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Summary To be effective in the treatment of type 1 diabetes (T1D), telemedicine (TM) must answer the key question of the patient: what dose of insulin to inject? The answer to this question can be provided by means of a powerful tool that the patient can carry around with him, allowing simple and frequent communication with the caregiver, a key condition for the provision of effective motivational support. The Diabeo system, that meets these characteristics, has shown to be effective in T1D patients with a poor glycemic control, leading to a 6-month substantial reduction in HbA1c (–0.9% vs controls). Since then, two further programmes have been implemented into the Diabeo system: one for automatic analysis of BG values that allows caregivers, according to the analysis, to further motivate patients and/or adjust their treatment accordingly; the other one is the integration of a computerised task delegation protocol, set by the doctor according to individual requirements, offering the physician the time of specialised nurses to assist him in training and monitoring patients. Can the Diabeo system be integrated in the management of patients with basal-bolus insulin regimens? A large-scale (750 patients) and longer (2 years) study, the TELESAGE study, is to be initiated in France during the course of 2012 with Sanofi-Aventis as the sponsor. This study will include patients with T1D or T2D, chronically poorly controlled despite basal-bolus therapy. It should provide an accurate picture of the extent of the metabolic benefits obtained according to whether Diabeo is used alone or in conjunction with a delegation of tasks’ protocol. The costs of this form of management will be assessed, as will any savings achieved. Study results should enable the health authorities to make a decision concerning the funding, relevant organisation of healthcare, and dissemination of the Diabeo system. |
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