A telemedicine-based energy monitor for managing diabetes mellitus

Diabetes mellitus is a chronic disease in which the body does not produce sufficient insulin or in which the body has high insulin resistance thus making the regulation of blood glucose metabolism difficult. Currently, diabetes is still incurable. All patients need to well manage their blood glucose levels to reduce the risk of complications.This dissertation is comprised of two major studies. In diabetes type I, the blood glucose can only be managed by multiple daily injection of insulin. However, most patients tend to have difficulty in deciding the right amount of insulin dose. The first study is the development of a mathematical model of blood glucose levels, which leads to the development of a decision support system for diabetes type I using the Markov theory.In some type II and gestational diabetes, blood glucose can be managed by choosing diet properly and by exercising regularly. However, people tend to overestimate their activity levels. The second study describes the design and development of a wearable device based on the triaxial accelerometer that estimates the energy levels of normal daily physical activity with comparable accuracy to the gas analysis.This device development leads to two clinical studies. The first clinical study investigates whether the energy monitor could help people with diabetes in promoting and managing their daily activity and help to improve the glycosylated haemoglobin and body mass index. The second clinical study investigates whether the energy monitor could help pregnant women with gestational diabetes in managing their daily activity, blood glucose levels and body weight gain.This thesis also develops a telemedicine system to automate the data collection during the clinical trial period. The system would securely transmit all diabetes and energy data from the participants' home to a remote server.A key finding of this study was that a higher activity score results in smaller fluctuations in blood glucose levels between measurements in both diabetes and gestational diabetes subjects. This suggests that higher activity levels would make the management of diabetes more effective by reducing the fluctuation in blood glucose levels