TELEMATICS APPLICATIONS Programme

Form A: OVERVIEW OF T-IDDM PROJECT

A.1 - Summary Information on the Project

Project Number - Acronym - Title
1047 - T-IDDM - Telematic management of Insulin Dependent Diabetes Mellitus
Lead sector	Other sectors (Initials)	Start	End	Project Duration (months)
health care		01-JAN-1996	31-DEC-1998	36

Total Cost (ECU)	EU - Contribution (ECU)
837 KECU	837 KECU

Project Objectives, Summary description and anticipated results:

Diabetes causes metabolic alterations and long term invalidating complications related to renal, neurological, cerebrovascular, cardiovascular and peripheral vascular diseases. In Europe about 30 million people suffer from diabetes; 20% of them require exogenous insulin administration to survive (insulin-dependent patients). Recent medical evidences show that a better metabolic control achieved through Intensive Insulin Therapy can delay or prevent the development of long-term complications. It requires frequent insulin injections, accurate blood glucose monitoring and strict surveillance by health care professionals. This patient management procedure is expensive and time-consuming. It is calculated that 7% of the total European health care expenditures is absorbed by diabetes care and the major part of this budget results from the management of the above mentioned complications. The administration of an appropriate therapy and the reduction of chronic complications are expected to produce economical benefits for patients, their families, and the community. A considerable saving of money could be obtained through the use of telecommunication services for the active monitoring of the patients. Telematic management services can also be helpful in providing all patients with equal access opportunities to specialized health care centers, independently, for instance, of their geographical location. The T-IDDM Project concerns the design, implementation and testing of a telematic service to assist Insulin-Dependent Diabetes Mellitus (IDDM) patients, providing the physician with a decision support tool for improving management of patients according to the best current medical practice. The service we propose exploits two main components: a patient unit and a medical workstation. The patient unit provides assistance to the patient under the form of a set of local consultation procedures, autonomous decision-support tools and teleconsultation to the remote medical workstation. The medical workstation deals with the long-term management of the patient by assisting the physician in choosing an appropriate treatment protocol, defined in terms of insulin timing, type, and total amount, as well as a diet scheme. The two modules are able to work independently, but they rely on a bidirectional communication channel to exchange relevant information: the patient unit receives the day by day therapeutic strategy to follow from the workstation, under the form of the treatment protocol, and is able to communicate relevant data back to the medical workstation. T-IDDM proposes a major shift from hospital-based to patient-based information systems.

• Users involved:

  The project will involve both patients and physicians as users. The project proposes a new model of medical care, in which the patient will play an active role in the self-management of the therapy, and the physician will be given an instrument for low-cost, continuous monitoring. Physicians and groups of patients will be involved both in the user needs definition and in the verification and demonstration phases.

• Technologies and/or approach used.

  The system architecture is built on an adaptive hierarchical control system based on three main components: a medical workstation, a patient unit and a telecommunication service (public telephone networks) that connects them. Several methodologies will be investigated from Artificial Intelligence to Control Theory, and different technological solutions will be considered, including portable and mobile telecommnication systems.

• Expected benefits for the citizen:

  T-IDDM will define a new telematic service for the management of a socially relevant chronic disease. The proposed architecture can be considered as a general architecture for coping with other, in some sense similar, medical problems. Furthermore, the costs of Insulin Dependent Diabetes Mellitus management should be reduced by exploiting T-IDDM methodologies. So, the benefits for the citizens are three-fold: direct benefits for the patients suffering from Diabetes Mellitus and their families, indirect benefits for patients suffering from other chronic diseases and benefits for all citizens coming from a rationalization of medical expenses.

• Expected benefits for the users of the application:

  T-IDDM is expected to provide diabetic patients at home or in other non-clinical environments with a more effective treatment, so delaying the onset and/or slow the progression of chronic complications. Moreover T-IDDM should allow a cost-effective monitoring and a continuing education of patients through teleconsultation services, and should enable the patients to customize the insulin therapy within the bounds established by the physicians.

• Expected benefits for the European Industries:

  Diabetes Mellitus (DM) is a major chronic disease in the developed countries; the market of telematic technologies is hence potentially wide for European Industries. T-IDDM will test and experiment innovative methodologies and will utilize on-market technical solutions, in order to provide a demostrator that could be used as a basis for an industrial product.

• Contribution to EU-policies:

  Diabetes Mellitus (DM) is a major chronic disease in the developed countries. In Europe about 30 milion people suffer from DM. DM accounts for up 4-5% of the public health budget. These findings have important implications for health policy makers. Significant cost savings could be achieved if T-IDDM goals will be reached.

Name of Institution/Organisation	City + Postal Code	Region	Country	Number of Employees on 1/1/1995	Turnover in 1994 (KECU)
Consorzio di Bioingegneria e Informatica Medica., Pavia	Pavia, I-27100	IT2	IT	10	500

Parent Company

Controlling Company (Country)

Title, First Name, Name	Professor Mario Stefanelli	Address:	Dipartimento di Informatica e Sistemistica Universita' di Pavia via Abbiategrasso 209, I-27100 Pavia, Italy
Tel:	+39-382-505354	Fax:	+39-382-505373
E-mail 1:	tiddm@ipvaim.unipv.it	E-mail 2:	mstefa@ipvstefa.unipv.it

Participants Code	Name of Institution / Organisation	City + Postal Code	Region	Country	Number of Employees on 1/1/1995	Turnover in 1994 (KECU)
C 2	Grupo de Bioingegneria y Telemedicina Universidad Politecnica de Madrid	Madrid E-08025	ES3	ES	1000-5000
C 3	Consorzio Padova Ricerche	Padova I-35127	IT32	IT	10	1635
C 4	Medicom International Ltd.	Tampere SF-00290	FI11	FI	6	230
C 5	SOGESS S.r.L.	Milano I-20123	IT2	IT	13	2100