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Report

Teaser, summary, work performed and final results

Periodic Reporting for period 1 - POWER2DM (POWER2DM - Predictive model-based decision support for diabetes patient empowerment)

Teaser

Summary

Diabetes is a chronic disease. Type 1 diabetes (T1DM) is characterized by deficient insulin production and requires daily administration of insulin. Type 2 diabetes (T2DM) results from the bodyâ€™s ineffective use of insulin and requires lifestyle adjustment and/or oral antidiabetic medication. T2DM comprises 90% of people with diabetes around the world, and is often unnoticed until late stage, once complications have already arisen.
A raised blood sugar is a common effect of uncontrolled diabetes and over time leads to serious damage to many of the body\'s systems, especially the nerves, blood vessels, eyes and kidney. In 2010, there were approximately 285 million people in the world diagnosed with T2DM. In 2012, diabetes was the direct cause of 1.5 million deaths.

There is an urgent need to develop cost-effective intervention strategies for diabetes. Given the enormous scale of the problem, and the fact that such a large percentage of T2DM cases arise due to an unhealthy lifestyle, personalized care systems that include innovative self-management support strategies, well-linked to the medical care of patients, are of prime importance.

The main objective of POWER2DM is to develop and validate a personalized self-management support system (SMSS) for T1 and T2 diabetes patients that combines and integrates (1) a decision support system (DSS) based on leading European predictive personalized models for diabetes interlinked with predictive computer models, (2) automated e-coaching functionalities based on Behavioural Change Theories, and (3) real-time Personal Data processing and interpretation.
The DSS will be based on the complementary combination of proven predictive models for short term plasma glucose prediction, medium term diabetes progression, and long term risk scoring for diabetes complications. These models will be integrated in adaptive personalized behavior change interventions to increase adherence of the patients to their care program and improve their interaction with health professionals. A cloud-based Data Integration Service, collecting and processing data from personal devices and EHR/PHR in real-time feeds the DSS.
The results of the SMSS with respect to clinical parameters, awareness, acceptance and empowerment of the patient to participate in the care process will be evaluated in 3 EU countries (see Fig. 1).

Work performed

The requirement analysis and conceptual design (Fig. 2) for the POWER2DM personalized, integrated SMSS was performed. Initial use case scenarios and the corresponding user and technical requirements were specified. Software test plans were established and the actual programming began. Prototype I for POWER2DM was realized.
Relevant long-term risk scoring models were chosen. The precise specifications of the inputs and outputs for the short-, mid- , and long-term models were established. The protocols for software communication between the POWER2DM SMSS components and the predictive models were developed and the software components were programmed and tested.
The first prototypes of the 2 main components of the DSS were implemented, fully integrated with all other POWER2DM SMSS components. The Action Plan Engine offers guided goal setting, activity planning, and weekly review functionality. The Communication Engine issues push messages to support the patient based on Behavior Change Techniques.
The Personal Data Store (PDS) was established based on technical and functional specifications. The API service for all components to interact with the PDS was established. Software to import data from the selected self monitoring devices for measurement of glucose, physical activity, heart rate, and sleep was programmed, such that the data can be transferred to the PDS.
A first version of the POWER2DM mobile app was developed.
The first clinical pilot study was performed. It produced a valuable dataset containing large amounts of continuous data for further analyses. It provided valuable insights into self-monitoring issues and the user experience of mHealth devices by patients with type 1 and type 2 diabetes.
A Communication and Dissemination Plan was developed and the Projectâ€™s website was constructed.
A working relationship with diabetes patient organisations in Spain and The Netherlands was established and several discussion meetings with patients were held.
A first iteration of the POWER2DM Exploitation Plan was developed.
A liaison with Dutch SMEâ€™s was formed aiming to create a basis for rapid implementation of POWER2DM in the Dutch healthcare setting.

Final results

Progress beyond state-of-the -art:
POWER2DM will extend the following existing methods and tools of the project partners:
TNO: the MT2D-Marvel model for mid-term predictions from Mission-T2D (www.mission-t2d.eu);
IDK: the KADISÂ® DSS tool to provide short term predictions and lifestyle simulations for daily glucose management;
SRFG: the EMPOWER Action Plan Engine from EMPOWER (https://www.empower-fp7.eu/)
The projected extensions to progress beyond state-of-the-art are summarized in Table 1.

Expected results:
1 - A personalized, integrated SMSS that offers action (care) plans in terms of changes in lifestyle, nutrition, physical activity and therapy adjustment for short term optimal metabolic control, medium term prevention of deterioration and long term avoidance of diabetes complications.
2 - A patient-targeted decision support system (DSS) by utilizing and interlinking predictive models for the short- (KADIS), mid- (MT2D-Marvel), and long-term (risk score models).
3 - An innovative Action Plan Engine building on EMPOWER, for personalized adaptive computer-aided health behaviour change interventions to support the patient to obtain and maintain healthy behaviour change.
4 - A cloud-based Data Integration Platform to collect and process the patient data coming from personal health systems, wearable sensors and mobile self-monitoring device in real time; acilitated by a well-defined data model and API.
5 - Validation proof of the integrated SMSS system in terms of health outcomes, adherence to care programmes, acceptance of the new organizational process including the ICT components by care providers.
6 - A mobile interface to the POWER2DM SMSS for use on smart phones and tablets, thus stimulating EU industry in the area of personal devices, eHealth and self-management support tools.

Socio-economic impact:
POWER2DM, through its expected outcomes (Fig. 3) will contribute to significant reduction of the societal burden of Diabetes throughout Europe and the World. The major impacts will be:
- Improving the participation of the patient in the care process
- Improving the management of a disease by reducing the number of severe episodes and complications
- Increasing the importance of the prevention sector in healthcare using predictive modelling
- Boosting the development of personal devices used for self-management of health
- Improving individual self-control of health and of disease prevention

Wider societal impacts:
POWER2DM will create healthier lives and thereby more productive societies.
POWER2DMâ€˜s innovative preventive diabetes care model will lead to optimization of the utilization of European healthcare resources. The tele-monitoring based self-care model will reduce the burden on acute healthcare workers, and will improve access to care of patients living in rural and remote areas.