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Telemedicine

Glucose under control

Software monitors diabetes by cell phone

miguel boyayanThe patient uses his mobile phone to type in his blood sugar level and his next meal; the system informs the dose of insulin that he has to takemiguel boyayan

A telemedicine service to help diabetics monitor their disease and improve their quality of life will start operating commercially in early 2008. Named GlicOnLine, the system was developed by Quasar Telemedicina, a company based at the Cietec company incubation center at the University of São Paulo/USP. The service allows diabetics to disregard calculations and tables used to evaluate the quantity of carbohydrates they can consume at each meal and the necessary doses of insulin. The diabetic can use the cell phone or a palmtop to type in their blood sugar level (which diabetics must constantly monitor) and the menu that will comprise their next meal. The system contains a list of 600 foods with home measures, such as soup spoons, skimmers, and the like. The system responds instantly, also by mobile telephone, the dose of fast action insulin necessary to offset that intake.

The entrepreneurs’ aim is to provide software for health care plans, government authorities and institutions that treat diabetes. “We don’t want to sell the software directly to patients because only people that can afford it would resort to the service,” says physician Quasar director, Karla Melo. To avail himself of the service, the patient has to be referred by a physician. The medical professional will feed the system with data on the diabetic, informing specific data about the patient’s metabolism, which will guide the treatment. The physician can keep track of the situation on the internet in real time and adjust the treatment at any time. In the traditional model, these interventions only occur when the diabetic suffers a crisis, or during periodic visits to the doctor. “GlicOnLine stores the information about each patient electronically, in the patient’s medical records, which allows for accurate evaluation of the evolution,” says Floro Dória, Quasar director and Karla Melo’s husband.

The Quasar software is being evaluated by 20 patients undergoing treatment at the Nead-HC diabetes treatment center, an NGO linked to the Clínicas teaching hospital at the School of Medicine, the University of São Paulo/FMUSP). The NGO is run by endocrinologists and endocrinology professors. The patients were divided into two groups: one was equipped with mobile phones to do the control via the GlicOnLine software, whereas the other calculated everything manually with tables and calculators. To ensure comparison accuracy, the therapies were inverted after three months: the group using the mobile phones switched to the tables and vice versa. “It was sad, and at the same time, gratifying, to hear the complaints voiced by the group who had already used the mobile phones and did not want to stop doing so,” says Karla Melo, who is part of the diabetes team at the Clínicas hospital and a member of Nead-HC. “But this had to be done so that we could compare the two therapies,” she says. The system is also being tested at private health care services, such as the Hospital Domiciliar do Dr. Kleber Tavares, a home care facility in the city of Belo Horizonte, State of Minas Gerais.

The idea of developing the software arose from a practical need. Karla Melo has type 1 diabetes – which affects young people and which leads to on-going insulin dependence. In 1997, she substituted the traditional therapy, based on fixed insulin doses, with an automatic system. An insulin pump places the hormone under the skin, applying smaller and more accurate doses at short intervals of time before meals. This kind of intensive treatment demands the participation of the patient and its objective is to avoid blood sugar peaks; these peaks have devastating, long-term consequences on the patient’s health. Moreover, the intensive treatment prevents the malaise and the fainting spells caused by hypoglycemia, which occur when the hormone is at the peak of its activity and drastically reduces blood sugar levels.

Counting
This therapy is linked to another step: the carbohydrate count, whereby the patient can previously measure the effect of a meal and calibrate the dose from the insulin pump better. “I noticed that my quality of life improved enormously, but not all patients benefited from this therapy. We found that some patients had difficulty in making so many calculations and giving themselves the proper dose,” says Karla. A recent research study conducted by the Oswaldo Cruz Foundation and by the Federal University of São Paulo, comprising more than six thousand diabetics in Brazil, showed that 75% of them did not control their blood sugar levels properly.

The automated service was created by Floro Dória, who also owns a systems analysis company. The first step, back in 2003, was to develop an algorithm to organize the calculations, in order to pass them on instantly to the patient. The funding for this development was obtained from the FAPESP’s Technological Innovation Program for Small Companies (Pipe), now called Program for Innovative Research at Small and Very Small Companies; the company was incubated at Cietec in 2005. The first prototype went into operation in 2005, with patients from the Clinicas Hospital, as part of a study about the evaluation of the telemedicine system’s impact on patient compliance with treatment and on the improvement of the patient’s quality of life. During the project’s second phase, which required that a business plan be presented, the Quasar partners continued to develop the system with the aid of a scholarship student who is also a diabetic. At first, the idea was to create a voice service, through which the patient would inform his data and receive the instructions as a voice message. However, the convenience of mobile communication has advanced so much that the voice system is now less used. “This system is still available, but will only be used by illiterate patients who are unable to use a mobile phone,” says Dória.

The Project
Long-distance blood sugar control (nº 04/09111-0); Modality Program for Innovative Research at Small and Very Small Companies (Pipe); Coordinator Karla Melo – Quasar; Investment R$ 409,950.00 (FAPESP)

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