IntelliH Remote Patient Monitoring Technologies for Diabetes

Introduction: 

IntelliH is a SaaS based Remote Patient Monitoring platform with a focus on proactively managing Diabetic, Congestive Heart Failure (CHF) and post-operative patients. It provides a risk stratified dashboard for care coordinators on PC, MAC and Android tablets. A patient App on iOS and Android devices (Phones and Tablets) wirelessly collects physiological data from monitoring devices such as Glucometers, Weight Scales, Pulse Oximeters, Blood Pressure Monitors, Thermometers and sends that to IntelliH on the cloud for analysis. IntelliH uses data from these noninvasive sensors to help health systems stay ahead of decompensation in their chronic disease patients.   

The IntelliH platform tracks care plans, analyzes received vitals and generates alerts that are customized to an individual patient. It prepares a comprehensive disease specific report for doctors to analyze across any longitudinal period. The IntelliH solution enables immersive collaboration with patients, care givers and care teams through rich telehealth videos as well as secure texts.   

This document reviews the physiologic rationale for using Remote Patient Monitoring for Diabetic patient management using the IntelliH platform 

Remote Patient Monitoring for Diabetes: 

Figure 1: 

CDC estimates that in 2018 Diabetes affects more than 34.2 Million people in the US*1. In 2016-2018 risk factors for Diabetes related complications were significant: 

Risk Factors for Diabetes *1

  • 89% were overweight or obese 
  • 38% were physically inactive 
  • 50% had an A1C of 7.0% or higher 
  • 68.4% had a systolic blood pressure of 140mmHg or higher or diastolic pressure of 90mmHg or higher 
  • 43.5% had a non-HDL cholesterol level of 130mg/dL or higher 
  • 38% were physically inactive (less tha10 minutes of moderate or vigorous activity each week) 

Of these 19.2% met the criteria of A1C<7.0%, Blood Pressure <140/90 mmHg, non-HDL cholesterol <130 mg/dL and were nonsmokers.The problem even in managed environments is severe. A study*2 conducted by Newton, Adeel S and Sadeghi-Yarandi in a nursing home of 1409 patients with an average age of 80 years showed that the prevalence of Diabetes in this population was 34.2%. An estimated 10% of these residents received no medical treatment, and 25% received a sliding insulin scale only. There were 60% of residents who were treated with another form of insulin therapy.  

Clinical Challenges in managing patients with Diabetes

  • The complexity of managing a large population of patients with varying needs across multiple care settings 
  • The disconnect and the lack of longitudinal disease context on either side with the absence of information and a lifeline to patients living outside of the perimeter of the clinic or the hospital 
  • The inability to stratify patients by risk dynamically and proactively giving attention to patients that need it most 
  • The siloed approach of care to managing chronic patients    

Remote patient monitoring holds the promise of providing early warning indicators that herald the advent of disease decompensation and impending hospitalization.  In conjunction with a Care Coordination and patient management platform such as IntelliH allows Healthcare providers to overcome the challenges of managing diabetes. 

This document reviews the IntelliH solution and some of the monitoring technologies that can be used for remote patient monitoring to provide a way of assessing patients so that advanced signals of disease decompensation are properly analyzed, enable care coordination and patient management proactively which may help avert an adverse outcome or hospitalization (Table 1).  

Table 1. Signals of Disease decompensation in Diabetes Patients 

Biometric data to be measured

Current Technology

Blood Sugar

Bluetooth enabled Glucometer

Weight

Bluetooth enabled weight scales

Blood Pressure

Blue Tooth enabled Blood Pressure Monitors

Diet

Diet Diary tracking carbs and calories

Activity

Smart phones, Fitbit, Apple Watch

IntelliH is a comprehensive virtual care platform that provides: 

Structured workflows for Care Coordination:  

IntelliH Care Coordinator Dashboard
  • Intuitive dashboards 
  • Patient Risk stratification 
  • Smart alerts and customized range-based alerts  
  • Care Plan compliance and tracking 
  • Multi-party telehealth, secure chat and health tweets 
  • Data driven decision support with  
  • Disease specific reports
  • Correlation charts correlating dosage to vitals or diet to vitals
  •  Subjective insights from Questionnaires and tweets 
  • Integration to EMR’s such as Epic, Cerner, Athena and AllScripts 

Blood Sugar: 

Patients capture their blood sugar on the IntelliH patient App using a Wireless enabled Glucometer that sends this reading to Care Coordinators on the IntelliH SaaS dashboard. The IntelliH system tracks patient compliance as well as alerts Care Coordinators if the Vitals are out of bound or progressing in the wrong direction 

Capillary blood glucose monitoring (CBGM) allows providers, patients, and care teams to identify glycemic patterns to direct glycemic management decision-making. 

CBGM can be used to determine blood glucose values that are out of a patient’s target range and to identify patterns in blood glucose fluctuations to evaluate the medication regimen. 

Patients with diabetes have special safety needs related to medication management (polypharmacy), prevention of hypoglycemia and excessive hyperglycemia, fall prevention, foot care, and transitions of care. 

Blood Pressure: 

IntelliH Patient’s App 

A Blue tooth enabled Blood Pressure Monitor wirelessly connected to the IntelliH’s Patient App on iOS and Android devices collects a patient’s blood pressure as well as their heart rate and transmits that to the IntelliH cloud where the data is analyzed to sense any decompensation 

The American Diabetes Association suggests that high blood pressure with Type-2 Diabetes is a lethal cocktail that significantly increases the risk of a Heart attack or stroke. In addition it leads to other issues such as kidney disease and retinopathy triggered blindness.  

The American Heart Association recommends weight loss and a combination of moderate and vigorous exercise each week as well limit salt, high-fat meats and whole fat dairy products to manage blood-pressure. 

The IntelliH App incorporates features to track: 

  • Weight 
  • Activity 
  • Diet 

It also correlates Diet in particular Sodium consumption to the measured Blood pressure. 

Weight: 

The correlation of weight to diabetes and pre-diabetes is well understood. As with blood pressure weight can be managed by combining moderate to vogorous exercise daily along with controlling carbs and sugar consumption. 

Marion Franz*3 notes that a “5% weight loss has been shown to improve pancreatic Beta-cells and the sensitivity of liver and skeletal muscle to insulin, with larger relative weight losses leading to graded improvements in key adipose tissue disturbances”.  

IntelliH Patient App

Patients capture their weight using a Blue Tooth enabled Weight scale connected to the IntelliH Patient’s App on iOS or Android devices and send that to IntelliH in the cloud. IntelliH tracks weight gain against a patient’s dry weight and generates proactive smart alerts to care coordinators when it senses abnormal or progressive weight gain 

Weight loss is important for controlling A1C both for diabetics and pre-diabetics.   

The IntelliH App has features to track weight, physical activity and Diet. Care coordinators can define desired ranges of weight customized to individual patients. IntelliH will then start tracking weight gain or loss progression and Alert care coordinators if an intervention is required. 

Known interventions such as exercise and nutrition are important to manage to weight outcomes.  

The IntelliH solution incorporates a Patient 360 feature that allows the multi-disciplinary teams- physicians, nurses, care givers, nutritionist to work collaboratively with patients to ensure comprehensive weight management as an integral part of the care plan.

Diet:

No one diet fits an individual. The American Diabetes Association notes:

“A panel of scientists, doctors, endocrinologists, diabetes educators and dietitians reviewed over 600 research articles over the course of five years to see what diets—or eating patterns—work well for people with diabetes. The results were published in our Nutrition Consensus Report.” 

The Diabetes plate method recommended by ADA is a simple way to manage a daily diet by balancing vegetable, protein and carbohydrates. 

Source: ADA – Introducing the Diabetes plate method 

IntelliH Patient App 

The IntelliH Patient App allows patients to capture an image of their food plate while the platform automatically calculates the nutritional component on the food plate and prepares a Diet Diary that can be reviewed by nutritionists across any longitudinal period. Nutritionists can now correlate the Blood Sugar spikes of a patient during the day to the food consumed as well as their activity during a day and work with patients to prepare a healthy meal regimen that helps them manage their blood sugar, their blood pressure as well as keep their weight in check. 

Activity: 

The Centers of Disease control and prevention notes that physical activity is extremely important for patients with Diabetes as it makes the body sensitive to insulin which helps to manage diabetes. *4 

CDC recommends at least 150 minutes of moderate exercises per week or about 20-25 minutes of activities per day. It also recommends at least two of these days to incorporate some vigorous activities that work the large muscles. *4 

The IntelliH patient App tracks physical Activity and makes that available to patients and Care Coordinators. 

Conclusion: 

Diabetes is a burdensome disease with high morbidity and leads to other serious conditions such as strokes, liver problems and retinopathy and mortality that is challenging to manage.  As the population ages and a significant number of patients develop other co-morbid conditions such as congestive heart disease, remote patient monitoring, with its ability to extend the perimeter of the health care system to the patient’s home, becomes increasingly important.  By utilizing current technology that makes use of the underlying pathophysiology of the disease and uses a variety of relevant biometric data markers as an early warning system, remote patient monitoring can satisfy the promise of appropriately applied technology to rein in a disease that otherwise would-be huge weight on the health care system. 

IntelliH: 

References: 

*1. National Statistics Diabetes Report 2020- CDC US Deptt. Of Health & Human Services: https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf  

*2 Newton CA, Adeel S, Sadeghi-Yarandi S, et al. Prevalence, quality of care, and complications in long term care residents with diabetes: a multicenter observational study. J Am Med Dir Assoc. 2013;14:842-846. http://www.ncbi.nlm.nih.gov/pubmed/24055534 

*3 Weight Management: Obesity to Diabetes- Marion Franz  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5556579/ and  
Heymsfield SB, Wadden TA. Mechanism, pathophysiology, and management of obesity. N Engl J Med 2017;376:254–266 [PubMed] [Google Scholar

*4 Get Active! – https://www.cdc.gov/diabetes/managing/active.html  

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