Diabetes Connected Health: A Pilot Study of a Patient- and Provider-Shared Glucose Monitoring Web Application Journal of Diabetes Science and Technology 2009 Alice J. Watson,Joseph C. Kvedar,Basmah Rahman,Alexandra C. Pelletier,Gregory Salber,and Richard W. Grant

Outline Background Background Research Design and Methods Research Design and Methods Results Results Discussion Discussion Lessons Learned Lessons Learned Implications for Future Research Implications for Future Research

Background “ current standard of care ” frequently fails to deliver on evidence-based recommendations for practice. “ current standard of care ” frequently fails to deliver on evidence-based recommendations for practice. Requirements for more transparent reporting of outcomes and new payment systems that reimburse based on outcomes rather than visit. Requirements for more transparent reporting of outcomes and new payment systems that reimburse based on outcomes rather than visit. A remote blood glucose monitoring application [ “ Diabetes Connected Health “ (DCH)] A remote blood glucose monitoring application [ “ Diabetes Connected Health “ (DCH)] Allows patients to upload glucometer readings from commercially available glucometers. Allows patients to upload glucometer readings from commercially available glucometers.

Research Design and Methods Both patients and providers had access to this Web site, where the data could be viewed, analyzed, and discussed. Both patients and providers had access to this Web site, where the data could be viewed, analyzed, and discussed. Subjects were recruited from a primary care practice. Subjects were recruited from a primary care practice. 20(8 decline)→12(5 ineligible)→7 20(8 decline)→12(5 ineligible)→7 Prominently featured a graphic representation of blood glucose readings. Prominently featured a graphic representation of blood glucose readings. A “ journal ” page allows patient to make notes and comments about each reading. A “ journal ” page allows patient to make notes and comments about each reading.

Provider can access to patient blood glucose readings and notes. Provider can access to patient blood glucose readings and notes. One-way messaging allowed provider to send comments to each patient. One-way messaging allowed provider to send comments to each patient. Each participant was asked to upload their readings using the modem once per day. Each participant was asked to upload their readings using the modem once per day.

Results Participant Satisfaction: Participant Satisfaction: Five “ Excellent ” or “ Good ” Five “ Excellent ” or “ Good ” Remaining “ Average ” or “ Satisfactory ” Remaining “ Average ” or “ Satisfactory ”

Patients are motivated to improve self-management because they know their provider is watching. Patients are motivated to improve self-management because they know their provider is watching. The DCH application facilitated greater communication between patient and provider. The DCH application facilitated greater communication between patient and provider. The use of the product increased patients ’ general awareness of their blood sugar and its changes. The use of the product increased patients ’ general awareness of their blood sugar and its changes. The application would be most useful for newly diagnosed patients or during times of medication titration. The application would be most useful for newly diagnosed patients or during times of medication titration.

Discussion The number of comments per month increased, indicating ongoing engagement. The number of comments per month increased, indicating ongoing engagement. Self-monitoring is likely to be of value when test results are linked to educational or behavioral advice and changes in clinical management. Self-monitoring is likely to be of value when test results are linked to educational or behavioral advice and changes in clinical management.

Lessons Learned Limitations: Limitations: Small sample size and short follow-up period. Small sample size and short follow-up period. Demography Not generalizable. Demography Not generalizable. Shortcomings: Shortcomings: Messaging was one-way. Messaging was one-way. Difficult to integrate the use of the Web site to provider's workflow. Difficult to integrate the use of the Web site to provider's workflow. User wanted more flexibility in how the readings were displayed. User wanted more flexibility in how the readings were displayed. More flexibility in where and when patient could upload readings. More flexibility in where and when patient could upload readings. More contextual information around high or low readings. More contextual information around high or low readings.

Implications for Future Research Primary outcome measure will be change in HbA1c over the 6-month study. Primary outcome measure will be change in HbA1c over the 6-month study. Improvements: Improvements: Two-way messaging. Two-way messaging. Integration of the program with other data sources. Integration of the program with other data sources. A summary page detailing all their patients along with key metrics. A summary page detailing all their patients along with key metrics. Customize the appearance of the graph. Customize the appearance of the graph. New method of data upload via a computer. New method of data upload via a computer. Dates where medication changes were made are highlighted on the graph. Dates where medication changes were made are highlighted on the graph.