Glucose concentration in the blood stream is a critical vital parameter and an effective monitoring of this quantity is crucial for diabetes treatment and intensive care management. Effective bio-sensing technology and advanced signal processing are therefore of unquestioned importance for blood glucose monitoring. Nevertheless, collecting measurements only represents part of the process as another critical task involves delivering the collected measures to the treating specialists and caregivers. These include the clinical staff, the patient’s significant other, his/her family members, and many other actors helping with the patient treatment that may be located far away from him/her. In all of these cases, a remote monitoring system, in charge of delivering the relevant information to the right player, becomes an important part of the sensing architecture. In this paper, we review how the remote monitoring architectures have evolved over time, paralleling the progress in the Information and Communication Technologies, and describe our experiences with the design of telemedicine systems for blood glucose monitoring in three medical applications. The paper ends summarizing the lessons learned through the experiences of the authors and discussing the challenges arising from a large-scale integration of sensors and actuators.

The increase in the availability and reliability of network connections lets envision systems supporting a continuous remote monitoring of clinical parameters useful either for overseeing chronic diseases or for following clinical trials involving outpatients. We report here the results achieved by a telemedicine infrastructure that has been linked to an artificial pancreas platform and used during a trial of the AP@home project, funded by the European Union. The telemedicine infrastructure is based on a multiagent paradigm and is able to deliver to the clinic any information concerning the patient status and the operation of the artificial pancreas. A web application has also been developed, so that the clinic staff and the researchers involved in the design of the blood glucose control algorithms are able to follow the ongoing experiments. Albeit the duration of the experiments in the trial discussed in the article was limited to only 2 days, the system proved to be successful for monitoring patients, in particular overnight when the patients are sleeping. Based on that outcome we can conclude that the infrastructure is suitable for the purpose of accomplishing an intelligent monitoring of an artificial pancreas either during longer trials or whenever that system will be used as a routine treatment.

Prenatal monitoring of Fetal Heart Rate (FHR) is crucial for the prevention of fetal pathologies and unfavorable deliveries. However, the most commonly used Cardiotocographic exam can be performed only in hospital-like structures and requires the supervision of expert personnel. For this reason, a wearable system able to continuously monitor FHR would be a noticeable step towards a personalized and remote pregnancy care. Thanks to textile electrodes, miniaturized electronics, and smart devices like smartphones and tablets, we developed a wearable integrated system for everyday fetal monitoring during the last weeks of pregnancy. Pregnant women at home can use it without the need for any external support by clinicians. The transmission of FHR to a specialized medical center allows its remote analysis, exploiting advanced algorithms running on high-performance hardware able to obtain the best classification of the fetal condition. The system has been tested on a limited set of pregnant women whose fetal electrocardiogram recordings were acquired and classified, yielding an overall score for both accuracy and sensitivity over 90%. This novel approach can open a new perspective on the continuous monitoring of fetus development by enhancing the performance of regular examinations, making treatments really personalized, and reducing hospitalization or ambulatory visits.

The design and implementation of telemedicine systems able to support the Artificial Pancreas need careful choices to cope with technological requirements while preserving performance and decision support capabilities. This article addresses the issue of designing a general architecture for the telemedicine components of an Artificial Pancreas and illustrates a viable solution that is able to deal with different use cases and is amenable to support mobile-health implementations. The goal is to enforce interoperability among the components of the architecture and guarantee maximum flexibility for the ensuing implementations. Thus, the design stresses modularity and separation of concerns along with adoption of clearly defined protocols for interconnecting the necessary components. This accounts for the implementation of integrated telemedicine systems suitable as short-term monitoring devices for supporting validation of closed-loop algorithms as well as devices meant to provide a lifelong tighter control on the patient state once the Artificial Pancreas has become the preferred treatment for patients with diabetes.