.

A mobile teletransmission modules (patient’s and physician’s) are basic components supporting treatment of the difficult diabetes in the MODEL CENTER. These units allow for bi-directional continuous communication between patients and their physician / diabetologist in-between the control face-to-face visits in the CENTER.

The most important functions realized by the Patient’s Teletranmission Module are as follow:

• storage of the patient’s self-monitored data related to the patient’s state and lifestyle as well as a course of the treatment, i.e. electronic log-book functionality,
• edition of the stored data,
• automatic teletransmission of the collected data to the main data base of the CENTER according to pre-defined transmission schedule (i.e. synchronization of contents the local and distant data bases),
• automatic teletransmission of the selected data to recipients such like: physicians, dietitians, nurses, parents of the diabetic child, etc.
• monitoring alarm conditions and notifying the selected recipients (including the physician) about occurrence of the alarm states that require prompt actions to be taken,
• presentation of the treatment results in statistical and graphical formats covering different time periods,
• facilitation of the day-to-day monitoring and treatment of the disease by provision of an access to diabetes simulators, internet based dietary expert systems, etc.,
• modification of the module’s configuration parameters related to a way of operation, such like: type and category of the transmitted data, frequency of the data transmissions, addresses of the data recipient’s, alarm state detector parameters, etc.,
• voice communication between patients and the physician.

The Physician’s Teletransmission Module shares the functionality of the patient’s module excluding the self-monitoring data dispatching to other recipients. In contrast to the patient’s module, the physician’s module makes it possible to view the data of many different patients whose data are synchronized with the main data base of the CENTER.

The teletransmission modules can support monitoring and treatment of patients with difficult diabetes and pregnant diabetic patients as well, because in both cases similar or even the same set of the data is collected and the only differences that occur are related to frequency of the data transmissions (that is usually higher in case of patients with difficult diabetes) and to a duration of the application of the modules (few weeks in case of patients with difficult diabetes and many months in case of pregnant diabetic patients).

The mobile units use smart phone devices controlled by Windows Mobile Professional operating systems as a hardware basis. Two devices with screen resolution of 240 x 400 pixels (including Sony Ericsson Xperia X1 with the sliding QWERTY keyboard and Samsung Omnia i900 without a hardware keyboard; both with a touch screen operated with a stylus) and one device with 480 x 800 pixels screen resolution (HTC HD2 with touch screen operated with a finger).

Software of the mobile modules was implemented in VisualBasic (VB.NET) using WindowsForms, technology, .NET Compact Framework ver. 3.5 and Windows Mobile Software Development Kit (WM SDK ver. 6.0 and 6.5.3). At the time of implementation that was the only solution available for WM platform.

Physician’s Mobile Teletransmission Module. Main form.

Patient’s Mobile Teletransmission Module. Exemplary data input forms.

Patient’s Mobile Teletransmission Module. Electronic log-book.

Patient’s Mobile Teletransmission Module. Exemplary graphical presentation of the treatment results.

Difficult Diabetes Module. Graphical presentation of the treatment results.