I had this “convergence” moment tonight.

Here I am at the teen boys campout. A light, cool summer breeze blows across my face as I overlook a truly beautiful view of the sparkling lights of Texas hill country spanning over 25 miles. I’m micro-blogging about the campfire talk via my cell phone while actively engaged in discussion with 25 teen boys with diabetes, plus my 3 outstanding facilitators. The discussion ranges from every conceivable medical issue about diabetes in kids that you might imagine, to driving and diabetes, to girls, and everything else in-between.

I suddenly get an e-mail request from a mom in west Texas who’s family is part of my Diabetes HouseCall practice. In two minutes I’m able to review her son’s blood sugar trends via the GlucoDYNAMIX day over day plot collected by her son’s GlucoMON device, plus her son’s insulin pump settings, and reply via my phone with suggested changes to his management. I don’t miss a beat.

It then hits me: it doesn’t get any better than this!

…and yet another entrant in the race to continuous non-invasive sensing

http://www.echotx.com/SonoPrep+Continuous+Glucose+Monitoring

Wow…this could be a full-time job keeping up with the world of diabetes technology concept companies. On the one hand this is good. On the other hand, how many are dedicated to improving lives vs. delivering a quick exit for their investors? Let’s hope that Echo is committed and at least one of their platforms will make it into the hands of people while improving lives.

November 30^th 2007 just became a milestone in my 20+ year career as a pediatric endocrinologist. I hope it will also become a milestone in the care of all children with type 1 diabetes as well. This was the day I performed my first high speed Internet based pediatric diabetes care follow up visit using a pilot service called Diabetes HouseCall™. As a first of its kind event, it involved having my patient and their parent comfortably ensconced in their living room 220 miles away from me, yet fully in my view (and theirs) as their pediatric diabetologist. Full visual and audio contact was maintained for a 30 minute plus encounter.

Even better, all my patient’s blood sugar data was automatically collected with accurate and reliable time stamps and presented in my preferred color-coded format by the Diabetech® Automated Diabetes Management System™ which includes the GlucoMON® wireless blood glucose meter device and GlucoDYNAMIX™ software. In addition, the patient’s highly accurate Homecheck-A1c™ results including the %A1c value were provided to me in advance allowing time for my careful review prior to the visit.. Having this data in the patient’s record in advance probably saved 15 - 20 minutes vs. the typical patient visit.

During the encounter, I was able to perform a complete pediatric diabetes follow up visit, including the chance to answer all patient and parent questions. A follow up care plan was defined and in three weeks I will receive an updated blood sugar logbook highlighting trends resulting from this visit automatically forwarded to me via GlucoDYNAMIX. Our next virtual visit will take place in 3 months with scheduling handled efficiently online.

With Diabetes HouseCall, actual face to face visits need only be done yearly since the patient has a regular physician to manage any non-diabetes related medical problems if they arise. HouseCall is pure time with the diabetes specialist, unencumbered by a crowded and noisy waiting room (during flu season no less) and no time spent performing tasks such as downloading meters and blood sample collection. Families will also forgo that long drive to the clinic and back and for many families who drive longer distances or fly, no hotel and meals. While we’re at it, no missed time at work for these parent’s either. And one last benefit for the families with two involved parents that I see is making it easier to have both parents available to attend the visit thus avoiding the stress of one spouse trying to re-enact the visit later that evening.

Therefore, November 30^th 2007 marked to me the beginning of a new era in diabetes care: the virtual visit with inexpensive and easy to use, commercially available PC equipment and broadband access that can be had for as little as $15/mo in many areas of the Country. Most importantly, a comprehensive high quality pediatric endocrinology visit was conducted in the home of my patient, without the need for:

1. Taking as much of their time away from parent’s work or the child’s school;
2. A tedious waiting room stay and registration process; and,
   
3. A 450 mile round trip (it’s green!).
   

They were also able to spend more quality time with their diabetes doctor (30+ minutes of face to face time: match that with most diabetes office visits!). From my standpoint, my patient’s glucose, A1C and ancillary test data were seamlessly transferred to me in my preferred format and the appointments were made online by the family. This is the future of high technology diabetes care, but it’s not meant to be a total replacement for all face to face encounters. Once yearly visits are preserved, which allows full access to the entire diabetes team, including me. Diabetes HouseCall was just a dream a little over 2 years ago. Now it’s a reality