Diabetes mellitus brings in many complications, such as retinopathy, angiopathy, neuropathy, atherosclerosis and other processes that can affect patients’ vital systems and lead to disabilities or even death.
There is no way to early detect and prevent complications that would be as effective as constant monitoring of the patient’s overall health status, including glucose, the HbA1c level, headaches, dizziness and so on. As patients tend to underestimate the consequences of a careless approach to their glucose level, caregivers need to be connected to this process as well.
To allow that, we came up with the concept of a technology to ensure systematic care of diabetic patients between face-to-face appointments.
Standing tall against the risk of complications
Our concept is based on an HIPAA-compliant Diabetes Management System (DMS) connected to the EHR and the mobile application (as its backend). It gathers the patient’s data from the EHR and the patient (via the mobile app), analyses it and, if needed, notifies the physicians and other care team members about the disturbing changes in the person’s condition, such as:
- Series of abnormal increases of the blood glucose or HbA1c level
- Double vision
- Numbness in feet
- High temperature and other symptoms
Upon receiving a notification, the health specialist can adjust the treatment plan to help the patient control their blood glucose better and suggest scheduling an appointment or checking other vitals (for example, doing lipogram tests). This way, the communication is held via the DMS-based messaging.
More questions than answers?
As this article focuses on diabetes complications, many DMS components fall out of the picture. You might have some questions about the system’s architecture and logic, such as what personalized information patients get, how they can share health data with physicians or how the data analytics module is implemented. We got you covered – click and find out more about the concept of chronic disease management software that we use as the basis for our diabetes solution.
Real-world Examples
According to the UKPDS research, a 1% decrease in the HbA1c level reduces the risk of hyperglycemia-based complications by 36%. As even such a small correction matters, patients need to tightly control their blood glucose all the time. However, they tend to disregard this control as complications develop gradually, not showing any intense symptoms until it is too late.
Let’s see how this chronic care management system for diabetes can help to timely recognize and prevent the following complications:
- Retinopathy
- Sensorimotor neuropathy
- Hypoglycemia
Retinopathy
A high glucose level affects both small and large blood vessels, changing the content of the liquid in the lens, its form and, consequently, the acuity of vision. As it takes time, patients (especially elderly people) might confuse the typical early retinopathy symptoms, such as blurred vision, floaters or impaired color vision, with other reasons, such as fatigue, bright lighting, age-related changes and so on.
To timely recognize that a diabetic patient has the symptoms indicating an eye lesion, we suggest sending them DMS-based requests in the mobile app. The patient uses the app to input their objective (blood pressure, blood glucose) and subjective (vision problems and headache). Then, the health specialist is notified about the disturbing symptoms and recommends scheduling an urgent appointment with an ophthalmologist. In other cases, the system can be configured to send recommendations automatically.
Sensorimotor Neuropathy
When patients poorly control their diabetes compensation, they most likely will face neuropathy. Let’s talk about sensorimotor neuropathy, one of the most probable neuropathy types which affect patients’ extremities.
The danger is, patients tend to overlook sensorimotor neuropathy. A high glucose level compromises nerve sensitivity and worsens the blood flow, especially in the leg vessels. Even in the case of regular nurse visits, feet examination is somehow a rare practice – only 15% of diabetes patients undergo this procedure. Thus, they need a motivation to learn how to self-check their feet regularly and track any discomfort. If they don’t, this can lead to a trophic ulcer, gangrene and even extremities amputation.
To avoid this, we suggest sending the patients DMS-based notifications to examine their feet and toes, instructions on choosing the right footwear and requests to send their data (with photos, if needed), where patients can also mention numbness in feet, redness, feet swelling and more.
A health specialist receives alerts about the patient’s health status changes and recommends scheduling an appointment with a surgeon, after which the medication scheme will be adapted to prevent the complication’s development.
Hypoglycemia
Unlike the previous two complications, hypoglycemia is acute and develops too fast to wait for a physician’s response or notification. A hypoglycemic attack can lead to a coma, disability (due to a permanent brain damage) or death. Unfortunately, the mobile app can’t catch the patient red-handed and force them to take glucose pills or eat carbs.
What we can offer to diabetic patients is systematic chronic care management. This way, patients will journalize their daily diet, physical activity and medication intake as well as record abnormal sensations. The latter can indicate the early symptoms of hypoglycemia: for example, shivering, dizziness, headache, sweating and others. When the patient enters this information in the app, they will get a push notification urging to measure the blood glucose.
Though warning the patient about the risk of hypoglycemia, however, this notification is not enough to guarantee the person’s safety. Hypoglycemia symptoms can vary and be blunted under the influence of certain medications such as beta blockers.
Thus, the DMS and the mobile app primarily serve as a tool for systematic diabetes control. They allow recognizing certain patterns in early hypoglycemia symptoms, and, therefore, dangerous patient behavior, or a need to revise the treatment scheme.
This way, the patient won’t accidentally pass out while driving the car, get aggressive and unreasonable or experience blurry vision and other severe hypoglycemia symptoms.
Arming Patients against Diabetes Complications
When facing the diagnosis to live with and control for the rest of their lives, patients sometimes shut their eyes and ears. Their subconscious tries to defend them from a traumatic experience, so they even hope that knowing less is the key to avoiding acute and chronic complications. Sometimes, their minds think that forgetting about the disease makes it disappear.
Sadly, diabetes doesn’t work this way. To live a full life, enjoying good food, energetic days, calm sleep and many happy adventures, patients have to accept the disease and learn to control it daily. With an 11-year experience in custom medical software development, we came up with a custom diabetes management solution that connects patients with their caregivers for the sake of uninterrupted care.
The patients journalize their daily achievements and objective, blood glucose, pressure, temperature and other data in the mobile app, and the physicians are notified about the patients’ behavior, problems and disturbing symptoms as well as recommend scheduling an appointment, if needed.
This way, patients feel support from the caregivers and get used to daily self-checks and control. As a result, they can recognize negative trends and patterns in their health status and timely prevent or handle complications at early stages.
Caregivers also benefit from the positive changes in population health, which means reduced readmissions and costs and improved health outcomes.
If you want to find out more about our custom diabetes management solution and its integration with an EHR, feel free to contact us. We’ll be happy to discuss the details and offer you a free consultation and a PoC.
By Uladzimir Sinkevich, Java Department Manager at ScienceSoft.
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