Health Goes High-Tech

Young diabetics and their doctors use cell phones to monitor disease.


April 23, 2008 — -- In 2006, 14-year-old Glenn Leinart's family feared a bout with the flu was about to kill him.

Within three months, "he lost 50 pounds, chugged gallons of water, and was constantly going to the bathroom," remembers his mother Della Leinart, who was pregnant with twins at the time.

Leinart was diagnosed with Type 1 Diabetes, a chronic disease in which the pancreas stops producing insulin that is used to convert sugars into glucose. Normally, the glucose would fuel the body's cells in a healthy person. Unlike the more common Type 2, which is brought on by obesity, Type 1 has a sudden and mysterious onset -- and there is no cure.

"They told me that they think certain people are predisposed genetically to getting it and then when you get a virus the antibodies attack your pancreas, but they really don't know," Leinart said.

Doctors knew that Leinart would have to monitor what he ate at all times, measure his blood sugar by pricking his finger five to 10 times a day and use a syringe to inject insulin now necessary for him to process the sugars and starches in food.

Maintaining proper blood sugar levels is an arduous process, especially tough for children who may forget to brush their teeth or get their report card signed; when they forget to measure their blood sugar levels, however, the consequences can be life threatening.

Extreme high and low levels in the short run lead to confusion and, if not caught in time, can cause a coma. Long term extremes lead to sight loss, kidney failure, heart disease, and loss of sensation in extremities.

Luckily, Leinart got an unexpected high-tech helper: his cell phone.

Most people don't leave the house without their cell phones, which gave tech startup Confidant an idea: Use mobile phones as powerful databases and liaison to health care professionals for patients with chronic diseases.

"After you start dealing with it you realize it really stinks. You need to incorporate it into your routine. Diet and exercise now become life and death," Leinart said. "You have to develop a positive attitude or it will take you over. You realize quickly it's not going to go away."

Confidant's program is part record keeper and part motivator. The glucose meters that diabetics use can communicate wirelessly with Bluetooth enabled phones which in turn can send the data to a database where doctors and nurses can keep an eye on a patient's readings.

If you forget to test your blood, a text message is sent to your phone. If your blood sugar is too low over a long period of time your doctor can adjust your insulin levels or suggest diet changes well before you need to be rushed to an emergency room.

Dr. Mark Piehl, the Medical Director of WakeMed Hospital's Diabetic Pediatric Center, saw the potential instantly.

"Treatment of diabetes has focused on consequences for so long rather than on improving the management. I see this as a tool to work with patients to see what might be causing the problems and to send them back a job well done text message when they are doing well and a reminder if they are forgetting to test," Piehl said. "Mobile management is one of the few technological advancements we have seen with diabetes in a long time and the potential is very exciting."

Piehl introduced the Confidant technology to 10 young patients for a six-week trial. They were given a free cell phone and asked to give it a try. Leinart was one of those patients.

Piehl says all the kids enjoyed the trial and offered valuable feedback to improve the process.

"It's easy. It's fun. It reminds them to check more often," Piehl said. "We know it makes them test more often and now we would like to discover if testing more frequently works in the overall improvement of keeping them within their blood sugar range."

During the WakeMed trials, Leinart found himself sticking to his normal disciplined routine of testing when he woke up, before every meal, mid-morning, after school, and at bedtime.

"I want to do well for myself and my doctors, so I don't need that whole big brother is watching thing to motivate me. But I've gone to the WakeMed Hospital summer camp and I know those little kids have high levels and they don't know to monitor it too well yet," he said. "Positive reinforcement is good. Doing it well no matter how you get it done is doing it right and a lot of kids are connected to their phones anyway, so I think it will help them."

Confidant makes the software themselves and has been conducting their trials with off-the-shelf cell phones that run on the AT&T wireless network. The programs are created for a Java environment that is present in most modern AT&T phones and the medical devices connect to the phones without wires due to the carrier's open serial Bluetooth framework.

The open standards are important to make sure the most phones will work with the most devices, because their business model is planning on a lot of volume, Marc O'Brien, Confidant's VP of Sales says.

"Chronic diseases are an epidemic in our country and we see this being a tool for not only diabetics, but people with asthma, high blood pressure, heart problems and people trying to lose weight. We are going to start rolling out our service wherever points of care are involved," he said. "The software is going to be a single download over the air and we are aiming for an all inclusive price of $1 a day."

As the company negotiates rates with insurance companies, clinics and hospitals they are also responding to early user feedback. The interface is being spiffed up and there is now a way to enter diet, exercise and medications into the phone so the doctors will have a more complete picture of the patient's overall health.

Piehl is working on a grant proposal to do a follow up study that will include 50 patients and is especially interested in incentive-based programs.

"I think it would be fantastic to see if children would respond any differently to a reward system where testing a certain amount of times a day would earn you a song download, or keeping your levels within range would allow you access to a certain game," he said.

Today, nearly two years to the day since he was first diagnosed, Leinart is one foot taller, has put on 40 pounds of muscle and is a 16-year-old wrestling champ at Sanderson High in Raleigh, N.C.

Having to measure his complex carbohydrates, simple sugars, and managing portion control made Glenn a self-taught nutritionist and he has taken up jogging for fun. Even if the life-saving supplies weigh him down he says he won't leave the house unless he's prepared.

"Even when I go for a run I have my insulin, blood glucose meter, some juice in case my levels get too low," he said. "And I don't go anywhere without my cell phone."

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