Megan Brooks

May 06, 2011

May 6, 2011 (Tampa, Florida) — In a year-long study, a mobile-phone-based remote patient monitoring system helped patients with type 2 diabetes and uncontrolled hypertension get their blood pressure (BP) under control.

Dr. Joseph Cafazzo

Study patients who merely checked their BP at home, without reporting it to their physician through the remote system, had no marked change in BP during the study.

"The act of just giving a patient a [BP] home monitor had no effect," said Joseph Cafazzo, PhD, PEng, senior director of eHealth Innovation at the University Health Network, in Toronto, Ontario, Canada. "It had to have the telemonitoring component."

"We believe that patients become far more self-aware and more accountable to their care provider knowing that the data are going back to their care provider and that the care provider will be acting on it," he explained.

Dr. Cafazzo presented the study findings at a press briefing here at the American Telemedicine Association (ATA) 16th Annual International Meeting.

Mobile Health a "Hot Topic"

Dale C. Alverson, MD, ATA president and medical director of the Center for Telehealth at the University of New Mexico Health Sciences Center in Albuquerque, said "mobile health, or mHealth, is the hot topic in telemedicine technology. These are applications for remote monitoring of patients with chronic disease, such as diabetes and chronic congestive heart failure, through a mobile phone-based system."

This technology is "becoming ubiquitous," he added, "and in our program, we are seeing the providers and the patients adopting this technology in ways we may never have dreamed of. It adds that mobility and that sense of connection between patient and provider."

Dr. Cafazzo and colleagues developed and tested an mHealth intervention to automate capture of BP readings through a mobile-phone-based system that provides "actionable messages to patients and critical alerts to physicians," they explain in a meeting abstract.

Their study involved 110 men and women with type 2 diabetes and uncontrolled systolic hypertension. Study subjects had a mean age of 62 years and a mean weight of 90.2 kg (198.4 lbs).

Over the course of 1 year, half of the subjects monitored their BP at home with a standard home BP monitoring system (the control group). The other half used a Bluetooth-enabled BP monitor that transmitted readings through a mobile-phone-based remote patient monitoring system to their family physician (the intervention group). These patients were also given automated reminders after 3 days of not taking their measurements.

At baseline, patients' mean daytime BP was 142.7/77.1 mm Hg. After 1 year, Dr. Cafazzo reported, the intervention group had a 9.1 mm Hg dip in systolic BP (P < .0001) and a 4.6 mm Hg dip in diastolic BP (P < .0001). In contrast, there was virtually no change in the control group.

According to the investigators, "50% of patients in the telemonitoring group had their BP under good control (130/80 mm Hg)," compared with only 29% in the control group (P < .05).

"The family doctors caring for these patients really had nothing to do with the improvements. This was really a self-care tool and the patients were performing better self-care because they were more self-aware, more accountable," Dr. Cafazzo said.

During the briefing, Dr. Cafazzo shared similarly promising findings from a recently completed study in which a mobile-phone-based system significantly improved uncontrolled BP in a group of chronic heart failure patients.

For the heart failure patient, he explained, "we have a decision support engine that looks at the data and only sends relevant data to the clinician when the algorithm determines that the patient is deteriorating at home."

This is a "first of its kind," he added, in terms of using a mobile-phone-based system to monitor multiple parameters.

Next Target: Adolescents With Diabetes

Dr. Cafazzo also presented preliminary findings from the first clinical trial of an iPhone application called "Bant," which has a fully integrated glucometer and targets adolescents 12 to 16 years of age with type 1 diabetes.

"This is a very difficult population," he said. "They are transitioning from being totally dependent on their parent's care to asserting their independence, and unfortunately their [glycated hemoglobin] often starts to increase. We knew this population would be amenable to the iPhone, but that their attention span would be very short."

To entice these young people, the researchers incorporated a social networking application. "There is essentially a microblogging chat room where these kids can exchange their experiences; so far, kids are using it and usually they talk about music, the iPhone, anything but their diabetes," Dr. Cafazzo reported.

There is also a redeemable point system that rewards participants with iTunes for taking and reporting their blood sugar levels regularly. "The rewards mechanism appears to be working very well," Dr. Cafazzo said.

The study currently has 28 adolescents enrolled. Dr. Cafazzo said he hopes to report full results at the next ATA meeting.

The study authors and Dr. Alverson have disclosed no relevant financial relationships.

American Telemedicine Association (ATA) 16th Annual International Meeting: Abstract 243. Presented May 3, 2011.

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