Mobile-based Disease Management System for insulin dose adjustment in type 2 diabetes for specialist outreach and diabetes telehealth service (REMODEL-IDA): A pilot randomised controlled trial.

In partnership with Australian E-Health Research Centre, CSIRO (Commonwealth Scientific and Industrial Research Organisation), and the Department of Diabetes and Endocrinology at PAH, the Centre for Online Health, University of Queensland, developed a mobile-based disease management system (MDMS) to support the transformation of the provision of specialist diabetes care. This system is modelled on a highly successful CSIRO platform that supports in home cardiac rehabilitation leading to improvements in adherence and clinical outcomes . This system has been modified to enable real time monitoring of BGL in patients with diabetes, and to support patient care. The system comprises an app for iOS- (Apple) and Android-based smartphones, and a web-based clinical portal. The mobile app enables patients to use a Bluetooth-enabled glucose meter (Accu-Chek® Aviva Guide, Roche Diagnostics GmbH) to upload their BGL readings to the clinical portal. The mobile app also provides an insulin diary that allows patients to manually enter the dose and time of their insulin injections, along with a free text comment for each dose (e.g. "before dinner"). These data are subsequently transmitted and uploaded to the clinical portal via the internet. The clinical portal presents the uploaded data in graphical and tabular formats for the CDEs and endocrinologists to monitor and manage a patient's condition. Integrated alerts, which can be customised by clinicians, highlight out of range measures. Through the portal, the clinicians can review the patients’ BGL data and insulin dosages, and send messages to the patients’ mobile phones. A summary of their diabetes care is also displayed based on the clinical information entered. Patients receive optional automated individual text-messages based on frequency of BGL testing and BGL values. These messages serve as prompts to test BGL as recommended, consider reasons for out of range BGL measures and to seek medical advice if required. The messages also contain links to national diabetes website for additional information regarding self-management of diabetes. Mobile app screens enable a review of progress. We obtained patient and clinician feedback on the MDMS through a proof of concept trial with diabetes patients who had stable glycaemic management. This enabled enhancements to the MDMS. The management of the intervention group will use the MDMS as described earlier for insulin dose adjustments. For the intervention group, the researcher will (1) install and demonstrate the mobile app on their individual smartphones and (2) provide and demonstrate the use of Accu-Chek® Aviva Guide, Roche Diagnostics GmbH, which pairs via Bluetooth to the mobile app and sends blood glucose recordings automatically to a web-portal daily. The participants will be followed up for the duration of their enrolment into the IDA service which can last up to 4-6 weeks. CDE shall provide advice to the patient on insulin titration through messages sent via the mobile app. The participants who complete the IDA before 3 months will be discharged from the MDMS but followed up at 3 months to obtain an HbA1c. The study will be terminated for participants who continue to be in the IDA at 3 months and an HbA1c obtained. The principal researcher will follow-up the participants in liaison with the CDE. For participants who do not have a compatible smartphone, a smartphone or tablet will be loaned for the duration of the study.