Browsing by Author "Turner, Jane"
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- ItemImplementation of telehealth support for patients with type 2 diabetes using insulin treatment: an exploratory study.(2009-06-03) Turner, Jane; Larsen, Mark; Tarassenko, Lionel; Neil, Andrew; Farmer, AndrewBACKGROUND Initiating and adjusting insulin treatment for people with type 2 diabetes T2D requires frequent clinician contacts both face to face and by telephone We explored the use of a telehealth system to offer additional support to these patients METHODS Twenty three patients with uncontrolled T2D were recruited from nine general practices to assess the feasibility and acceptability of telehealth monitoring and support for insulin initiation and adjustment The intervention included a standard algorithm for self titration of insulin dose a Bluetooth enabled glucose meter linked to a mobile phone an integrated diary to record insulin dose feedback of charted blood glucose data and telehealth nurse review with telephone follow up Additional contact with patients was initiated when no readings were transmitted for 3 days or when persistent hyper or hypoglycaemia was identified Reponses of patients and clinicians to the system were assessed informally RESULTS The mean SD patient age was 58 years 12 with 78 male The mean SD diabetes duration was 6 4 years 4 5 HbA1c at baseline was 9 5 2 2 and the decrease in HbA1c at three months was 0 52 0 91 with an insulin dose increase of 9 units 26 A mean SD of 160 93 blood glucose readings was transmitted per patient in these three months Practice nurses and general practitioners GPs viewed the technology as having the potential to improve patient care Most patients were able to use the equipment with training and welcomed review of their blood glucose readings by a telehealth nurse CONCLUSIONS Although the concept of telehealth monitoring is unfamiliar to most patients and practice nurses the technology improved the support available for T2D patients commencing insulin treatment
- ItemStepwise self-titration of oral glucose-lowering medication using a mobile telephone-based telehealth platform in type 2 diabetes: a feasibility trial in primary care.(2013-02-26) Nagrebetsky, Alexander; Larsen, Mark; Craven, Anthea; Turner, Jane; McRobert, Nicky; Murray, Elizabeth; Gibson, Oliver; Neil, Andrew; Tarassenko, Lionel; Farmer, AndrewBACKGROUND Telehealth supported clinical interventions may improve diabetes self management We explored the feasibility of stepwise self titration of oral glucose lowering medication guided by a mobile telephone based telehealth platform for improving glycemic control in type 2 diabetes METHODS We recruited 14 type 2 diabetes patients to a one year feasibility study with 1 1 randomization Intervention group patients followed a stepwise treatment plan for titration of oral glucose lowering medication with self monitoring of glycemia using real time graphical feedback on a mobile telephone and remote nurse monitoring using a Web based tool We carried out an interim analysis at 6 months RESULTS We screened 3476 type 2 diabetes patients 94 of the ineligible did not meet the eligibility criteria for hemoglobin A1c HbA1c or current treatment Mean standard deviation patient age at baseline was 58 11 years HbA1c was 65 12 mmol mol 8 1 1 1 body mass index was 32 9 6 4 kg m2 median interquartile range IQR diabetes duration was 2 6 0 6 to 4 7 years and 10 71 were men The median IQR change in HbA1c from baseline to six months was 10 21 to 3 mmol mol 0 9 1 9 to 0 in the intervention group and 5 13 to 6 mmol mol 0 5 1 2 to 0 6 in the control group Six out of seven intervention group patients and four out of seven control group patients changed their oral glucose lowering medication p 24 CONCLUSIONS Self titration of oral glucose lowering medication in type 2 diabetes with self monitoring and remote monitoring of glycemia is feasible and further studies using adapted recruitment strategies are required to evaluate whether it improves clinical outcomes
- ItemTelemedicine-supported insulin optimisation in primary care.(2010-11-25) Larsen, Mark E; Turner, Jane; Farmer, Andrew; Neil, Andrew; Tarassenko, LionelWe investigated the feasibility of a mobile phone based system for patients with type 2 diabetes who had recently commenced insulin therapy but remained poorly controlled The system was evaluated in a feasibility study in a general practice setting with 23 patients over six months A total of 22 patients successfully completed the study and used the system for a mean of 217 days range 162 376 Blood glucose control improved as reflected by a mean decrease in HbA 1c of 0 66 P 0 05 with the mean insulin dose increasing by 17 units P 0 006 Blood glucose monitoring compliance was high with readings available for 6 2 days per week although use of the mobile phone decreased during the study On average the mobile phone diary was used for 3 5 days per week Insulin dose adjustments were made throughout the study by all patients but not as frequently as would be expected for the degree of hyperglycaemia observed