Virtual Watchdog Keeps 25 Diabetes Patients Honest

Posted: November 16, 1998

Sherrie Chinn, a 51-year-old Camden woman who learned late in life that she has diabetes, knew she should check her blood sugar every day.

But she hated blood. And she didn't experience many symptoms - so it was easy to pretend the disease was not there.

``I was very in denial,'' she said. ``I was just like, `I'll do it later, I'll do it later.' ''

Now, she does it every day - twice a day even.

The difference, for Chinn, was a new computer program that links to her doctor. Every day, she enters her blood-sugar level, what she eats, and her exercise regimen into a computer that holds a place of honor in the center of her living room.

A few hours later, her doctor reviews the information and sends encouragement and advice via e-mail.

``My patients have been much better about checking their glucose levels now that they know their doctor is watching,'' said Mira Kheny, Chinn's doctor.

Chinn and Kheny are participants in a study, begun in August, that is testing whether computer software can be used to improve the health of diabetics. It is sponsored by Virtua Health, an alliance between the West Jersey Health System and Memorial Health Alliance.

Though Chinn still hates needles and blood, knowing that her doctor would be monitoring her activities gave her the incentive she needed to begin testing her blood sugar regularly.

``Before, I hardly even took my blood sugars. I wasn't disciplined,'' Chinn said. ``This is fantastic, because I'm hooked right up to the doctor. When the house gets quiet and the kids are in bed and settled, then I can get on the computer and put my blood sugars in, my medication, and what I've eaten for the day.''

The computer program, dubbed Community Health Advancement through Technology (CHAT), is one of the first of its kind in the country. In addition to giving patients access to their physicians, it provides a chat room where diabetics can talk to one another, gives patients access to health information, and helps participants calculate how many calories they consumed and burned on a given day.

Hospital officials are hoping CHAT can be expanded to help those who have other chronic diseases, such as heart problems, asthma and emphysema. It also could be used to help women monitor their pregnancies.

But first, researchers will study whether there is a marked improvement in the health of the study's participants.

``We're anticipating that it will help more people have tighter control over their blood glucose,'' said Dorothy Cox Fisher, vice president for community health at Virtua Health. ``Diabetes has serious complications that can be avoided, but only if patients control their blood sugar.''

For years, doctors have stressed to diabetics the importance of checking their glucose a few times a day to make sure it stays within a prescribed range. If they allow their blood-glucose levels to remain high - even if they do not initially have symptoms - the result can be serious complications, including heart disease, stroke, vision loss, amputation and kidney disease.

Before becoming involved in the study, Chinn, like other diabetics, was supposed to document her blood-sugar levels, activities and diet in a logbook that her doctor reviewed every three to six months.

``A lot of them don't do it, or they want to make their doctors happy, so they just make it all up,'' said Tracy Carlino, a nurse and certified diabetes educator with Virtua Health.

The new software encourages patients to stay honest, since their entries are checked frequently.

``I get to look at the information every day, and I can help them change their diet or exercise or insulin based on that,'' said Joel Epstein, an internist with Virtua Health who has 10 patients in the study.

The study, which is being funded by Intel Corp., requires doctors and their patients to log on weekly, Carlino said, but most are doing it more frequently. Two diabetes educators also check patient logs at least twice a day, looking for problems.

Of course, when patients detect dangerously high or low blood-sugar levels, they are instructed to call their doctor or go to a hospital instead of waiting for help through the computer, Carlino said.

About 25 diabetics are participating now, but that number will grow to about 240 by the end of the year, Fisher said.

``I'm glad I got to be in this study,'' Chinn said. ``I didn't really realize before what the consequences could be - that if my blood sugar stays high, I could be damaging my organs. I want to be around for a while, for my grandkids.''

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