Antonio Greco-Daniele SancarloUnità Operativa Complessa di Geriatria

IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG)

Implementation of a solution for the remote monitoring of subjects affected of metabolic

diseases: the Metabolink project.

70% DI OVER 65 HA ALMENO 2 MALATTIE CRONICHE

ParadoxWe are still practicing acute care

medicine in a world of chronic disease

19th century models at the dawn of the 21st century

5

Productive

Interactions

Informed, Activated Patient

and Caregiver

Prepared, Proactive Practice

Team

Health SystemHealth Care Organization

Self-Management Support

Delivery System Design

Decision Support

Clinical Information Systems

CommunityResources and Policies

Improved Outcomes Wagner, 1996

L’anziano fragile: il problema della definizione

Prevenzione

GestioneVMD

Ahmed, AJM, 2007Ferrucci, J Gerontol, 2006Fried, Hazzard Book, 2005Kulminski, Rej Res, 2007Rockwood, CMAJ,2007Senin, EdiSES, 2006

Specifico fenotipoalmeno 3/5

caratteristicheFisiopatologia

specifica?

FriedProgressivo accumulo di deficitbiologici, funzionali, sociali:Indice di Fragilità

Rockwood

- Activities of Daily Living (ADL) 6 items

- Instrumental Activities of Daily Living (IADL) 8 items

- Short Portable Mental Status Questionnaire (SPMSQ) 10 items

- Mini-Nutritional Assessment (MNA) 18items

- Exton-Smith Scale 5items

- Cumulative Illness Rating Scale_comorbility (CIRS) 14items

- Number of drugs 1- Social index

1TOTAL 63

items

Development and Validation of a CGA-based Multidimensional

Prognostic Index (MPI)

Mild ModerateSevere

SCORE 0.180.09 0.480.09 0.770.08RANGE 0.00-0.33 0.34-0.66

0.67-1.0

M. P. I.

Pilotto & Ferrucci, Rejuvenation Res 2008; 11: 151-61

The Multidimensional Approach to the Older Patient with Chronic Kidney Disease

Alberto Pilotto, Daniele Sancarlo, Marilisa Franceschi, Massimiliano Copetti, Piero D’Ambrosio,

Carlo Scarcelli, Luigi Ferrucci

Multidimensional Prognostic Index Based on a Comprehensive Geriatric Assessment Predicts Short-Term Mortality in Older Patients With Heart FailureAlberto Pilotto, Filomena Addante, Marilisa Franceschi, Gioacchino Leandro,

Giuseppe Rengo, Piero D’Ambrosio, Maria Grazia Longo, Franco Rengo, Fabio Pellegrini, Bruno Dallapiccola and Luigi Ferrucci

Circ Heart Fail 2010; 3: 14-20

A Multidimensional Prognostic Index (MPI) based on a comprehensive geriatric assessment predicts short- and long-term all-cause mortality in older

hospitalized patients with transient ischemic attack

Daniele Sancarlo • Andrea Pilotto • Francesco Panza • Massimiliano Copetti • Maria Grazia Longo • Piero

D’Ambrosio • Grazia D’Onofrio • Luigi Ferrucci • Alberto Pilotto

J Neurol 2012; 259 (4): 670-678

Background

• The diabetes represents one of most serious public health disease for the planet.

• The WHO estimated about 60 million of subjects are affected in Europe. In Italy the rough prevalence is 5.8%.

• The prevalence of disease in the next years will grow both as a result of the aging of the population and to the increase of the risk factors such as overweight and obesity, sedentary lifestyle and lack of proper nutrition education.

Aim

The aim of the Metabolink project was to develop a smart solution for elderly people with diabetes and obesity, in order to promote a healthier style of life, improve diabetic control (glicaemic control, blood pressure, adherence to a specific diet and treatment) trying to reduce overall cost for the community.

Platform overview

Dispositivi integrati

14

Integrabilità nel SSNCare giver

MMG/PLS

RMMG/Fascicolo Sanitario

Piano terapeutico

Piano terapeutico

Controllo

monito

raggio

Rendicontazio

ne

Rendicontazione

Rendicontazione

Sched

a San

itaria

Indivi

duale

Paziente

Dir. Medico

Monitor e controllo

Sistemi informativi dipartimentali/Regionali

Sistemi informativi Ospedalieri

Import/export

METABOLINK

Import/export

15

Methods

Each patient of the first cohort were adequately informed and they was provided by a kit comprising a glucose meter, a scale, a blood pressure monitor, a count steps and a mobile-phone all with NFC interface. Every patient received at the beginning and at the end of the study a complete clinical assessment including a standardized comprehensive geriatric assessment (CGA)

Pilot studyTwo cohorts of 20 patients each were included: 1) Cohort treated with Metabolink support in addition to the

standard care. 2) Cohort treated with standard care.

The follow-up lasted 2 months.

Inclusion criteria3) age ≥ 60 years, 4) diagnosis of diabetes5) ability to provide informed consent.

MethodsEvaluated parameters

Forum participation

Glycemia

Weight

Blood pressure

Mobility

Compliance to treatment Compliance to diet

Heart rate

Test

CGA

QLES-Q

GSQ

Open questionnaire

Patients at baselineParameters (mean) Metabolink Standard care

Age 70,5 69,2

ADL 5,2 5,5

IADL 7,1 7,4

MNA 27 28

CIRS 4,3 4,1

MPI 0,3 0,2

Education Level 5 4,6

Results

Parameters Δ percentage from basal

Metabolink Standard Care

MPI 0,3% -

GSQ 3.9% -

Q-LES-Q 3.8% -

Results

After experimental period, from a subjective point of view patients in cohort 1 have appreciated the possibilities offered by the system and felt them more secure.

Metabolink cohort showed an increase in resiliency, self perceived well-being status and quality of life.

Conclusion

The system was accepted by all the patients and they learned efficaciously in a few hours to use it.

Preliminary data suggest a positive impact of Metabolink in the diabetes disease management for the elderly people.

More work however has to be done to produce a solution that could be more suitable to the elderly population and validated by a larger sample size.

Grazie per l’attenzione