Consultant/ Clinical Senior Lecturer Digital Diabetes: Dr Debbie Wake Consultant/ Clinical Senior Lecturer Dundee, Scotland

Online self management support DIabetes Virtual Clinics E-learning ePHRs Online coaching/ behaviour, Exercise and lifestyle change Social Media/ On-line Peer Support Insulin Management Systems/ Dose Prediction m-health/ apps Remote Monitoring and Feedback D-Nav/ DIGS Diabeo

HOME BLOOD glucose upload NEW OLD Images on right from Diasend- can we contact them to get permission? Image on left- can we look

Diabeter Dr.H.J. Veeze Permission from Dr Veeze in Diabeter to use this

Remote Glucose Monitoring Jothydev Kesavadev, India Mean HbA1C reduction from 8.5 ± 1.4% to 6.3 ± 0.6% at 6 months (P<0.0001)

DAWN Health Foundation (SHINE) SKYPE CLINICS IN NEWHAM, ENGLAND PATIENT QUOTES: 'It’s brilliant. It was a ten-minute appointment. Getting to the clinic takes longer. It saved so much time. It’s for busy people with busy lives.' 

 'Sometimes in hospital I’ve felt the doctor was in control and you don’t want to waste their time but I want to get back to work… you feel liberated in your own home, it’s on your terms.’ The choice of software provider is important for ease of use and reliability. Patients who have had several webcam appointments have: reduced HbA1c levels, fewer A&E attendances modest efficiency savings.

AUTOMATED INSULIN ADVISOR BLOOD GLUCOSE MONITOR WITH INBUILT INSULIN ADVISOR (D-NAV/ DIGS) TYPE 1 DIABETES – PUMPS_CLOSED LOOP ONLINE WEB GLUCOSE PREDICTION – TREATMENT ADVISOR MOBILE APP with remote health care support DIABEO, Voluntis ? Need permissions from D-NAV/ DIGS, DIABEO, Anywhere that will allow an image of a ‘closed loop system fro type 1 diabetes’ see top right, and manage BGL ? Contact via their website

Diabetes Apps / m-health FEATURES: Blood Glucose Monitoring Insulin Logging (+/- CHO ratios) Activity Tracker CHO tracking Ratio wizard Physiological Measurements (Home BP, blood results etc). Weight Tracker Medication (Rx) (+/- alarms) Graphic Displays and Analytics Reminders and Alarms (RA) Patients Education Online data backup Social Media Integration Multiple user/ family features

Predictors of success Web based interventions to improve diabetes care are wide ranging and can improve glycaemic control. Kingshuk Pal*, et al (2013) Predictors of Success (Ramadas et al) Goal-setting Personalised coaching Interactive feedback and on-line peer support Mobile device HCP interaction

www.mydiabetesmyway.scot.nhs.uk

Personalised INFORMATION “Patients preferred computer systems that provided information from their medical records to systems that just provided general information. www.mydiabetesmyway.scot.nhs.uk 14

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Glucose ReportS

Data driven push decision support Multiple Data Sources Algorithm Engine Personalised advice www.mydiabetesmyway.scot.nhs.uk

Messaging Example Data Driven Glucose Support Messages (SMS):   ” Thanks for using Diabetes Glucose Support. We’ve noticed that you are experiencing episodes of low blood sugar (hypoglycaemia) almost every day. Are these due to increased activity or, missed meals? Your insulin dose probably needs reduced. Contact your diabetes team to discuss more” ““Thanks for uploading. Your lunch time and pre dinner blood glucose has been high recently. If you use twice daily insulin and you aren’t suffering any symptoms of hypoglycaemia, then consider a 10% increase in your breakfast time insulin. (that’s around 1 unit extra for every 10 units of insulin you take). Phone your diabetes nurse to discuss further. Set initial pre-meal glucose targets of less than 10 and gradually work towards the national target of 4-7."”

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Communication tools E-learning Modules: Driving and Diabetes LIVE CHAT:   Diabetes Nurse: How’s things? AM: Here’s My sugar levels today 0900- 4.4, 12.00- 5.2, 1600- 7.1, What do you think? E-learning Modules: Driving and Diabetes Advanced Carbohydrate Counting

E-learning Education Resources Remote Glucose Data Upload Social Media Communication Tools (Peers/ HCP) Electronic Patients Health Record Access Personalised Advice (Algorithms) Patient Reports

History Available to all patients with diabetes across NHS Scotland with diabetes (>25,000 current registrants (2016)). Low running costs 115,000 website hits per month