Study doubts benefit of basic blood glucose self-monitoring for non-insulin T2 diabetes

June 21, 2017 | by

Is it the technology, or the human touch? It’s only one study, but the sample size is substantial–450 patients–as was the length of time, one year. This randomized group in the Monitor Trial study published earlier this month in JAMA Internal Medicine came from 15 primary care practices in central North Carolina. All were over 30, were Type 2 diabetics who did not use insulin for control, and had glycemic control (hemoglobin A1c) levels higher than 6.5% but lower than 9.5%, which placed them higher than normal but within excellent to fair control (Endocrineweb.com). The 450 patients were divided into three groups: one with no self-monitoring of blood glucose (SMBG) but were monitored at their doctor’s office, another monitored themselves once daily, and once-daily SMBG with enhanced patient feedback including automatic tailored messages delivered via the Telcare meter (acquired by BioTelemetry in December ’16).

There were no statistically significant differences among the group either in the A1C or another measurement, health-related quality of life and “no notable differences in key adverse events including hypoglycemia frequency, health care utilization, or insulin initiation.”

It seems that in this relatively benign group, self-monitoring alone or mildly enhanced–in other words, patient engagement in SMBG–made no significant difference. The UNC-Chapel Hill researchers concluded that “This pattern suggests that, for SMBG to be an effective self-management tool in non-insulin-treated T2DM, the patient and physician must actively engage in performing, interpreting and acting on the SMBG values.” (Editor’s emphasis) In other words, more–not less–human contact would be needed for SMBG to work better, at least with this group! This Editor would then like to see a comparison with insulin control. Also Healthcare Dive

What’s news at the end of the week

June 11, 2015 | by

Care Innovations harmonizes seniors, Panasonic adds diabetes, Jawbone and Fitbit bite, the first EHR/PHR Hack and Concussion in Cleveland. Converging its interests in remote patient monitoring with its long-time footprint in senior housing resident monitoring (QuietCare), Intel-GE Care Innovations is testing its Health Harmony remote patient monitoring system, partnering with two California-located Front Porch communities and the Front Porch Center for Innovation and Wellbeing. The residents selected have poor chronic condition management or have returned after a discharge from a skilled nursing facility. No disclosure on projected number or duration–and it doesn’t appear that QuietCare is part of the monitoring. Release….Panasonic just bought Bayer Healthcare’s diabetes/blood glucose monitoring device unit for $1.13 billion as Bayer continues to shed non-life science businesses. While old-school prick-and-bleed monitors are being eclipsed by continuous glucose monitors (CGMs) and mobile-based devices such as Telcare in the US and in Europe, there’s plenty of market remaining in the West, and new ones in Asia and the Middle East for simple devices. It joins Panasonic’s existing blood pressure monitors. MedCityNews….Jawbone and Fitbit continue to snap at each other in court, with the former on Wednesday filing a second lawsuit on patent infringement, specifically “a wellness application using data from a data-capable band”, with the added fillip of going to the International Trade Commission, which could ban the import of Fitbit products or component parts. The 28 May lawsuit was about Fitbit’s hiring of five former Jawbone employees who allegedly stole IP. The companies between them have hundreds of patents, and as this Editor has noted in previous IP and patent troll articles, the US Patent and Trademark Office (USPTO) is not especially rigorous in ensuring that patents are not overbroad. Wonderful for the IP attorneys, but not exactly what Fitbit wants as a runup to their expected IPO next week. Wall Street Journal….Now an EHR and PHR join Hackermania Running Wild. Medical Informatics Engineering reported Tuesday that in May their server was cyberattacked, exposing PHI of patients in five clients and separately information contained in the NoMoreClipboard PHR subsidiary. POLITICO reports that this is the first recorded instance of an EHR compromise. MIE Release, POLITICO Morning eHealth….If you are in the Cleveland, Ohio area and have an interest, Concussion: A National Challenge is a free, two-day event on detection and diagnosis sponsored by the National Academy of Engineering, the Institute of Medicine, Case Western Reserve University, Metro Health and Taipei Medical University. Advance registration required.

Qualcomm (Second) Life: a conversation with Jim Mault

December 19, 2014 | by

One of the surprises for this Editor, and for others attending the mHealth Summit, was to see the sizable presence of Qualcomm Life on both the exposition floor and during the sessions. From a near-nil presence at ATA 2014 and gone dark on news, the floodlights snapped on last week with new partners and a new emphasis: coordination of chronic and transitional (hospital to home) care management (CCM/TCM).

On the show floor, the spotlight was on the partner companies which mixed the established with (mostly) the early and mid-stage. Readers will recognize names such as AliveCor, Telcare, OMRON, Nonin and Airstrip; not so well known are Vaica, Orion Health, Monitored Therapeutics, IMPak Health, Vital Connect, Care Connectors, toSense (CoVa), Dexcom, InteliChart, TruClinic, ForaCare, VOXX, vitaphone (outside of Europe), Propeller Health and Noom Health (a NYeC Digital Health Accelerator 2014 graduate). The partners occupy different parts of the management continuum, integrating communications, record sharing, population health management, sensor-based monitoring, traditional and non-traditional vital signs monitoring, medication management, behavioral change methodologies and PHRs. The 2net Hub is still present for data transmission, sharing and storage, but more prominent is Qualcomm Life’s HealthyCircles platform which provides the clinical management ‘glue’: secure communications, record sharing and care team coordination. HealthyCircles was purchased in mid-2013. Founder James Mault, MD, FACS joined Qualcomm Life as VP/Chief Medical Officer.

We had some post-mHealth Summit reflection time by telephone this Wednesday while Dr Mault was in Boston. (more…)

Tunstall adopts new Tactio in patient management

November 13, 2014 | by

Tunstall Healthcare is partnering with Canadian mHealth developer Tactio Health Group in what is a distinct first for them: creating a mobile care management system that is 1) smartphone-based for the patient and 2) prominently integrates non-Tunstall apps and devices. The patient uses the smartphone and the Tactio-developed mTrax app to collect a wide spectrum of data–everything from activity, sleep, pregnancy, body fat and mood tracking to the traditional constellation of vital signs. This uploads to the care provider’s tablet mPro Clinical App which overviews, details and reports the data for each patient and patient groups in care. The data comes from well-known mHealth apps outside the Tunstall world: BodyMedia, Fitbit, Fitbug, Garmin, Jawbone UP, Medisana and Wahoo Fitness, as well as connected (presumably Bluetooth) medical devices from A&D Medical, Mio, iHealth, Telcare, Withings and Nonin. Tunstall has also added two-way patient coaching and  health journal features.

Tunstall’s positioning for what they call Active Health Management or AHM is “supported self-management” and “shift(ing) from reactive care to cost-effective active care.” (more…)

Verizon adds Telcare, Genesis to monitoring platform

February 28, 2014 | by

Verizon received a second FDA clearance for its health management software platform, and added blood glucose management monitors Telcare and Genesis Health as part of it. The first clearance, according to Mobihealthnews, covered five telehealth devices from Ideal Life. Verizon’s intentions are to ‘white label’ market the system to providers who plan to use personally gathered telehealth as part of a patient management program in integrated delivery networks (IDNs), where it is currently in trial–plus health plans and self-insured employers. Verizon’s platform also has ‘gamified’ educational and motivational functions, including its own virtual currency for rewards. If this is proven in the US, will this be marketable in the UK and EU–and will Verizon go it alone or seek partners? Hat tip again on the story to reader Mike Short via Editor Charles.  

$3,300 annual savings from diabetes monitoring: study

February 25, 2014 | by

A study published in this month’s Endocrinology (US) demonstrated a $3,300 per person annual reduction in employee healthcare costs in a trial of the Telcare mHealthmonitoring system in conjunction with ActiveCare data analytics used for an employee diabetes management program (N=143). The amount was the average decrease in 12 month claims between 2011 and 2012 for those who enrolled and used the program, versus those who enrolled but did not use the program demonstrated a $282 per person increase. Telcare press release, TouchEndocrinology.com (abstract/text) Hat tip to Editor Toni

A New Year’s Resolution, ADLs and a new care option

January 7, 2014 | by

Here are three items that are each important and have hit my screen in the past couple of days – sadly, try as I may, I’m struggling with a common linking theme.

The first, that the 3G Doctor alerted me to, is a simply brilliant talk by Telcare‘s CEO Dr Jonathan Javitt at the Technion Social-Mobile-Cloud Meets Medicine Conference on the 17th December 2013. We’ve all made the arguments that technology enables the genuinely continuing care that long term conditions require, rather than the episodic care our health service is set up to provide, and that technology ensures that patients have clinical support 24/7 rather than in the brief period the doctor or nurse sees them.  However Dr Javitt brings all the arguments together to make such a powerful case that the only sensible way to treat long term conditions is to use technology to help the patient that anyone opposing it might as well try to argue that the earth is flat. As a result I have decided that my New Year’s resolution this year will be no longer to rise to the challenges of the naysayers. (I wonder how long I can keep it.)

The second item is a new take on monitoring activities of daily living (ADLs). For those new into telecare, continuous ADL monitoring looks a brilliant way of picking up an early decline in cognitive or physical decline, often well before symptoms show up in a change of vital signs or response to questions. The challenge though is whether the computer analysing the ADLs is smart enough to cope with activities such as the invasion of the grandchildren, or can cope with multiple occupancy. So it’ll be interesting to see how well CarePredict’s service is received. This uses a bracelet to track someone being cared for, rather than relying on PIRs or similar sensors as many other ADL systems do. Of course, like falls detectors, the problem with wearables is that people take them off, although the mHealth News item claims that ‘seniors’ like the bracelets.

The third item is a BBC item on the attractions of care homes in countries where the cost of living is lower, such as Thailand, which does feel a tad mercenary, although where there is genuine reverence for older people the quality of care can be excellent, and recent revelations suggest that care for older people in the UK is hardly without its problems. A combination of Skype and cheap flights certainly means that it is possible to keep in touch regularly. If it gets to be considered a viable option, it will certainly complicate the economics of technology to stay at home vs care home.

Hat tip to Prof Mike Short for alerting me to the BBC item.

International CES unveils in NYC

November 15, 2013 | by

The trends and items of note for next January’s show in Las Vegas

  • The ‘Internet of Things’ is the phrase-du-jour–embedding anything and everything with sensors (digital elements) and blending the physical and digital worlds
  • Consumer Digital Health Care was listed as #3 of CEA’s 2014 Technology Trends to Watch (PDF link). What is hot is self-tracking (1/3 of mobile users have tracked using a smartphone and tablet, and over half are now concerned about data security), integrating tech for seniors (touching on Selfhelp’s Virtual Senior Center [TTA 17 Mar 2010], remote monitoring (telehealth and telecare) including GrandCare Systems and kiosk HealthSpot Station, patient adherence, FDA approval of apps and the home as a healthcare hub.
  • Robots were the #4 trend: consumer robots such as home cleaners Roomba, Ecovacs; robots in eldercare; humanoid robots like NAO; robotic prosthetics and exoskeletons.

Digital health will again be showcased as a TechZone  (more…)