Effect of Mobile Phone Telemedicine on Diabetes Care

Background: Telemedicine use for insulin titration, blood glucose self management, and education have shown to improve HbA1c, reduce hospitalizations, and improve blood glucose control.  To date the educational tools used to transmit data include glucose meters, glucose meter data tracker programs, and recently mobile phone applications.  However, a major limitation of mobile phone applications is the communication between health care providers and patients.  There are concerns of privacy, accuracy, and efficacy using this closed loop system of communication.  Thus direct communication between a patient and health care provider for management decisions has not been evaluated for its usability and efficacy.

Method: We have developed a mobile phone application called Diabetes Doctor.  Diabetes Doctor allows patients to record blood glucose values, the type and amount of insulin administered, and any dietary information they prefer to document and notify their provider using an easy and unobtrusive user interface.  The data entered can also be displayed as a log or graph for additional pattern recognition.  Privacy between the provider and patient meets HIPAA standards with complete end-to-end encryption between the mobile phone user and the provider.  We have tested the mobile application for accuracy by entering 100 artificial blood glucose values, type and amount of insulin into the mobile phone application.  The provider responded with 100 artificial insulin dose recommendations after interpretation of the data that may help control blood glucose values.

Results: This form of communication between a patient and provider is deemed to be accurate with 100% reproducibility of transmitted data.

Conclusions: Diabetes Doctor is a novel mobile phone application that can facilitate transfer of blood glucose data between patients and providers.  We plan to perform a prospective randomized controlled trial of participants with type 1 or type 2 diabetes mellitus treated with a basal and bolus insulin regimen to use the mobile phone application for transmitting blood glucose, insulin regimens, and dietary information directly to providers for an insulin regimen change.  Usability, quality of life, and compliance will be compared.

Disclosure: Dr. Patel is the inventor and has ownership interest in the Diabetes Doctor mobile phone application being used in this study.