Foster, K; Javaherian, K; Zhang, CR; Patel, K; Schell, A; Huynh, J; and Blanchard, M
Introduction:
Blood glucose control for diabetics remains a difficult goal to achieve among patients, in particular because of inconsistent communication of blood glucose values to physicians outside of office visits. Blood glucose diaries have low compliance rates, and underlying socioeconomic issues, medication side effects, and medication non-compliance contribute to blood glucose control difficulties. To address these issues, we designed, implemented, and piloted an inexpensive automated text message (SMS) and phone communication system, EpxDiabetes, to aid in the management of Diabetes.
Methods:
EpxDiabetes was designed based on interviews with academic and community physicians and patients at Washington University in St. Louis, Mercy Hospital, and the Family Care Health Center. EpxDiabetes sends regular prompts to patients to report their fasting blood glucose (FBG) via SMS or phone call. The system algorithmically adapts to the patient’s needs and can vary message frequency appropriately. If the patient reports a FBG value beyond set thresholds, their provider receives an actionable alert. For longitudinal monitoring, EpxDiabetes provides a regular report prioritized by average FBG levels. In this pilot, a total of 35 patients were followed for over 8 weeks at Mercy Hospital and Washington University in St. Louis while tracking response rates and average FBG levels.
Results:
Preliminary results show that, on average, 86% of patients respond to the system each week. We have found that patients using EpxDiabetes for 8 weeks have experienced a 34.6 point reduction in FBG from a baseline calculated as the average of the first week of reported FBG values. In these patients, median baseline was 168.1 with an interquartile range of 158.8 to 196.5. In addition, we have been able to identify and alert providers in real- time to 11 cases of acute hypoglycemic or hyperglycemic events over the 8-week period for the 35 patients initially recruited. We also report a cost-benefit analysis that demonstrates the capability of EpxDiabetes to be sustainable and generate revenue for practices via novel fee-for-service codes.
Discussion:
EpxDiabetes is a novel system that leverages an inexpensive, widely adopted technology to provide clinically relevant information to the provider and efficiently improve patient-provider communication. In an initial pilot, EpxDiabetes demonstrated strong patient engagement and retention as well as beneficial effects on FBG levels in diabetes patients. A 400-subject randomized controlled trial to assess the impact of this system on HbA1c reduction and patient compliance will begin in January 2016, with interim findings available by May 2016.