The T-IDDM project concerns the design, implementation and testing of an intelligent telemedicine 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 exploits two main components: a patient unit (PU) and a medical workstation (MW). The PU 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. It will be developed on a portable computer (pocket computer, hand-held device, pen-computer, etc.) capable of communication through fixed and mobile telecommunication networks with the MW.

The MW deals with the long-term management of the patient 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. To this purpose, it exploits both medical knowledge and clinical information, from both patients' home monitoring and the periodic evaluation of their metabolic control performed by the physicians.

The key issue of the proposed architecture regards its implementation in a telemedicine context. 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 the glucose time series together with the corresponding insulin deliveries as well as other relevant information, back to the physician's workstation. T-IDDM proposes a major shift of the primary focus away from hospital-based information systems and medical practice, to widely-available, decentralized, low-cost assistance. The project goal is to take advantage of the current state of telecommunications technologies and infrastructures to define, develop, validate and evaluate a set of telemedicine services and applications to accomplish the following specific aims:

• To provide an effective treatment leading to good glycemic control, and to achieving a careful balance between insulin therapy, diet and physical activity. Delay the onset and/or slow the progression of chronic complications.

• To provide diabetic patients at home or in other non-clinical environments with an appropriate level of continuous and intensive care through telemonitoring and teleconsultation services, taking into account the needs of remote or isolated individuals that are unable to reach frequently the hospital institutions.

• To allow for a cost-effective monitoring of a large number of patients, automatizing data collection and the management of a large set of therapeutic protocols.

• To support continuing education of patients through teleconsultation services.

• To allow the patient to customize the insulin therapy within the bounds established by the physicians.