When Telemedicine Does Deliver!: Telemedicine and diabetes management. Schwarz P. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. Telemedicine and diabetes
management
Prof. Dr. med. habil. Peter Schwarz
Department for Prevention and Care
University Hospital „Carl Gustav Carus“ Dresden
Chairmen „Diabetes Prevention“ German Diabetes Association

2. TIME to ACT - alarming facts
1. Type 2 diabetes and its cardiovascular complications are becoming
more prevalent throughout the world.
2. The conditions and risk factors that precede type 2 diabetes have also
increased substantially. These risk factors are well-known: obesity,
central adiposity, physical inactivity and unhealthy diet.
3. At the time of diagnosis and the longer that diabetes exists, disease
complications are more likely – mostly CVD.
4. Prevention is the key: modifiable risk factors need to be addressed
through effective interventions
5. Prevention of type 2 diabetes is effective and needs management

3. Carus Consilium Sachsen (CCS) - geographic area
It includes 4 regional districts and 1 district capital – the city of Dresden.
16.03.2010

4. Aged population 2006
with prospective development 2020
60,0
50,0 47.3
40,0 35.9
Ratio of the elderly
Population 65+ years 30,0
jeweiligepopulation
Overall Bevölkerungsveränderung in %
of age compared to
18 to <65 years of age 20,0 Altenquotient
Aged population
Altenquotient 2020
Aged population 2020
10,0
-
- 10,0 - 7.0
Quelle: Statistisches Landesamt Sachsen

5. Challenge  The patient with diabetes
• Chronic disease with stigmatization
• Patients in all age groups with the nadir in middle age
• Quality of treatment depends on physician - patient interaction
• 45% of the patient have depressive symptoms
• Self Monitoring of blood glucose is the main step of diabetes treatment
• Documentation is integral part of self-management
• Compliance for documentation is the key in diabetes treatment
• Extremely costly diseases due to treatment and complications

6. Overview of the current way of Diabetes Management

7. Diabetes Management - GlucoTel one possible Answer
The Problems The Solution
• Current system involves patient • Removes requirement for patient to
manually recording results in a log manually record and transfer
book or via manual down- and measured values
uploading procedures • Caregivers, granted access by the
• Reviews of this data with a caregiver patient, can monitor values anytime
is only done periodically (generally online and deficiencies in treatment
every 3 months) can be spotted in ‘real-time’
• Patients are routinely poorly or non- • Closes the gap between the patient
compliant and results are not and the caregiver offering better
recorded accurately resulting in poor disease management for the
monitoring of disease and potential patient and better quality of care
mis-diagnosis for the caregiver
• Any deficiencies in a patient’s • Payers will have the option to
treatment can only be spotted by the monitor non-compliant patients
caregiver at long intervals and might consider potential
solutions to this costly problem
GlucoTel has the potential to significantly reduce
overall healthcare costs for diabetes treatment

8. GlucoTel | Blood Glucose Monitoring and Diabetes Management System
• Real-time transmissions
• Bluetooth enabled meter
• Wireless transmission to
mobile phone
Blood • Mobile phone automatically
transfers test result to
Glucos patient online log book
e Meter

9. Diabetes Telemonitoring & Management System

10. Online Disease Management - www.bodytel.com
Internet platform that is accessible via
normal internet browser and contains:
• Secure Patient Data Center
Real-time, CE Approved and FDA conform, HIPAA
compliant, hosted by third-party with double
redundancy
• Alert Manager
Enables caregivers to set up thresholds and alerts
Web 2.0 Module (Instant Messaging, Email),
Legacy Module (Text Message, Fax, etc.)
• Access Manager
for administrating access rights to caregivers
• Web Shop
Subscription manager (automatic. supply with
goods [e.g. test strips])
for all BT products and special 3rd party products
• OEM Interface
for third party sensors
• eHealth Interface
HL7 electronic, patient record e.g.
into the Google healthcare record
• In the medium term, the BodyTel Center will seek to become a ‘one stop shop’ for patients with diabetes with
numerous add-on options including:
– Ability to order diabetes focused books on cooking, disease management, lifestyle, etc.
– Access to information on diabetes for newly diagnosed patients including online blogs, etc.
– Ability to attract third-party diabetes relevant
advertising

11. Care Study to test the effect of Telemedicine
1. Critical analysis of the telemedicine need
and the compliance situation of the patient
in real health care
2. Baseline analysis of the treatment status
and possible telemedicine adherence
3. Every 6 month standardized survey with
up to 4000 patients about the added
value of diabetes telemedicine (GlucoTel)
application and treatment effect
4. Identification of barrier to telemedicine in
real clinical care of diabetes patient
5. Development of an telemedicine medical 893 patients included
management for diabetes patients in real
health care
16.03.2010 Prof. P. Schwarz, 11

12. Advantage for patients and disease management
• GlucoTel changes and eases the live of diabetics
no written diary anymore; Glucose values immediately available to caretakers, etc.)
• Telemedicine can offer more convenient services to the patient
Patients receives service than stigmatization
• The patients do what they do and receive more quality service
• Telemedicine changes behavior do to perceived supervision
my doctors know my glucose value in the same moment
• Telemedicine helps reducing costs to the Social Security System
Pay per test and quality management
• Telemedicine (GlucoTel) is able as a tool to build customer satisfaction
• Telemedicine (GlucoTel) provides the missing link

13. Necessary strategies for intervention for a new public-
health approach to diabetes prevention
Easy to understand Easy healthy Perrsonal MY benefit
Personal intervention material food choices in feedback about from prevention
(minorities, social daily life progress
groups)
Intervention Management
structures for
Targeted
intervention in
Quality
management
Physician
education
Secondary
prevention
structures intervention high risk groups intervention programs
programs
Guidelines for Community Work side risk Intervention Community
Community diabetes screening reduction small manager based primary
prevention EB programs and big education prevention
and practice business programs
National National Health Tax incentive in City planning Environmental Health lifestyle
Diabetes Plan insurance private sector (reimbursement) programs for education at
State (reimbursement) for screening exercise school

14. Necessary strategies for intervention for a new public-
health approach to diabetes prevention
Easy to understand Easy healthy Perrsonal MY benefit
Personal interventionmaterial food choices in feedback about from prevention
(minorities, social daily life progress
groups)
Intervention Management
structures for
Targeted
intervention in
Quality
management
Physician
education
Secondary
prevention
structures intervention high risk groups intervention programs
programs
Guidelines for Community Work side risk Intervention Community
Community diabetes screening reduction small manager based primary
prevention EB programs and big education prevention
and practice business programs
National National Health Tax incentive in City planning Environmental Health lifestyle
Diabetes Plan insurance private sector (reimbursement) programs for education at
State (reimbursement) for screening exercise school

15. Development and Implementation of a European Guideline
and Training Standards for Diabetes Prevention

16. Network
who are active in
diabetes prevention
Thank you for
your attention
www.activeindiabetesprevention.com