GPRS MOBILE PHONE TELEMEDICINE SYSTEM FOR SELF MANAGEMENT OF TYPE 1 DIABETES
A novel system based on a General Packet Radio Service (GPRS) mobile phone has been developed to assist in the self-management of patients with Type 1 diabetes. This system is described and its capabilities are compared, both to conventional treatment and to previous telemedicine work. Further work with the system is discussed, including the important practical problem of scalability (a topic not always addressed in telemedicine studies) which might be solved using a generic Grid architecture.
Type 1 diabetes mellitus causes the complete destruction of insulin-producing beta cells in the pancreas. If untreated, lack of insulin leads to excessively high blood glucose (BG) levels which cause long-term complications due to organ damage. These complications can be delayed or slowed by intensive insulin therapy, consisting of frequent BG measurements and at least three daily insulin injections (or the use of an insulin pump) to maintain BG levels around a nondiabetic range [1]. However, this therapy brings a risk of hypoglycaemia (low blood glucose levels) which has symptoms ranging from lethargy to a coma requiring hospitalisation.The insulin regimen must therefore be adjusted carefully, taking into account the time-delayed effects of different types of insulin. In conventional treatment, patients typically record the results of BG measurements from a meter, along with details of insulin injections and other information which might affect BG levels, in a paper-based diary. At three-monthly clinics this diary is discussed with a clinician and changes may be made to the insulin regimen. This method has several disadvantages, notably that any significant trends in the data, such as susceptibility to overnight hypoglycaemia, may not be identified for up to three months. Indeed, the diary itself may not be entirely accurate, since patients may “adjust” recorded BG levels to show better control than has actually been achieved [2]. These drawbacks have been addressed in the literature by a variety of telemedicine systems designed to assist in diabetic self-management. These have included electronic patient diaries [3] and systems which download and store BG readings directly from a meter. A direct connection to the BG meter is clearly preferable since it removes from the patient the burden of transferring the reading and avoids any temptation to “adjust” readings. Some systems include occasional transmission of the BG readings and diary information to a central server. This ought to ensure the timeliness of the data viewed by the clinician, if data are sent frequently. However, it would be better to avoid any intervention from the patient in this transmission, since making the patient responsible for connecting their system to the server may result in irregular updating [4]. Previously the technology available for transmission, such as a land-line modem, has required human intervention to initiate transmission. In comparison to previous work, the GPRS-based system described here seems to be unusual in offering direct data download from the BG meter with immediate wireless transmission of readings and diary information to a central server. The patient is not required to type in BG readings by hand, nor to remember to connect to a server at regular intervals. A mobile phone provides a natural way for clinicians to contact the patient, using a Short Message Service (SMS) text message or a voice call to the phone. The burden on the patient is minimised since the system is light, compact and based on a mobile phone which is already used by many patients.
A widely available blood glucose meter (LifeScan Inc.) was interfaced to a mobile phone capable of GPRS data transmission (Motorola Plc.) using purpose-built hardware. Before taking each BG measurement, the patient connects a cable between the BG meter and the phone. Custom software (e-San Ltd. [6]) on the phone downloads the BG reading from the meter and then guides the patient through a series of questions on their lifestyle and general health, such as recent diet and e
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