Abstract Title
Feasibility and Validation of an Electronic Patient Diary and Internet-Based Clinical Management System in Insulin-Treated Type 1 and 2 Diabetes Patients
Abstract Information
Abstract Number:  1168-P
Institution:  Boston, MA; Wellesley Hills, MA.
Results:  Home blood glucose (BG) and symptom diaries are most useful for clinical management when the data can be accessed, analyzed and utilized in real time. To test such a system, we analyzed data from 58 patients (31 males / 27 females) with type 1 and 2 diabetes who transmitted glucose, insulin dose, hypo/hyperglycemic events, and symptom (43 item checklist) data daily using a programmed, handheld PDA with a wireless acoustic modem, standard phone and toll-free number. E-diary data were processed on a central server, and reports and dosing algorithms made available 24 hrs/day to 22 clinics via a password-protected website on which physicians submitted weekly dosing reports. E-diary BG records were validated against baseline 3-day continuous glucose monitoring (CGMS) and glucose meter data. Patients had mean±SD age 50±11 yrs, FPG 171±69 mg/dL, and HbA1c 7.5±0.7%. Average e-diary use was 52±31 days during which 14,242 BG values, 442 hypo/hyperglycemic events, and 717 symptom checklists were processed through the web-based system. Mean e-diary BG correlated with baseline CGMS mean, median, minimum, maximum, and % time >180 mg/dL (r = 0.65, 0.61, 0.55, 0.64 and 0.66; all P<0.001). Within-individual e-diary BG SD correlated with CGMS range and SD (r = 0.56 and 0.58), and e-diary BG % time >180 mg/dL correlated with CGMS % time >180 (r = 0.58). Patient-entered e-diary BG and glucose meter data had near perfect agreement (r = 0.99, slope = 0.994, intercept = 0.6). Of 378 dosing reports submitted, physicians agreed with the web-based algorithm for basal and pre-meal insulin adjustment 75% of the time. Conclusions: This e-diary and internet-based diabetes management system provided a valid and reliable means for clinicians to access and utilize home BG records in real time allowing for distance-based intensive diabetes management.
Conclusions:  Presentation: 6/11 - 12:00:00 PM-02:00:00 PM
Reception: 6/11 - 06:30:00 PM-07:30:00 PM
Poster Hall (WCC-Hall C)
Category:  Health Care Delivery