Diabetes mellitus

Choose a specific focus of patient practice (clinic). Select a particular disease process
(diabetes type 2). Identify and fully describe a technology element that could be involved in
providing care to a patient with Diabetes Type 2, with your selected disease process and the
patient practice (Clinic). Define how this technology will integrate treatment, monitoring or
communication from the identified care setting (Clinic) to the home and then to ongoing care
through the clinic.

Your case report must include the following:

  1. Introduction with a problem statement and your disease process described from the
    focus of patient practice.
  2. Synthesized literature review.
  3. Description of the case/situation/conditions. Use a real life patient situation or
    condition to describe your case, including the problems the patient encounters and the
    barriers to care.
  4. Describe at least one technology that may be used as a solution to the patient situation
    or condition described in your case.
  5. Describe how the technology can be used specifically in the case you have proposed.
  6. Summary of the case integrating proposed solutions(s).
  7. Conclusion.

Case Report: Mobile Based Diabetes Remote Monitoring System
Diabetes mellitus is a serious chronic condition, which imposes considerable financial
and social burdens worldwide. Good management of type 2 diabetes (T2D) calls for self-
management by patients and multidisciplinary care offered by healthcare providers. Effective
management is essential in enhancing health-related quality of life, reducing the risk of
developing complications and reducing hospital admissions. On the other hand, poorly

CASE REPORT: MOBILE BASED DIABETES REMOTE MONITORING SYSTEM 2
managed T2D is linked to severe complications such as amputations, kidney disease,
blindness, nerve damage, heart disease and even death of the patient (Garg, Shah & Akturk,
2017). This paper describes a mobile-based diabetes remote monitoring system that can be
used to provide care to a patient who has diabetes type 2.
Synthesized Literature Review

Because of changes in ethnic diversity, age distribution, and population size, diabetic
patients usually fail to get their recommended care. Coughlin (2017) pointed out that less
than 50% of diabetic people meet the recommended levels of HbA1, lipid control, and blood
pressure. On the other hand, effective management of this condition could delay or prevent
complications, and decrease the need for hospitalization. Effective communication is of vital
importance to this process, and an increasing body of literature demonstrates that using
information technologies (IT) might improve the care of diabetes (Jendrike, Baumstark &
Chen, 2017).
IT is understood as using digital technologies like the Internet, software, computer
and mobile apps for transmitting, manipulating and storing different sorts of information. In
the healthcare field, the phrase eHealth is commonly utilized interchangeably in referring to
information technology (Recupero, Mahnke & Pinsker, 2013). It is notable that IT-enabled
diabetes management (ITDM) can improve the process of diabetes care and offer support to
diabetic patients. This might consequently produce both economic and clinical benefits.
Various scholars have looked at the possible benefits of the use of IT in the management of
diabetes and reported that using information technologies brings about a corresponding
improvement in measures of diabetes care such as lipids, blood pressure, as well as HbA1
(Recupero, Mahnke & Pinsker, 2013; Grady et al., 2016).

CASE REPORT: MOBILE BASED DIABETES REMOTE MONITORING SYSTEM 3
Remote monitoring of diabetes by healthcare professionals in the clinic and by
patients is especially beneficial for diabetes management that necessitates intensive
monitoring and behavioral adjustment (Grady et al., 2016). Mobile health interventions
wherein people with diabetes transmit diabetes-related information to their healthcare
professionals have been found to be clinically effective as they improve HbA1c, even in
research studies where there was no direct feedback from the healthcare professionals. This
suggests that feedback from the healthcare professionals in the clinical setting may not
always be essential for success (Zhou et al., 2014).

Description of the Case/Condition

The patient in the case is a 66-year-old Joy Adamson. She is a retired African
American woman who was first diagnosed with Type 2 Diabetes 3 years ago. The other
medical condition of this patient is obesity. Joy Adamson has fasting blood glucose records
that show values of 118-127 mg/dl, indicating borderline diabetes. When she was initially
diagnosed with diabetes type 2, the healthcare professional advised her to lose a minimum of
15 lb, although no additional action was taken. She lives near Little Brevard, a small remote
region in rural North Carolina.
This patient was referred to the diabetes specialty clinic by her family physician. She
presents with foot pain, suboptimal diabetes control, and recent weight gain. For the last
seven months, Joy Adamson has been attempting to increase her exercise and lose weight but
has not been successful. The patient had been started on Diabeta/glyburide 2.5 mg each
morning on a daily basis. However, she stopped to take this medication owing to dizziness, a
feeling of mild agitation, and sweating that she experienced during the late afternoon.
Besides, this client takes Lipitor/atorvastatin 10 mg every day for elevated triglycerides, low

CASE REPORT: MOBILE BASED DIABETES REMOTE MONITORING SYSTEM 4
high-density lipoprotein (HDL) cholesterol, and elevated low-density lipoprotein (LDL)
cholesterol. The patient follows the everyday schedule and tolerates the medication.
In the last six months, she has taken pancreas elixir, gymnema sylvestre, as well as
chromium picolinate to improve her diabetes control. Even so, she discontinued taking these
supplements because of not seeing any positive outcomes. Joy Adamson does not test her
levels of blood glucose at home and also expresses hesitation that this procedure is going to
assist her in improving her diabetes control. However, the physician already knows that this
patient has high levels of sugar. All in all, Joy Adamson has uncontrolled T2D and complex
comorbidities. She lives with her 69-year-old husband. They both have three grownup
children who are married. Both her father and mother had T2D.

Technology that may be used as a Solution to the Patient Situation
One specific technology that might be utilized as a solution to Joy Adamson and help
her in controlling her diabetes is a mobile-based diabetes remote monitoring system. This is
essentially a technology that facilitates patient’s monitoring of the disease outside the clinical
setting, for instance at her own home. It typically involves 2-way communication in which
the patient captures and sends clinicians the information required to facilitate diabetes
management between scheduled clinic visits (Garg, Shah & Akturk, 2017). The mobile-based
diabetes remote monitoring technology allows healthcare professionals to monitor the
patient’s control of the disease between visits and to adjust or alter patient care plans
accordingly (Saffari, Ghanizadeh & Koenig, 2014).
Mobile devices such as smartphones provide the flexibility and mobility so that
patient care could be delivered wherever the patient might be. According to Alhodaib (2014),
the prevalent usage of cell phones by people of all socioeconomic groups and various ages’
increases healthcare access, especially for patients who live in remote areas and those who

CASE REPORT: MOBILE BASED DIABETES REMOTE MONITORING SYSTEM 5
are elderly. Joy Adamson is one such patient who is elderly and comes from a rural area; she
may find the use of technology beneficial in controlling her diabetes. Monitoring of self-
management behaviors, as Zhou et al. (2014) pointed out, could also be motivational to the
patient and enable more regular contact between the diabetic patient and her clinicians. This
could result in necessary changes not just in treatment plans, but also in the patient’s self-
management behaviors.

How the Technology Can be Used Specifically in the Proposed Case
The remote monitoring of Joy Adamson’s diabetes will entail using a mobile device in
which this patient would be provided with a glucometer that will connect to a smartphone and
upload data instantaneously. All the stored data could then be instantly transmitted to Joy
Adamson’s clinicians at the clinic. This technology also entails using image messages MMS
or text messaging SMS in sending data and receiving feedback promptly. Besides, the
diabetic patient can use this technology to consult directly with her healthcare professionals
for individual recommendations, thus facilitating teleconsultation as well as remote
monitoring of the patient’s diabetes (Saffari, Ghanizadeh & Koenig, 2014). Reinforcement
strategies like emails, text messages and phone calls for promoting the patient’s adherence to
diabetes medication is linked to greater benefits. It is notable that this technology will
promote access and engagement of the patient and increase the frequency of her contact with
the care team. This will in turn help improve Joy Adamson’s diabetes management.
In essence, the patient will use her smartphone to upload the readings of her blood
glucose; receive charts with blood sugar monthly, weekly and daily trends; text-message or
email her clinician with questions; and receive messages or reminders concerning self-
management. Personal contact with clinicians at the clinic is included in this technological
intervention. Connecting with the clinician via SMS, email, MMS, and phone calls would be

CASE REPORT: MOBILE BASED DIABETES REMOTE MONITORING SYSTEM 6
beneficial to this patient, although an initial one-on-one meeting between Joy Adamson and
the healthcare professionals at the clinic will make communication through SMS, email,
MMS, and phone calls more meaningful. Also, uploading data from glucometers to visualize
the trends would be of benefit to the diabetic patient. The graphs will enable the patient to see
how her eating and physical exercise patterns have affected the level of her blood sugar
(Jendrike, Baumstark & Chen, 2017). On the whole, the mobile-based diabetes remote
monitoring technology will promote the patient’s general health awareness.
Summary of the Case Integrating the Proposed Solution
In summary, the case is that of 66-year-old African American patient who has
uncontrolled diabetes. This elderly female patient lived in a remote area in rural North
Carolina and was first diagnosed with the disease about three years ago. Her family medical
doctor and presents with foot pain, suboptimal diabetes control, as well as recent weight gain
referred her to the diabetes specialty clinic. Over the last several months, the individual has
been trying to increase her exercise and lose weight although these efforts have mainly been
fruitless. Joy Adamson does not test her levels of blood glucose at home and is not ready to
do so. She has high levels of sugar. The proposed solution to help control the patient’s high
level of blood sugar is to use a mobile-based diabetes remote monitoring system. This
technology facilitates patient’s monitoring of the disease outside the clinical setting, namely
at her home. It involves 2-way communication in which the patient captures and sends to the
medical professionals the information required to facilitate diabetes management between
scheduled clinic visits. The technology would enable healthcare professionals to efficiently
monitor Joy Adamson’s control of the disease between visits and adjust patient care plans
accordingly. The patient can utilize this mobile-based technology to consult directly with the
medical doctors for individual recommendations, and in so doing facilitating teleconsultation
and remote monitoring of Joy’s diabetes.

CASE REPORT: MOBILE BASED DIABETES REMOTE MONITORING SYSTEM 7

Conclusion

To conclude, this paper has described one technology that would be used to provide
care to a patient best. Using the case of an elderly female patient with Type 2 Diabetes, this
paper has explained how a mobile-based diabetes remote monitoring system can integrate
monitoring and communication from the clinic to the patient’s home and then through
ongoing care through the clinic. The patient would be provided with a glucometer, which will
connect to a smartphone and upload data right away. The stored data could then be instantly
transmitted to her clinicians at the clinic. Mobile-based interventions have been reported by
various scholars to have resulted in statistically significant improvements in both self-
management and glycemic control.

References

Alhodaib, H. (2014). Information technology in DM. Diapedia.

CASE REPORT: MOBILE BASED DIABETES REMOTE MONITORING SYSTEM 8
Coughlin, S. S. (2017). Mobile technology for self-monitoring of blood glucose among

patients with type 2 diabetes mellitus. Mhealth, 3(47): 10-30.

Garg, S. K., Shah, V. N., & Akturk, H. K. (2017). Role of mobile technology to improve
diabetes care in adults with type 1 diabetes: the remote-T1D Study iBGStar in type
1 diabetes management. Diabetes Ther, 8(3): 811-819

Grady, M., Cameron, H., Levy, B., & Katz, L. (2016). Remote health consultants supported
by a diabetes management web application with a new glucose meter demonstrates
improved glycemic control. Journal of Diabetes Science and Technology, 10(3):
737-743.

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