Adolescents don't always check their blood glucose levels as oftenas they should. Because frequent monitoring is a keystone ofdiabetes care, this can make their parents frantic.
In response, parents may try to dictate their children'sbehavior, a tactic that often backfires with rebellious teenagers.Upcoming mobile technologies may lessen the need for parentalinterference by giving adolescents an independent way to workthrough the complex information necessary to make good self-caredecisions.
Dr. Aaron E. Carroll, Assistant Professor of Pediatrics at IndianaUniversity's School of Medicine, believes that future monitoringsystems incorporating mobile communication with testing may reducethis parent-teenager conflict.
"Just the fact that there is diabetes makes for a lot moreconflict, nagging, and difficulties in the parent-adolescentrelationship," he states. "I don't think there is any quicktechnological fix to solve these problems. However, we have studiedhow to use technology to improve the adolescent-parent-doctordynamic and make things better."
What Exists So Far and How It Works
Most diabetic patients test their blood sugar level several times aday and log the results, but the readings aren't usually reporteduntil the next doctor visit. To address this problem, NorthCarolina's Confidant, Inc., has developed a device that collectsinformation from a glucose meter and transmits it wirelessly viamobile phone to a file server.
The file server then interprets this information, compares it toother measures taken over time, and sends encouraging orinstructional messages back to the patient. Thomas Wall, VP ofBusiness Development, says, "For kids, especially teenagers, using acell phone is familiar ground. [This program] is like carrying adedicated personal health coach built into a mobile phone.
Not only is it convenient and promotes healthy decision-making,but it also offers customized coaching to motivate and supportlifestyle changes." The latest FDA clearance occurred in 2006, butrefinements continue and the technology is not yet available.
Dr. Lori Laffel, Chief of the Pediatric, Adolescent and Young AdultSection at the Joslin Diabetes Clinic in Boston, headed a pilotstudy involving a wireless hand-held device. "We found that youthages 8-18 with type 1 diabetes were more apt to monitor their bloodglucose levels more often when engaged in a game called DiaBetNet,"she says. DiaBetNet integrates blood glucose, insulin dosing, andcarbohydrate intake data and challenges users to predict their nextglucose levels.
"The data stored in the PDAs are wirelessly transmitted to acentral secure server," Dr. Laffel explains. "The study demonstratedthe ease of introducing new technology to pediatric patients withdiabetes, with an additional benefit of increased blood glucosemonitoring among the game group participants."
Dr. Carroll's team has done usability studies of an all-in-oneFDA-approved diabetes cell phone with built-in glucose monitor,designed by Healthpia America in New Jersey and set to be availableto the public later this year.
"Kids don't want to be stigmatized. They don't like beingdifferent, so hiding the technology in the cell phone is a bigplus," Dr. Carroll reports. He hopes that such devices will tightenthe relationship between the doctor, clinic, and child.
"We'd be building up the independence of the child and improvingthe adolescent's ability to manage their own diabetes," he says.However, he stresses, "This is still early. It needs further studyto show that it actually does work and makes a difference beforepeople are going to widely adopt such expensive technology."