Phone App Improves Metabolic Control in Type 1 Diabetes

By Will Boggs MD

NEW YORK (Reuters Health) Feb 04 - Use of the Diabeo software on a mobile phone improves metabolic control in patients with chronic, poorly controlled type 1 diabetes, researchers from France report online in Diabetes Care.
An active electronic log book such the Diabeo system facilitates the management of complex insulin treatment of type 1 patients, improves blood glucose results and quality of life, and assists follow up by physicians "thanks to the transmission of whole data through GPRS (General Packet Radio System) and Internet," Dr. Guillaume Charpentier from Sud-Francilien Hospital, Corbeil-Essonnes, France told Reuters Health in an email.
Dr. Charpentier and colleagues evaluated the efficiency of the Diabeo system in improving metabolic control in a randomized, open-label, parallel-group study of 180 patients with chronic, poorly controlled type 1 diabetes. Voluntis, makers of Diabeo, provided the software, and sanofi-aventis partially funded the trial.
Diabeo software is uploaded onto smart phones with Internet connection that provides bolus calculators using validated algorithms; plasma glucose targets; automatic algorithms for adjusting carbohydrate ratio and basal insulin or pump basal rates; and data transmission to medical staff computers.
Mean HbA1c was 9.07% at baseline. At the end of the 6-month study, HbA1c was significantly lower in the 60 patients allocated to electronic logbook alone (8.63%) and in the 59 patients allocated to electronic logbook plus teleconsultation (8.41%) than in the 61 patients allocated to the usual paper logbook (9.10%).
Only the difference between the electronic logbook plus teleconsultation group and the usual paper logbook group remained statistically significant after adjustment for multiple comparisons.
Similarly, significantly more patients in the electronic logbook plus teleconsultation group (10/59, 17%) than in the paper logbook group (1/61, 1.6%) reached the target HbA1c of 7.5% or less, with patients in the electronic logbook only falling in-between (4/60, 6.7%).
The frequency of symptomatic, non-severe hypoglycemia didn't differ between groups and did not increase from baseline.
Also, quality of life at baseline and endpoint did not differ between the groups.
Total time spent on follow-up was the same among groups, but participants in the electronic logbook only and usual paper logbook groups spent additional time traveling to and from the hospital, waiting for consultations, and carrying out administrative procedures.
Researchers say the software didn't require more time for the patient to manage diabetes. The combined time of launching the software on the smart phone, inputting blood glucose values and meal carbohydrate intake, and reading the software dose recommendation was less than 10 seconds, and transmission of the data was automatic and instantaneous.
"The Diabeo system is now proposed routinely to any patients treated with a basal bolus insulin regimen with either multiple daily injections or pump (that is to say nearly all type 1 patients and some type 2 followed in our center and other co-investigator centers), owning a smart phone or willing to acquire one," Dr. Charpentier said. "There is no specific skill require to use the system except to be able to use a mobile phone in a current manner."
He says that a nationwide study should begin in 2011, enrolling 600 patients, at the request of the health authority in order to obtain reimbursement by national health care insurance.
"The system has been adapted to type 2 patients treated with long acting insulin titration algorithm and automatic coaching about blood glucose monitoring, diet and physical exercise, and hypoglycemic events." He added that it's currently being evaluated through a multicenter randomized trial.
Diabetes Care. Posted online January 25, 2011. Abstract