“Diabetes doctor 2.0” should overcome language barrier

Eric Sijbrands, Professor of Internal Medicine at Erasmus MC, came up with the idea for DiabetesStation, a device that communicates with diabetes patients in their own language and allows them to perform physical examinations and blood tests themselves. A test version of the device can now be found at the Gezond op Zuid general practice centre, ready to be further tested in real-life situations.

Eric Sijbrands has a clear memory of how he came up with the idea: “In 2009, following an evaluation at our diabetes outpatients’ clinic, we found that nearly three quarters of our patients barely spoke any Dutch. Because of this language barrier, we are not always able to help them as well as we’d like to.” There had to be a better way of going about things, he felt. One night he was making some sketches at home. “I quickly realised that an ICT application might provide a solution to the language issue.”

These initial sketches eventually resulted in the DiabetesStation, which Sijbrands has developed in recent years, in association with a telemedicine company named 24Care. He describes the device as a “diabetes doctor, version 2.0”. “The patient talks to a screen as if talking to a real doctor. This can be done in eight languages, and since the device has a touch screen, it can even be used by illiterate persons.”

The station requests all sorts of medical information, which the patient can provide himself or herself by performing measurements, ranging from photos of their retina and blood pressure measurements to scans of their feet and blood tests. “Theoretically, we could also let the device handle urinalysis, but we are not offering that option so as to ensure the station stays clean,” Sijbrands says with a smile.

But the device is more than just a measuring instrument. Communication in the patient’s own language is vital, according to Sijbrands. “In this way it is much easier to explain to patients why you are treating them in a particular way. I think they remember information more easily this way. In addition, it allows us to take into account the patient’s cultural context. Diabetes patients must be given advice that fits in with their food culture, among other things.”

Initially, Sijbrands sought to develop a device patients could use at their own homes, but it was felt that this would probably result in unreliable measurements. However, the latest version of DiabetesStation is sufficiently mobile that it can be driven around the country in a small van. “This allows us to get it close to where the patients actually are,” Sijbrands explains.

“Take elderly people living in the countryside, for instance. It is often too much hassle for them to travel into town to be examined at a hospital, and to have to do it again two weeks later to obtain the results. They will now be able to do this in their own village, where it will take just a few hours, followed by a phone consultation with the treating doctor.”

Sijbrands hopes that the DiabetesStation will eventually be able to provide a large percentage of the care patients require. “I think 70 percent of the care diabetes patients require can be provided by this device. People involved in providing care to diabetics will have more time to deal with their patients’ actual problems, since the station will automate many administrative tasks and standard procedures.”

He also hopes the station will sharply improve scientific research into diabetes. “In the long term, the station will give us an enormous study population. We already know quite a bit about diabetes, but we’re still guessing at some aspects of it.” For instance, there has not been much research on how often patients should see their doctors for check-ups. “Down the track, once thousands of patients are using the system, we will be able to use them to conduct randomised trials. These will allow us to answer questions that are hard to research at present, which would significantly increase the level of evidence for how to treat certain patients.”

“The station can be made even more futuristic,” Sijbrands says, dreaming out loud. “For instance, I would like to be able to perform molecular point-of-care tests using the DiabetesStation. This will provide us with a better predictor for cardiovascular disease than the current methods, which will in turn allow us to devise patient-specific therapies.” For the time being, this is just a pipe dream, he feels. First he will have to prove that the DiabetesStation will save doctors time and be beneficial to patients’ treatments.

Next month Sijbrands will embark on the study, thanks to the € 56,000 raised by Erasmus MC staff members and others by cycling the Tour de Rotterdam. “Diabetics receive good care in the Netherlands. Anyone offering a solution like this will have to demonstrate that it provides treatment results that are at least equally good,” Sijbrands explains. “Of course we have a vague impression that this is the case, but now we will have to demonstrate it by means of some scientific research. Is Doctor, version 2.0 as good as Doctor, version 1.0?”