PARIS -- There are two million diabetics in France, of whom 10 percent have type 1 diabetes (1). To facilitate transmission of glucose information between patients and physicians, France Telecom uses the Orange GSM cellular network to send data to a secure server that contains patient files. Physicians are thus able to easily check the files and send appropriate medical advice to individual patients via SMS text messages.

Initial tests of this service began with a group of ten patients in Grenoble over a three-month period. Given the positive results, clinical trials involving several dozen patients and five attending physicians at the Grenoble and Toulouse university hospitals began in April 2003. The patients in the one-year trial are all treated using insulin pumps.

The objective is to assess improvements in therapeutic monitoring of patients thanks to this system.

The trial program has been made possible thanks to close cooperation among three partners:

• Roche Diagnostics, which is providing patients with meters and its technical and medical know-how in diabetes self-monitoring systems.
• Palm France, which has provided Palm™ m515 pocket PCs to allow patients to easily monitor their diabetes reliably and instantly, anywhere at any time. Additional information such as insulin dosage data can be entered directly in the pocket PC.
• Agir à Dom, a home healthcare company that provides medical and technical assistance for patients to assist the physicians treating diabetics.

A complete system for remote self-monitoring of blood glucose levels

Gluconet draws on three technologies:

• A Roche Diagnostics glucose meter with an infrared interface that stores daily measurements.
• A pocket PC with an infrared interface and either an integrated wireless phone function or an infrared connection to a standard cellphone. The pocket PC is loaded with software developed by FT R&D to download glucose data from the reader and transfer it to the server via the wireless phone link.
• A Web server containing patient files, also developed by FT R&D.

Patents prick their finger and place a drop of blood on a test strip that is then inserted in the glucose reader. They regularly use the infrared link to send the data to the pocket PC, which either has an integrated cellphone function or is connected to a standard wireless phone. This information is then uploaded to the patient’s file where the physician can consult it on the Web.

The physician can recommend a change in treatment by sending an email or SMS text message to the patient. The doctor can also send instructions to the patient in the form of a synthesized voice message.

Physicians need only a computer and an Internet connection to use the system. After checking patient data, if physicians decide to recommend a change in treatment, they simply enter the instructions on their computer and the message is recorded in the patient file and sent to the patient. The server containing patient files is based on the XML standard and is accessed via the Web.

Optimized glucose monitoring and fewer diabetes-linked complications

By simplifying exchanges of information and making patient data available on the server, Gluconet introduces several significant benefits:

• Specialist physicians can access patient data at any time and track their patients more closely between appointments when necessary (pregnant women, for example).
• Patients can store and access glucose data records on the Web, including graphics (threshold overshoots, averages, bar charts, etc.). They can also receive weekly medical recommendations based on the readings transmitted, complementing their quarterly medical appointments.
• Other health professionals involved in patient care have secure access to the medical files from anywhere, without requiring special software.
• Other universities have expressed interest in this type of telemedecine system, which would help them improve regular monitoring of patients thanks to remote access.

Note: (1) Type 1 diabetes is caused by destruction of the cells that produce insulin. Diabetics thus require continuous administration of insulin, which necessitates regular self-monitoring of their glucose levels.

France Telecom SA

Palm Inc.