The Diabeo mobile phone program, which recommends
insulin dosages, helped people with type 1 diabetes lower their
blood-sugar levels in a six-month study. Now a new analysis of the
data shows the app markedly improved glucose levels among patients
who used it relatively infrequently, raising red flags for their
healthcare providers who then intervened.
"What the electronic system is not able to do is the magic of the
doctor — to give motivational support to the patient, to encourage
the patient to do what the patient does not want to do," Charpentier
told Reuters Health.
"This system is a very good tool to improve the contact between the
patient and the doctor when the patient really needs the doctor. The
system can alarm the doctor at the right time," he said.
Charpentier, from Sud-Francilien Hospital in Corbeil-Essonnes,
France, co-authored a recent analysis published in Diabetes &
Metabolism reviewing the results of a prior study he led on the
Diabeo system, a smartphone coupled to a website.
The first study, completed in 2009, included 180 patients seen at 17
French hospitals with poorly controlled type 1 diabetes.
The app, given to two-thirds of the patients, analyzed
self-monitored blood-glucose levels, carbohydrate counts, planned
physical activity and other personal variables to calculate
recommended insulin doses. Half of the app users regularly discussed
their diabetes management on the phone with their doctors, who
tracked information from the app online.
Those who used the app had significantly lower glucose levels than
those who recorded their blood-glucose levels and other variables on
paper, that study found. But the researchers wondered how much the
automated advice on the insulin dose contributed to the improvement
and how much the telephone consultations contributed.
To answer that question, Charpentier and his team re-examined the
results and divided the patients who were given the app into one
group that frequently used it and another that infrequently used it.
Frequent users consulted the app for insulin doses at 90 percent of
their meals, whereas infrequent users consulted it at less than one
third of meals.
The app seemed to be most beneficial for infrequent users who had
telephone consultations with their doctors, the study found. Low
users reduced their glucose levels by more than 1 percent about 42
percent of the time, whereas high users lowered their glucose levels
by the same amount only 16 percent of the time.
However, the average drop in blood sugar was not significantly
different between high and low users.
believes the results highlight the benefits of doctors monitoring
glucose levels in their patients with diabetes, particularly for
patients struggling to comply with diet and exercise
In the current study, doctors reached out to patients in the group
with phone consultations whenever the patients seemed to be veering
off course, on average every 20 days, he said.
Generally-compliant patients tended to take advantage of the
smartphone system to help them monitor their insulin needs, while
noncompliant patients often did not. But doctors frequently could
talk their patients into compliance when they tracked their progress
online, saw they were not using the system and contacted them,
"It appears that for a number of patients — most likely those who
have the greatest difficulty in coping with diabetes and its
constraints — the primary benefit of the device was to facilitate
interaction with a caregiver. This aspect is essential to ensure
that the tool is not viewed by patients as simply a gadget, but as a
valid means of providing proper medical support," the authors write.
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"What this really speaks to is personalizing medicine," said Dr.
Latha Palaniappan, from the Stanford University School of Medicine
"This could help us figure out who's going to need the telephone
consultation. It's just better tailoring of therapy for the right
patient population," Palaniappan told Reuters Health. She studies
diabetes and cardiovascular disease but was not involved in the
Past research has been mixed on the use of telemedicine, or
diagnosing and treating patients using telecommunications
technology, for diabetes. A review of 16 studies suggested that
computer and mobile phone programs that tailor advice and support to
people with diabetes may do little to improve their health and
quality of life (see Reuters Health story of March 28, 2013 here:
But Charpentier said he believes the Diabeo system, currently being
tested on 700 patients in France, will prove itself so useful that
the French National Health Insurance system will pay to give it to
all of the country's 200,000 people with type 1 diabetes.
The system is not currently available in the United States, he said.
Palaniappan noted that the Diabeo system cut glucose levels in the
current study by more than another common system has done in
"This is at least as good as continuous glucose monitoring, which is
currently reimbursed by insurance," she said. A continuous glucose
monitor helps patients detect when their glucose values are
approaching dangerous levels.
People with diabetes frequently feel "depressed, discouraged,"
Charpentier said. With the app, he said, "You can help your patient
at the right time. It is the best way to use the time of the doctor
when the patient really needs it."
Telemedicine is improving at a rapid rate, Palaniappan said.
"As our technology is getting better, we're seeing better effects on
chronic health conditions," she said. "We can't be stuck in the old
conclusions. We have to continuously reevaluate because there's some
cool stuff going on with technology now."
Sanofi-Aventis and CERITD, a French nonprofit diabetes research
organization, funded the study. Charpentier said neither he nor any
of his colleagues on the research team have financial ties to the
Diabetes & Metabolism, February 2014.
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