Mira Mastoras , an 18-year-old college freshman with type 1 diabetes, runs 3 to 4 miles most days of the week. Too often, she faced a frustrating problem: Her blood sugar would sink during a workout, forcing her to stop and eat. But thanks to new technology that wirelessly sends her glucose readings to her doctor in real time, she no longer has to miss a step.
“We figured out what I should eat before a run and when I should turn off my insulin pump so my glucose levels don’t fall,” explains Mastoras, a biology major at the University of California, Davis. “It’s made a big difference and it’s so easy – I don’t have to hook up my monitor to my computer or write down my numbers to show them to my doctor. He sees them the same day and we can message about what’s happening and what to do.”
Mastoras is one of 10 teens and children with type 1 who participated in a recent Stanford University pilot test of Apple’s HealthKit—a software platform that gathers and shares health data—for tracking blood-sugar levels. Their physician, Rajiv Kumar, MD, a clinical assistant professor of pediatrics in Endocrinology and Diabetes at Stanford Children’s Health and a pediatric endocrinologist at Lucile Packard Children’s Hospital Stanford, wanted to find out whether access to a stream of blood-sugar data could help him, his patients and their caregivers deal with worrisome and sometimes dangerous blood-sugar swings more swiftly and effectively.
“We started the pilot project last March,” says Dr. Kumar. “It’s so successful that in late 2015 we offered it to all of our patients. More and more are signing up every week. Diabetes is very challenging to control, especially in children. They’re growing, changing and lead busy lives. They come in every three months for a check-up, but so much happens in-between. We usually don’t see all of that data. Access to home monitoring information lets us make better, more personalized decisions about their care, more promptly.”
Here’s how it works for Mastoras and Dr. Kumar’s other patients:
• The user wears a continuous glucose monitor (CGM). It uses a small needle to check blood sugar levels 288 times a day.
• Through a Bluetooth connection on the monitor, readings are sent wirelessly to a HealthKit data repository on the user’s iPhone with the permission of the user or their guardian.
• The readings are then sent on via HealthKit to the patient’s electronic medical records at Stanford Children’s Health. Stanford uses MyChart from Epic, an electronic medical record provider.
• Designated caregivers, such as Mastoras’ parents, can see the readings in real time.
• Doctors can view the readings with a three-hour delay—and can see charts and other reports that highlight trends for each patient.
• Users, caregivers and doctors can communicate electronically via a private link with questions and solutions.
Dr. Kumar and the other physicians in the practice don’t watch the numbers all the time. Instead, they receive reports every two weeks and can check readings in-between as needed. “We can look at trends and patterns and ask questions about things we would have missed before,” he says. “If blood sugar levels drop on Tuesdays, it might turn out that’s basketball practice day. A child might need an adjustment in their insulin dose or diet. Instead of waiting three months, we can figure it out quickly – without asking the patient or her family to do any more work.”
One kindergartener in the pilot test, Dr. Kumar says, suddenly had a string of overnight low blood sugar readings. “The analytics spotted it between appointments,” he says. “We had increased his insulin to deal with high blood sugars, but something was wrong. We discovered the child was receiving an incorrect dose at bedtime. We lowered that dose and worked out a safety plan with his caregivers in case there were future overnight lows.”
In addition to quick saves, Dr. Kumar says the system helps teens take control of their diabetes while still keeping parents in the loop. “With the continuous glucose monitor, caregivers and users can set alarms on the phone for highs and lows,” he explains. “And everyone has access to the data and can message. This lets me involve adolescents in their own care more. It’s very difficult for parents to let go and let older teens take over their care.”
Mastoras agrees. “My parents trust me to take care of myself, but they still check,” she says. “Sometimes I’ll say, I’ve had a stressful day and my blood sugars were low a lot. My dad will say “Yes, I noticed that.” I think it gives him peace of mind.”
HealthKit has been available since 2014 on iPhones with IOS8 and later operating systems; it’s also available on the Apple Watch. Healthkit is a platform that, with user permission, allows apps to share information – including data from a growing number of blood glucose meters. More than 1,500 health, medical and fitness apps now integrate with HealthKit, and it’s catching on for diabetes. Since January of 2015, Dexcom’s G4 continuous glucose monitor has been available with a wireless receiver that can send data directly to an iPhone. If a user chooses, she can also share it with others. It’s the monitor used in the Stanford study.
In late 2015, the Johnson & Johnson Diabetes Solutions Companies announced that people with diabetes using the OneTouch Verio® Sync blood glucose meter and LifeScan, Inc.’s OneTouch Reveal® mobile app would be able to view blood sugar readings directly in the Health app on their iPhone and choose to privately and securely share that data with their healthcare team.
In March of this year, Roche Diabetes Care announced that users of its Accu-Chek Connect System can now send blood glucose numbers to their electronic medical records using HealthKit. Accu-Chek Connect sends meter readings to an app, allowing them to be shared with caregivers via text messages. Adding HealthKit allows readings to flow into medical records kept by doctors and healthcare systems and to other health apps supported by HealthKit.
Dr. Kumar says he expects other diabetes devices – including glucometers, insulin pumps and even ‘smart’ insulin pens – will soon be enabled to transmit data directly to the doctor’s office, with a patient’s permission. That would allow people with type 2 diabetes to take advantage of this technology advance, and give physicians even more information. “It will be great when systems like this work with all mobile devices,” he notes. “Doctors will have a wealth of real-time information to help support their decisions.”