Your Daily Digital Doctor

Advanced analysis of home medical data can offer continuous care for patients with diabetes and other life-threatening chronic diseases.

By Eric Bender

February 20, 2004

Eighteen million people in the United States suffer from diabetes, and the disease cuts their average life expectancy by ten years or more. To keep the condition under control, they need to juggle diet, medication and exercise. And that can be a huge struggle even with the best treatment available.

But very few of those afflicted in this fast-growing epidemic get anything like the best treatment. Most patients don't get care from a specialist, don't take enough tests to properly track the disease, and fail to adopt changes in diet and exercise that can slow or sometimes stop the disease's progress and the onset of ugly complications, say healthcare experts. The general quality of diabetes treatment is "pretty embarrassing," says Alan Moses, senior vice president and chief medical officer for the Joslin Diabetes Center in Boston, the largest U.S. center of diabetes research.

Ideally, a patient with an incurable, life-threatening disease such as diabetes would take critical medical measurements at home each day, and immediately get advice from his or her doctor. While that remains impractical, new hope is on the horizon for digital monitoring systems that will help to fill this yawning gap-and to provide clues to each patient's treatment that no doctor could ever gather manually. This summer, Joslin will partner with Boston startup InterMed Advisors on a trial of one such alternative-a soup-to-nuts home monitoring system for diabetes patients. The InterMed project will combine patient education, daily in-home monitoring of blood glucose levels, and advanced analysis of the wealth of resulting data. It will also alert clinical staff as needed, and provide patients with daily, individualized feedback.

This systematic approach is one of the most ambitious ever undertaken in home patient monitoring. Ultimately, such home systems could raise the level of care not only for those with diabetes but also a variety of other potentially deadly chronic conditions, including heart disease and pulmonary ailments. Not so coincidentally, the monitoring systems also aim to save big bucks on the cost of home health care, emergency room visits and hospitalization.

Data-Driven Feedback

Because it can be so tricky to manage, diabetes is a poster child for patient monitoring systems. "Diabetes is a complicated disease, and it requires lots of behavior changes," says Medha Munshi, a Joslin physician working on the InterMed project. "It's really patients who manage their disease." Diabetes is caused by problems with insulin, a hormone that regulates how your body metabolizes glucose. In type 2 (adult onset) diabetes, your body doesn't produce enough insulin or can't handle insulin properly. In the far rarer type 1 (juvenile) diabetes, your body stops producing insulin altogether. In both cases, blood glucose levels soar-a condition that damages almost every part of the body.

Type 2 patients struggle to control the disease by restricting their diet, exercising, and often by taking one or more drugs. Keeping blood glucose in the proper range is a juggling act, often exacerbated by other medical conditions and the accompanying drugs. Illness, stress, schedule changes, and other variables further complicate the picture. Patients must monitor themselves daily and adjust their behavior as needed. While many have limited success, others don't understand the procedures-or find the effort too burdensome and don't even try.

InterMed's process, first tested in preliminary experiments last year, begins by educating patients about the disease. Then the company installs the monitoring system, with devices to measure blood sugar, blood pressure, weight, and physical activity (as gauged by a device that detects the patient's motion, skin temperature and galvanic response). Readings are automatically sent to a wireless home hub, which uploads the data once per day through the Internet to the system's central database.

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Once the system is up and running, data are analyzed by InterMed's patent-pending software. Alerts are generated for healthcare workers as needed-if, for instance, blood glucose levels keep running high. Finally, the system generates a "daily prescription for living," with individualized advice. InterMed plans to deliver this advice by a "virtual doctor" or "virtual nurse"-a simple animation of an actual clinician that appears on the patient's TV or computer screen. "The interactive model is the key to keeping patients involved in their care," says Munshi.

"They need to have a sense that what they're doing is working," adds InterMed founder and CEO Richard Rosen.