An extensive study conducted by Narayana Health City, Bangalore
The advent of new technologies has been immensely beneficial to healthcare management at both organizational and individual levels. The ubiquitous smartphone, for instance, is helping individuals to monitor their health, the number of calories they burn, etc. Always on the forefront to adopt new technology to offer better quality healthcare, Narayana Health City, Bangalore, conducted an extensive study in the area of remote diabetes management using the mobile app, Kaizala. This blog brings into focus on various aspects of the study.
Diabetes in India:
India has the unenviable distinction of being the diabetes capital of the world. With proper management, diabetes can be controlled and diabetes patients can lead a healthy life. However, owing to poor management of the condition, people with diabetes often develop many serious health problems.
Long-standing diabetes along with large glucose fluctuations (for e.g., glucose varying between 40 to 400) increases the risk of diabetes-related complications including cardiovascular conditions. Glycemic variability (GV) captures both hyperglycemic (high) and hypoglycemic (low) episodes. Minimising GV or glucose fluctuations can reduce the burden and risk of cardiovascular conditions as well as other diabetes-related complications. The study aimed to assess the efficacy of mobile applications on GV in diabetes patients.
A group of diabetes patients was subjected to an observational study in which they were advised to submit their blood glucose value through the mobile app, Kaizala regularly. Later on, the Mean, Standard Deviation, and Co-efficient of Variance (CoV) of the capillary glucose levels were calculated. A total of 1124 patients (75% with Type 2 Diabetes) were selected based on their willingness to participate, sign the consent form, get registered to the remote monitoring program, have a smartphone with an internet connection, willing to check sugar levels as instructed by the physician for at least one month and to inform the nurse practitioner regularly via the mobile app. Based on the allocated risk level assigned by the doctor, the nurse practitioner assigned a sugar checking plan (empty stomach, pre meals, and/or post meals) to the patients. The nurses maintained a log of the glucose readings and would review the glucose values with the physician once in 3-7 days depending on the clinical situation. They would revert to the patient based on the physician’s advice in terms of change in doses of insulin or oral anti-diabetes drugs. The revised prescription was uploaded by the nurses and was updated in the respective patient’s app. Patients were also able to take out the printout of their prescriptions if needed. Nurses also called the patients informing about the changes in their treatment.
Results: We noted that a significant reduction in the average fasting glucose levels (from 139mg/dl to 122 mg/dl) and pre-lunch sugars fell from 172 to 154 and pre-dinner sugars from 186 to 143. The Co-efficient of Variation (a marker of Glycemic Variability) reduced from 23-27 to 16-17 in pre-meal glucose values.
Although the study was not a randomized controlled study, it had clearly shown the improvement in glycemic control and reduction in glycemic variability. The reduction, we feel, was the result of a continuous feedback system to the physician to understand the patient’s biological response based on which the medication doses were adjusted. It also allowed patients’ active participation in the care delivery thereby improving compliance to treatment. One of the interesting findings of the study was this: a dedicated diabetes nurse practitioner can significantly reduce the load on the physicians and maintain continuity of care in between clinic visits.