Telemedicine in the management of young patients with type 1 diabetes mellitus: a follow-up study

Abstract

DCCT (Diabetes Control and Complications Trial) study showed that tight metabolic control of diabetes mellitus can delay the onset and/or reduce the frequency of vascular complications. Telemedicine, i.e. telecommunications and information technologies in health care, is a useful tool to achieve the DCCT goals. Our European Community (EC) sponsored Telematic management of Insulin-Dependent Diabetes Mellitus (T-IDDM) project implements a telemedicine service through on a careful analysis of current medical practice. The system is based on two components: Patient Unit (PU) and Medical Unit (MU) connected by a Telecommunication system (TS). PU allows data collection and transmission from the patient's house to the hospital, assists self-monitoring activity and suggests insulin variations. PU communicates patient's current metabolic state the MU. MU assists the physician in periodic evaluation and suggests the prescriptions to communicate back defining a treatment protocol. TS system is based on telephone lines, relying on the Intranet technology. To test the system functionality and potential impact in type 1 diabetes clinical practice, we enrolled 6 patients (4 males and 2 females), aged 9.9-15.8 yrs, with disease duration 2.1-6.4 yrs, intensively treated. One girl run out after a 1-year follow-up HbA1c levels decreased, but not significantly. Insulin requirement reduced, significantly in 2 patients (p = 0.02 and p = 0.07). A positive correlation was between number of links and protocol changes (p = 0.01), between number of protocols changes and HbA1c decrease (p = 0.02). In pediatric patients periodical visits are necessary, but T-IDDM enables continuity of care improving access and activities. An index is represented by the high number of messages between the 2 Units, seeming weekly exchange.