Blood sugar monitoring phone app investigated in Upstate

07/26/2014 12:00 AM

07/26/2014 12:43 AM

Managing diabetes can be tough.

To stay healthy, a diabetic often must check his blood sugar frequently, monitor every morsel he eats, take his medications and see the doctor regularly.

It can be hard on the patient, takes a lot of the doctor’s time, and adds to the nation’s health care tab.

What if there were an app that could let the patient test his blood glucose and send the results directly to the doctor, who could then tweak the treatment regimen remotely?

A pilot project is underway at Greenville Health System to see whether such an app works. And chief medical officer Dr. Angelo Sinopoli said the results look promising so far.

“We’re doing it with our employees right now,” he told The Greenville News. “And it winds up with less doctors’ office visits, so the expense is down, but the diabetes control is much better.”

The device, a cellularly enabled blood glucose meter, was developed by Telcare, a Maryland-based company which designs technology that bridges patients and health care providers.

It runs on the Verizon Wireless network, said Verizon spokeswoman Karen Schulz.

“We provide the secure connection to transfer that data on an ongoing real-time basis,” she said. “It’s part of the standard end-to-end work we’re doing now.”

Better control

Some 21 million Americans have diabetes, according to the U.S. Centers for Disease Control and Prevention. African-Americans and Hispanics are disproportionately affected.

Uncontrolled, the disease can result in serious complications, including blindness, heart and kidney disease, and amputations, CDC reports. And the direct medical costs of dealing with the disease totaled $176 billion in 2012.

Historically, Sinopoli said, managing a diabetic properly meant lots of expensive doctor visits, sometimes requiring the patient to make long drives. Because it takes so much time and is so costly, some patients stay away, and that can result in poor outcomes, he said.

So officials at GHS wondered whether a project like this could work, he said.

“With this method, the patients can check their blood sugars (on the glucose meter), and it simultaneously sends that result to our computer system via Verizon,” Sinopoli said. “And the real advantage to being able to do that is that you get immediate access to those results.”

So now as the numbers come across, the nurse can compare them against a chart that tracks blood sugar trends and call the patient with medication changes without going through the doctor, he said. It allows them to be connected in real time.

“It’s a big difference between normal diabetes self-management programs. Most are more coaching and education and there’s typically a limited time period and then there’s no more interaction,” he said.

“This is permanently ongoing so that patients with difficult-to-control diabetes are constantly being monitored by diabetes educators so they can even tell when they were supposed to check glucose and didn’t.”

And so far, he said, control of blood sugar is better and there are fewer phone calls from patients with concerns about their conditions.

“It’s very encouraging,” he said. “The patients are ecstatic in terms of their improved outcomes and the doctors are excited about it too. I suspect that in the not too distant future this will become the way we’ll be managing diabetes.”

Technology advancing

About 40 employees are currently enrolled, he said, adding that all the outcomes are being reviewed by an endocrinologist to assure that adequate care is provided.

The technology also should help ease the mounting doctor shortage, Sinopoli said, because nurse practitioners and other “physician extenders” can provide much of the care instead of the doctor.

“Non-physician providers will become the core of health care delivery in the future,” he said.

Though the Telcare product and patient equipment are paid for by some insurance carriers, the system isn’t widely covered yet, Schulz said. But Sinopoli said that’s likely to change over time as insurers are able to measure the effectiveness and savings.

While fitness apps have been around for some time, the technology is moving beyond just tracking calories and miles walked.

Apple last month unveiled its Health app, which collects data on heart rate, blood sugar and cholesterol among other information for users, according to the company’s website. And a new tool called HealthKit allows users to access and share health data with a doctor.

“We believe Apple’s HealthKit will revolutionize how the health industry interacts with people,” said Dr. John Noseworthy, CEO of the Mayo Clinic, which is creating an app that can be connected to HealthKit.

Eight in 10 people would like to interact with their health care providers via smartphone, a June survey by FICO, a California-based analytics and software company, shows.

“People are eager to have a dialog with their health care providers in ways that are convenient to them,” according to Dr. Stuart Wells, chief product and technology officer.

Mobiquity, a mobile engagement provider, reports a 19 percent increase in new health and fitness apps in the App Store last year, adding that 2014 will be the year “that mobile health will make the leap from early adopters to mainstream.”

The FDA reports that the industry estimates that 500 million smartphone users around the world will be using a health app by 2015 — health care professionals, consumers and patients.

Security concerns

The medical information in the Telcare app is simultaneously held up in the cloud and can be accessed at once through multiple portals, mobile or desktop, Schulz said.

And that could raise some security concerns. Some 61 percent of the consumers who responded to the Mobiquity survey said that privacy was the main reason that stopped them from using apps more than they do.

But Schulz said the Telcare BGM is the first FDA-approved device to run over the Verizon network, which is encrypted, secure and password-protected on both sides of the interfaces. And Sinopoli said that once the information gets to GHS, it becomes part of the hospital medical record, which complies with federal privacy standards.

“It’s as secure as any health care data is,” he said.

Other trials are underway using tablet technology to help patients manage blood pressure and weight while being connected with a provider, Schulz said. And there are also heart rate monitors that patients can wear inconspicuously, which upload to dashboads that patients can access, she said.

“(Mobile health) is a huge area for the wireless industry,” she said.

Sinopoli said there are phones that can send a patient’s pulse rate and electrocardiogram to the doctor simply by placing a thumb on the device. He believes the technology will eventually be applied across a wide array of conditions, from asthma to heart failure.

For example, he said, asthmatics blow into a peak flow meter which measures the severity of their condition. If a flow meter were hooked up to the same technology, providing the doctor’s office with real-time results, that would be more helpful than a patient telling the doctor about it some days or weeks later at an appointment, he said.

“This will be the wave of the future in terms of what will happen to health care,” Sinopoli said. “This technology will change the whole face of medicine.”

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