Mobile telemedicine at ETU to help patients with diabetes
Researchers from the Department of Bioengineering Systems of ETU "LETI" developed the system of effective remote monitoring for patients with gestational diabetes together with endocrinologists of Almazov National Medical Research Centre.
The development is a mobile app and a PC software package. It allows patients to keep an “electronic diary of observations” about the level of sugar in the blood and the events affecting it, as well as promptly send it to the doctor for him to make recommendations on the daily regimen and decide on further treatment.
“The identification of parameters reflecting the individual impacts of the disease is essential in the treatment of diabetes mellitus. The blood sugar level depends on various factors such as food composition and meal consumption regularity, the nature of physical exertion, and the duration of sleep. However, the dependence can vary significantly not only from patient to patient but for one patient at different points in time,” says the developer Evgeny Pustozerov, Associate Professor of the Department of Bioengineering Systems, Candidate of Technical Sciences.
Researchers of the Scientific Laboratory of Endocrine Diseases in Pregnant of Almazov National Medical Research Centre have conducted a study for several years, where they assessed the impact of diet and lifestyle on the on fetal development in case of a gestational diabetes pregnancy complication. In this case, the greatest difficulty for doctors is the continuous monitoring of the patient’s blood sugar level and identifying the causes of glycemic level changes. The former task, to track how the patient’s blood sugar level changes over a long period, is solved quite easily using the continuous glucose level monitoring system (CGMS). However, the recording of all significant events leading to these changes, and the assessment of the correlation between various events is difficult to implement.
“The traditional form of recording glycemic events that are significant in terms of glycemic control (blood sugar level, insulin injections, meals, physical exertion) is keeping a paper observation diary. However, it is not effective due to low patient motivation because of a doctor’s inability to provide daily feedback. In addition, the transfer, structuring, and analysis of data recorded by hand in such observation diaries are a significant difficulty for the doctor. Due to the impossibility of implementing sufficiently frequent in-person medical monitoring of the patient, there is a real need for remote monitoring of the disease. We proposed to develop software for recording the effects of nutrition and exercise in observation diaries.”
At the first stage, the task was to develop and implement a mobile application for remote data collection from a patient with gestational diabetes. An application for the Android operating system was developed, which allows a patient to make notes, edit them and send them to their doctor in the form of convenient structured tables - a kind of “electronic observation diary.” Subsequently, a similar application was developed for personal computers with Windows, MAC OS, and Linux operating systems. It was continuously updated and improved taking into account the wishes of patients and doctors.
At the second stage, a software package was developed that allows comparing data from diaries of individual patients and groups of patients. The developed software processes incoming data, including diary data and CGMS signals. A doctor can observe the relationship between various patient health indicators, evaluate the dynamics of the influence of various factors on blood sugar level, and obtain a quantitative assessment of this effect. The developed software was applied during the study at the Almazov Center with the participation of more than 400 patients with gestational diabetes.
"The use of the system has significantly reduced the time spent by doctors on routine data processing and using the data collected from observation diaries more effectively. The developed software package is also used for automated processing of data obtained during clinical trials. In particular, with the help of the applied system, it was possible to assess the individual nature of the correlation between the time of the peak of blood glucose level and the chemical composition of the latest meal.”
Currently, the development is applied at the Institute of Endocrinology of the Almazov National Medical Research Centre when monitoring patients with gestational diabetes mellitus. A modification of the program for monitoring patients with polycystic ovary syndrome has been developed. Work is underway to integrate fitness bracelets into the system to assess the effect on physical blood sugar levels of physical activity and sleep of patients more accurately.
The study is supported by a grant from the Russian Science Foundation (Project No. 18-75-10042).