Diabetes mellitus has reached epidemic proportions in western countries (Zimmet2001) and Diabetes type 2 is one of the fastest growing chronic conditions in the developed world. In Britain, a total of about 3 % (1.3 million) of the population have diagnosed diabetes. It is estimated that an additional 2 % of the population have undiagnosed diabetes. Type 2 diabetes is very closely linked to obesity and life style, which is now a major cause of health problems.
Tight glycaemic control and long term management
There is abundant evidence that shows tight control of the blood glucose level to be vital for good diabetes management and insulin therapy. Good glucose control requires frequent measurement of blood glucose levels and complicated algorithms for assessing the insulin dose needed to adjust for short term variations in activity, diet and stress.
REACTION will develop a range of services aiming at Tight Glycaemic Control (TGC) of diabetics in the general hospital ward using multi-parametric monitoring and closed-loop feedback to the healthcare professionals at the point of care.
Another focus area is an integrated approach to long term management of diabetes control; improved blood glucose monitoring, monitoring related disease indicators, clinical monitoring and intervention strategies, as well as education on life style factors such as obesity and exercise. REACTION applications will be developed that will monitor medication compliance, multi-parametric monitoring of related disease indicators as well as episode monitoring and emergency alarm handling.
Control for patients in hospital
Diabetes mellitus has been associated with a two- to four-fold increase in hospitalization rates and in-hospital hyperglycaemia has been found to be an important marker of poor clinical outcome and mortality especially in patients with type 2 diabetes.
Based on the emerging clinical evidence from several clinical studies, there are increasing efforts world-wide to establish tight glycaemic control in critically ill and hospitalised patients (VandenBerghe2001);(VandenBerghe2006);(Furnary2004);(Meijering2006).
Aggressive treatment of stress-induced hyperglycaemia in intensive care units has shown remarkable results in recent years. In a randomized, controlled study conducted in a surgical intensive care unit (Vandenberghe2001), strict control of blood glucose levels with insulin reduced morbidity and mortality, significantly reducing in-hospital mortality from 11 to 7 % in the entire study population.
Extensive nursing efforts
Tight glycaemic control in hospitalised patients has to be provided by healthcare physicians and/or nurses which requires extensive nursing efforts, including frequent bedside glucose monitoring, training to handle control algorithms or guidelines with intuitive decision taking and most importantly additional responsibility to prevent hypoglycaemic episodes.
REACTION will deploy a closed loop feedback system to tight in-hospital glycaemic control (TGC) allowing diabetes experts to handle control algorithms with intuitive decision taking and fuse therapy instructions to healthcare physicians and/or nurses at the point of care
With state of the art technologies, TGC is only possible in dedicated centres with highly motivated personnel.
The REACTION platform will facilitate TGC for patients in the general ward by continuous multi-parametric monitoring of blood glucoses, skin temperature and nutritional intake
Control for patients outside hospital
Careful monitoring of multiple parameters may represent a useful integrated basis for achievement of strict and sustained glucose control that will provide a better opportunity to reduce diabetic complications and improve patients’ quality of life.
Typical areas of improvement are blood glucose reading and insulin therapy feed-back. The technology for spot measurement of blood glucose levels is available but not directly transferable to insulin dose adjustments because of open-loop system.
The REACTION platform will close the loop and provide direct, on-line feedback to spot measurements of glucose levels combined with multi-parametric context awareness
This approach is, obviously, of great importance for insulin-dependent type 1 diabetic patients. Nonetheless, technology is likely to introduce better opportunity for type 2 diabetes as well.
While in Type 2 diabetes, punctual blood glucose readings may not necessary trigger therapeutic changes, analysis of blood glucose profiles over the time may allow early detection of trends thus allowing timely treatment adjustments.
The REACTION applications will provide advanced risk assessment, intelligent event handling and interfaces to professional crisis management teams
Following the treatment plan
Self-managing diabetes requires that the patient adheres to the treatment regimen. Adherence has been shown to vary significantly in patients with chronic diseases and has been reported as low as 38 % in patients with diabetes on oral anti diabetics (OAD) treatment. Studies imply that devices and technologies that can improve patient adherence are needed in clinical practice and can improve treatment efficacy, quality of life and reduce health economic cost.
The REACTION platform directly supports compliance schemes with its two way mobile communication infrastructure between patients and backend combined with rules based event handling and risk assessment