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

2. 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

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

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

5. 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)

6. 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.

7. 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

8. 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

9. 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

14. Personalised INFORMATION
“Patients preferred computer systems that provided information from their medical records to systems that just provided general information. 14

36. Glucose ReportS

37. Data driven push decision support
Multiple Data Sources
Algorithm Engine
Personalised advice

38. 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."”

39. e-learning 39

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

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

42. 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