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Monitoring Patient Glucose Levels: New Advances in software make it easier

Monitoring patient glucose levels and determining the response to intervention is critical when working with diabetic clients. The benefit of doing so in improved outcomes for both type 1 and type 2 diabetes has been clearly established by clinical trials conducted in both the U.S. and the UK1. Self- monitoring by patients of glucose levels, and the data provided is especially important for patients with a history of brittle diabetes, hypoglycemic unawareness, multiple dose insulin regimes and when intensive control is desired.

As a result, improving patient monitoring and compliance has been a goal of many glucose-monitoring systems in recent years. Painless or near painless blood and fluid sampling systems such as Minimeds continuous glucose monitoring system and the Cygnus Glucowatch have been developed. But there is another area in which great advances have been made as well: systems for reporting patient glucoses and developments that improve communication with healthcare providers.

The Need: Accuracy and Accountability

One consistently reported disadvantage of home monitoring has been the questionable accuracy of self-reported glucose level results. To meet the need for improved and more reliable data, most glucose monitors now include a memory component that can be reviewed by the physician and healthcare team.

But this is just the beginning of improving communication between physicians and clients. Increasingly sophisticated software has been developed that allows clients to download data from their glucose monitor into their PC, where it tracks and analyzes trends. Patients can now monitor their glucoses at home, download results, send them to their physicians offices and receive recommendations back.

Faster Access to Patient Data in Improved Formats

Access to glucose recordseven if the client is sitting at homeis only moments away with modern monitoring software that delivers data to highly secure s ervers (to maintain HIPPA compliance). For instance, with Minimeds continuous glucose monitoring system, glucose values are automatically downloaded daily for analysis and can be sent to a secure web site online. The physician can log onto the secure web site to view a graph of daily glucose levels for patients, read a summary of relevant statistics for the sensor and calibration readings, and look at a combined model day.

Another example of using cutting-edge software applications to facilitate communication with the physicians office is being adopted in Europe. Patients in France are using their cell phones to send their glucose levels and other information to their doctors offices via Gluconet. Clinical trials in France conducted since April 2003 by France Telecom R &D, in conjunction with Grenoble and Toulouse University Hospitals, are underway to determine patient benefits and cost reductions in using this method of transmitting data. The data is sent to physicians via the Orange GSM cellular network to a secure server that contains patient files. Doctors in France can then easily check files, and communicate with patients and offer recommendations via SMS text messages.2

Tracking Glucose Trends

Glucose meter manufacturers provide innovative software

Another new development in the arena of glucose monitoring and getting information to the physician and healthcare team was recently approved by the FDA (in November 2003). Roche Diagnostics Accu-Chek Smart Printer is a self-contained unit that is unique: it downloads and prints out glucose trends without needing a PC. It provides data and statistics as either clear graphs or color printouts, and makes it easier for physicians and healthcare professionals to monitor patient glucose levels and to view trends.

A physician can read trends over a day or a week, and this product gives fast access to information that can be used to identify events that cause hypoglycemic or hyperg lycemia, to track responses to activity, medication and diet and to provide more data for clinical decision-making. Using it is extremely easy, because there is no installation of software needed (the unit comes ready to go) and obtaining printouts consists of simply plugging the glucose monitor into a cable, pushing a button, then waiting a few seconds. The Smart printer is compatible with the Accu-Chek Compact, the AccuSoft Advantage, the Accu-Chek Complete and the Accu-check Active blood glucose monitors as well as hand-held PDAs.

Roche has created Compass Diabetes Care Software, and a PDA version known as Pocket CompassTM, which was cleared for use in June, 2002 by the FDA. The pocket compass software, designed for use with PDAs using a Palm OS, tracks glucose trends by storing and analyzing up to 1,000 blood glucose readings. Patients can use the infrared technology built into Accu-Check Compact or Active monitors to send data directly to their hand-held computers.

This software provides increased information to physicians, with reports, graphs and charts, as well as noting and correlating them to insulin, meal, exercise data and A1c levels.

LifeScan offers software that can be used with its meters, including its InTouch software package, which records and analyzes glucose profiles and provides enhanced patient information to the physician. The software records patient statistics in several formats, including noting hyperglycemic and hypoglycemia and a standard day format, as well as providing a correlation between insulin doses and glucose readings. It also includes a diabetes education and management component for improved patient teaching.

AIDA online is simulation software that has been available online as freeware since 1996. It allows the user to simulate the effects of changes in insulin and diet on glucose levels. It provides the healthcare provider, student or patient with a virtual diabetic patient and is a usef ul teaching tool.

Nearly half of all who download this program are diabetic patients or family members, but it is also used by medical students, pharmacists, nurses and diabetes educators as a training tool. The web site cautions that this software is not meant to be used for therapeutic planning purposes and encourages diabetic clients to discuss therapy with their physicians first.

TheraSenses Freestyle Co-Pilot is another program that allows patients with Internet Explorer web browsers to upload their glucose monitor readings and insulin dosage levels to a secure server and web site in the U.S. It allows uploading from one or several Freestyle monitors to one account, and develops a graphic of trends at its online database that can be accessed by the healthcare team. The physician or diabetes team can access readings and make recommendations to the client between office visits.

DiaTrends is diabetes management software designed by Overlook Software. It was designed by endocrinologists for use by healthcare professionals. It aggregates patient data into an easy-to-view format, shows trends, allows multiple queries into its database using different levels of specificity, and includes windows for demographics, lab values, and other pertinent parts of diabetes management. It is designed to work with Windows OS and can be integrated into any network.

Bayer Corporation has developed its WinGlucofacts Diabetes Information Management System software. This software was created to run with Bayer Ascensia blood glucose monitors, and allows patients to send information directly to a physicians office via email or web site. It runs on Windows, and takes client data and analyzes them to discover patterns and trends.

Clinipro was software originally designed by a software programmer with diabetes to help communication with his physician. He created a telemedicine component that would allow him to send the glucose readings to his physi cians office by email, and the first version of Clinipro was born.

It has since developed far beyond lists of glucose readings into award-winning patient medical software that presents patient data to physicians in easily read graphical or text format. Clinipro includes a strong diabetes management and education module that allows a physician to view data downloaded directly from 15 different glucose monitors. It also tracks medications, and has assessment screens created to help identify and monitor patient goals.

The education management module was designed to help collect the data needed for recognition as a certified diabetes education program by the ADA with education and outcome reports that include labs, exams, education summary and Hgba1c levels.

Significant advances have been made in recent years in the software that assists physicians in monitoring and tracking trends in their diabetic patients. Long gone are the days when scribbled logbooks or verbal recall of glucoses are needed. Now, gaining access to patient glucose readings is as fast as accessing a secure web page in many cases, and a physician can enter recommendations via the same method. Diabetes management has entered the information age-and the tools will only continue to improve.

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