1. WEB-BASED REMOTE MONITORING SYSTEMS FOR SELF-MANAGING TYPE 2 DIABETES: A SYSTEMATIC REVIEW H.Mushcab, G.Kernohan, J.Wallace, S.Martin

2. Presentation Outline Terminology Aim Background Methods Results Discussion Conclusion

3. Introduction  Technology today is part of our daily life. It is involved in our day to day activities and our wide communication networks. Technology and medicine combined can give people with diabetes more control over their condition and can offer them a quality life. This systematic review aims to evaluate evidence and prove our theory.

4. Terminology …and definitions Type 2 Diabetes Mellitus (T2DM): Metabolic disorder, characterised by insulin resistance and hyperglycaemia. Telemedicine (WHO): The delivery of healthcare services, where distance is critical factor, by all healthcare professionals using information and communication technologies for exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation and for the continuing education of healthcare providers.

5. Terminology…and definitions Telemonitoring: the use of information and communication technologies for the transmission of biometric data between the patients homes and health professionals for data interpretation and decision-making

6. Aim  To evaluate evidence for feasibility and impact of telemedicine and web-based telemonitoring for managing Type 2 Diabetes Mellitus

7. Background.. (T2DM) According to the International Diabetes Federation, diabetes is one of the leading threats to health globally. The epidemic is predicted to escalate to affect 438 million people by 2030 (Shaw, Sicree, Zimmet 2010) In the United Kingdom, Over 2 million people suffer from T2DM (Diabetes UK 2012) Recently, Telemedicine has been introduced as a powerful tool for healthcare delivery and chronic disease management, including Diabetes.

8. Background.. Telemedicine & Telemonitoring Telemedicine and diabetes have been growing and improving together for decades now to get the patient to a certain level of self-management Telemedicine is a combination of information management and communication technology that promotes, empowers and facilitates patient’s wellbeing (Peate 2013) Telemonitoring enables patients to monitor and transmit their biometric data from home and transfer it remotely to a central data management system where the healthcare provider monitoring the patient’s status

9. Methods.. Search strategy MEDLINE, EMBASE, CINAHL, AMED, Cochrane and PubMed were searched using the terms: telemonitoring for type-II diabetes mellitus self-management using web-based Internet solutions. Content: The technology used, trial design, quality of life and the Glycated haemoglobin (HbA1c) outcome measures Keywords: Type 2 diabetes; self-management; Telemonitoring; Telehealth; telemedicine; Connected Health Technology; Blood Glucose Monitoring

10. Methods.. Criteria Inclusion: Research studies exploring technological interventions for T2DM (Web-based systems with blood glucose transmission) English publication after the year 2000 Quasi-experimental studies and RCT Population: Adults with T2DM and on insulin treatment. Exclusion: Telemedicine for other chronic diseases Reviews without primary clinical data Case reports and personal opinion studies

11. Results 426 publications were identified; 19 met the criteria. Ten quasi-experiments and nine RCTs. Electronic transfer of glucose results from home to hospital appears to be more feasible for healthcare delivery. Fifteen studies showed significant improvement in HbA1c levels. One study showed high acceptance of the technology among participants.

12. Discussion It remains challenging to identify evidence in the rapidly changing area of remote monitoring in diabetes care. The optimal design of a telemedicine system is still uncertain and the impact of the real-time blood glucose transmissions is still controversial. However, this synthesis supports the use of modern technology and suggests that adoption of blood sugar monitoring is feasible, acceptable and useful.

13. Discussion Our paper fills the 10 year gap with more focus on web-based remote monitoring of insulin-treated T2DM and its impact on improving HbA1c and patients’ quality of life. In our review we keep the evidence up-to-date in a rapidly changing domain, newer technologies used around the world and including studies with recent developments in methods, away from RCTs solely and towards more “natural” methodology such as Cohort and Interrupted time series studies

14. Conclusion The use of telemonitoring systems is viable to manage T2DM and improve HbA1c level reduction and patient’s quality of life Telemonitoring may save time and travel expenses for patients as well as the care provider’s time and resources

15. Future work The understanding of how, why and when technology can improve clinical care and quality of life of T2DM patients requires further intensive and comprehensive investigation Further work is needed to provide more specific up- to-date evidence of user satisfaction, empowerment and clinical outcomes

16. Accessibility  Conferences: 1. NICH Ecosystem Meeting - Belfast 2. 19th Annual HISI Conference - Dublin 3. MMU 7 th Postgraduate Conference - Manchester 4. 8 th Saudi Students Conference - UK  Journals: 1. Diabetes Technology and Therapeutics

17. References  Shaw, J., Sicree, R., and Zimmet, P. 2010. Global Estimates of the Prevalence of Diabetes for 2010 and 2030. Diabetes Research and Clinical Practice. 87(1). p. 4-14  DIABETES UK, 2012-last update. What is diabetes?. [Online]. Available: http://www.diabetes.org.uk/Guide-to-diabetes/Introduction-to- diabetes/What_is_diabetes/ [09/11/2012] http://www.diabetes.org.uk/Guide-to-diabetes/Introduction-to- diabetes/What_is_diabetes/  Balanda, K. P., Barron, S., Fahy, L. Making Chronic Conditions Count: Hypertension, Coronary Heart Disease, Stroke, Diabetes. A systematic approach to estimating and forecasting population prevalence on the island of Ireland. Executive Summary. Dublin: Institute of Public Health in Ireland, 2010.  World Health Organization. 2010. TELEMEDICINE Opportunities and Developments in Member States. Report on the Second Global Survey on eHealth. WHO. Geneva  Peate, I. 2013. Technology, health and the home: eHealth and the community nurse. British Journal of Community Nurse. 18(5). p. 222-227