The aim for people living with diabetes on insulin is to achieve as optimal a level of blood-glucose control, minimising the risk of long-term complications. For those needing insulin this can be complex, with insulin doses changing from day to day according to food intake, exercise, illness and other factors. Whilst there has been much progress in supporting individuals on insulin to manage their own condition, guidance from diabetes clinicians is often needed. This requires careful review of the results of self glucose testing, and has usually been achieved by frequent clinic visits to review meter data which can be time consuming. Follow up by phone or email has been challenging as the results of self-glucose testing are usually not readily available for review. The COVID-19 pandemic and the need for social distancing this past year has emphasised the huge advantages of remote care, particularly for patients with diabetes (who were at higher risk of COVID-19).
Around 15% of those with Type 1 Diabetes currently use advanced diabetes technology like flash glucose monitors that can be cloud based and support remote care. However, there is limited NHS funding for these technologies with tight criteria for their use. Most people with diabetes using insulin therefore continue to use finger prick tests with standard glucose meters to monitor their condition. Digital tools like the DBm-Health app offer a great opportunity for many more to access remote patient care to not only help doctors respond more effectively to each person’s needs, but also for the patient to take more responsibility for their own health – while reducing the need for regular hospital visits. For the patient, the DBm platform requires a widely available bluetooth-enabled glucose meter, a smartphone on iOS or Android and internet access to allow the uploading of glucose results. Those who prefer to, can manually enter results into the app for uploading as well. It is easy to upload glucose results together with individual comments, for example regarding exercise and food consumption, which can be extremely useful fo patients to see and understand how their body responds to particular food groups.
DBm-Health uniquely enables diabetes clinicians to rapidly identify patients who are struggling to control their diabetes by reviewing their self-reported blood glucose readings in near real-time. This allows time to be spent advising those individuals whose blood glucose levels are not in range and who need help the most. Furthermore, simple changes, such as advice to change modify an insulin dose, can be sent to users via the platform, appearing as a message in the app on their phone. Users can also request a call back from the diabetes team for more complex issues, avoiding the need for emails or answer phone messages. This targeted approach to case load management is expected to significantly increase the efficiency of diabetes teams and will deliver a better service for patients.
Diabetes Specialist Nurses working on the pilot report that they can more quickly identify patients needing support, rapidly assess their glucose profiles and send messages to them via the app to advise on dose adjustments, in less time that a face-to-face visit or phone call would take. We therefore anticipate this will also result in fewer unscheduled phone calls and email enquiries from our patients, as they will feel supported through the app, knowing that a member of the team will see if they need help.
Here at Chelsea and Westminster as part of the CW Innovation programme, which is led in partnership with the Trust’s charity, CW+, we’re rapidly developing and embedding digital advancements that are making huge strides to bridge that gap to wellness. The COVID-19 pandemic has only heightened the need to deliver innovative care in this way. The Trust’s Diabetes team has been excited to work as part of CW Innovation and with Sensyne Health to rapidly develop DBm-Health during a challenging time period, and it has been exciting to see it come into use only months after our first discussions, and to see such encouraging early feedback from our patients.
We are already exploring new possibilities for this technology to improve patient care. Recent national guidelines highlight the importance of managing high blood glucose levels whilst having cancer treatment, and we are excited to have been awarded funding from CW+ and the Rosetrees Trust to explore the role for remote monitoring with DBm-Health to identify and manage those who develop high blood glucose levels during their chemotherapy, where the ability to give personalised support via the app may be particularly welcome.