An end and a beginning

The mHealth Grand Tour is over.

As partners in global access to better healthcare, we did what we set out to do. We designed a clinical study that would gather entirely new data on an under-researched field. We created a multi-vendor mobile technical solution to enable the clinical study, using interoperable industry guidelines. We gathered elite athletes with diabetes, sub-elite athletes with diabetes and athletes without diabetes willing to act as a control group, to take part in the study.

We presented a policy request to regulators in Brussels to facilitate innovation and rapid deployment of mobile health initiatives.

We raised awareness of diabetes in every country we visited, and in the countries where the partners live and work. Our riders raised money for diabetes charities and research. All participants – riders, staff and crew – experienced the journey of a lifetime.

Now the next phase begins. Will the research produce results for all people with diabetes, so they are no longer afraid to exercise, but can live fuller lives? Will our prototype end-to-end technical solution lead the way for standard devices and

common practice in the medical profession? Will policymakers implement a framework that promotes adoption of and reimbursement for mobile solutions?

Today was not the end; it was simply an extravagant proof-of-concept. We hope you will join us in the next phase, and the next.

In her real job, Lauren Sarno is the marketing manager for the GSMA mHealth initiative, part of the Connected Living Programme. A working group consisting of the mHealth Grand Tour partners is continuing. If your company or organisation would like to join, please be in touch.

We're almost there

We’re in Berga, the last stop before our arrival in Barcelona. Over the next few weeks, we’ll have time to edit the partner video, start work on the documentary, compile photo albums for the riders and most importantly, hear back from Professor Mike Trenell at Newcastle University (designer of the clinical study) and Dr Dan West at Northumbria University (our lead field investigator here on the Tour) whether the data are showing trends that can help shape clinical guidance in the future.

But for tonight, I’ll try to put into words and pictures the inexpressible. The camaraderie of the riders; the selflessness of the teams (the competition within teams!); the inexhaustible support of the physiotherapists, tour doctor, diabetic nurses and nutritionist; the cheerfulness of the staff who work day and night (literally) to make the ride appear seamless; the extraordinary beauty of the countryside – all have contributed to a once-in-a-lifetime experience.

Wish us luck for tomorrow – and for people around the world with diabetes whose lives may be enriched by what we discover.

Lauren Sarno is the marketing manager for the mHealth Grand Tour.

All the best from Continua!

As the Grand Tour nears the finish, my thoughts go out to the riders who have trained and prepared for this one-of-a-kind diabetes endurance exercise study and charity event. Continua Health Alliance is proud that its Design Guidelines have provided the framework to transmit and store the physiological data from the riders. Mobile networks are being used to transit the data throughout the ride, allowing the riders and all of us to track their health.

Clint with Eddie Merckx, who sent the riders off in good style from Brussels!

I was lucky enough to attend the start in Brussels, but the real excitement is taking place as the riders accumulate miles, enjoy beautiful vistas and challenge their fitness on the way to Barcelona. A subset of the riders is participating in a clinical study that will make it possible for all of us to join in the event and learn from their experience. These cyclists are sporting wearable sensors that relay their location, blood glucose and heart rate information through a series of channels to a web portal where you can track their progress. The real-time availability and capture of this information is what makes this event uniquely thrilling for the riders’ friends and family, cycling and mHealth enthusiasts and the many thousands of people who have, or care about someone with, diabetes.

I want to thank all of the participants for bringing attention to the issue of diabetes management, and especially those willing to take part in the study to demonstrate the value of mhealth and help explicate the relationship between blood glucose levels and endurance exercise. In addition to rigorous training, these riders had to learn about and become accustomed to the mHealth technologies they're using during the Grand Tour.

You can get an idea of how intense their training has been by looking through recent Twitter posts from some of the riders. You may also want to follow them on Twitter right now to get their personal perspectives on the Grand Tour experience, or to send messages of support. A few riders I’ve been watching this summer:

•        Ian Hay on Twitter, @ikisai, riding for Orange Healthcare

•        Paul Buchanan, tweeting for Team Blood Glucose

•        Team BG member Rob Woolfson

Good luck to all the cyclists from the team at Continua!

Clint McClellan

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Clint McClellan is President and Chairman of the Continua Health Alliance, an international non-profit organization and the leading organization convening global technology industry standards to develop end-to-end, plug-and-play connectivity for personal connected health.

Shaz's story

Editor's note: Shahzad Ahmed brightened our lives during the first three days of the mHealth Grand Tour. On his last evening with us, he told me his story, and I asked him to share it with you. We're looking forward to seeing him again for the last leg into Barcelona.

My story is about how the mHealth Grand Tour has transformed my life. I am a 45 year old Canadian living in UAE and working for Etisalat for more than 5 years. I have been fairly obese (111 kgs) and suffered from high blood pressure and I had very low stamina to perform any fitness activities. A short while ago, I decided that I was not going to be overweight and made my mind to take control of my health. My strategy was to watch my diet and start engaging in some fitness activities. In May 2013, an opportunity to participate in the mHealth Tour was announced at my workplace and I instantly knew that I wanted to participate in it.

I started training for cycling for the first time in my life just about 3 months prior to the start of mHealth Tour. I trained in the hot weather of UAE almost on a daily basis for several hours each day after work or on weekends. Every Tuesday I trained in the formula 1 circuit of Yas Marina circuit sponsored by Daman Active Life in Abu Dhabi.

I faced many challenges while I was training due to extreme heat and a month of fasting during the daytime when I trained during the night time. I also had an accident injury that prevented me from cycling for two weeks. Also, I could not give enough time to my family and my 6 year old daughter especially.

I was quite happy that I had lost more than 15kgs of weight and 6 inches of waistline in 3 months just when I arrived in Brussels. However, I was a bit nervous that I did not have enough experience to ride in cold and wet weather and hilly terrain.

The first day of the mHealth Tour was a great experience for me. I got the opportunity to meet Xavier Trias (Mayor of Barcelona) and Anne Bouverot (Director General, GSMA), which was especially exciting as I know our Group CEO Mr Ahmad Abdulkarim Julfar is also a member of the GSMA board. Moreover, the support from mHealth Grand Tour organizing team and my Etisalat team was great. Some of the mHealth Tour organizing team riders rode along with me at times to encourage me and motivate me. My experience to ride through the centre of Brusssels escorted by police and my ride through the mountains and small towns of Belgium, France, Luxemboug and Germany provided me with happy memories that I will cherish throughout my life.

On third day of the tour I got up early as it was my daughter's birthday. I missed her badly so I called her to say happy birthday. As I was getting ready for cycling at my hotel at Saarbrucken, I got a text message from her: "Baba - you are my hero!" I think it gave me enough strength to take on any challenge that would come my way.

By the third day I felt I had enough stamina, courage and strength to cycle from Saarbrucken to Baden-Baden (about 156k) without any issues. However, when I started it was raining and I had to put on my rain jacket and  I was a bit nervous riding downhill on wet roads, the types where I was doing 50kph downhill on previous days. This time, I did only 30kph but I preferred safety over time.

After lunch, two experienced riders, Richie and Susan from the mHealth organizing team, rode with me. They highly appreciated my effort. I was good on time so we stopped for a coffee enroute together and took some pictures over the Rhine bridge and mountains.

At the end of the day 3 and stage 1 in Baden-Baden, there was a formal dinner at the hotel where we were staying with speeches from our mHealth tour director Adam and Steve from the Etisalat team. Adam highlighted my story and appreciated my performance by riding over 100 miles on average each day of stage 1. When the audience gave me applause for my achievement, I felt like a hero for a moment with thoughts about my daughter.

I am looking forward to re-joining the Tour on the last stage and riding to the finish line in Barcelona and partying with all fellow riders and organizing teams.

Thank you mHealth Grand Tour organizing team, GSMA and team Etisalat for organizing such a wonderful life-changing, thrilling, adventurous, fabulous and perfect tour.

Wake up, stick your finger

When people with Type 1 diabetes exercise, they’re particularly at risk of hypoglycaemic events, caused by low blood sugar (the ones that fuddle your thinking). They’re at risk immediately after exercise, and again several hours later.

When the “several hours later” happens in the middle of the night, a hypoglycaemic event can be particularly dangerous. Because the athletes are asleep, they don’t notice the danger signs and can’t take corrective action. So when athletes have exercised during the day, some have a snack before they go to bed, some adjust their long-acting insulin dose…and sometimes they still get it wrong.

And when it comes to a multi-day event, well, there just is no data (evidence, best practice…) to help. Welcome to the mHealth Grand Tour.

So our riders with diabetes wake up, stick a finger, take a blood sugar reading, calibrate the Dexcom continuous glucose monitor (CGM) they’ve got stuck into their bodies, figure out what they need to eat and how much (guessing – but at Day 9, they’re getting better at guessing), and head out on the road.

If, despite their best efforts, their blood sugar gets too low, the CGM will beep, vibrate or both – their choice. Time to pull a TORQ gel, or a banana, or a croissant they took from the breakfast buffet out of their jerseys and try to raise their blood sugar.

And they’d better do it quickly – if they get too fuddled, they could end up in a ditch almost without warning.

If they’ve gotten it wrong in the other direction (beep, beep), time for insulin. Some of our Type 1 riders are wearing insulin pumps, some inject manually, but all have to guess how much extra is needed. Experience helps – the Team Novo Nordisk riders have exceptional glucose control, so this is routine for them. We’re learning a lot from them. For the recreational riders, it was originally poke and hope.

Over the ride so far, we’re all getting better. The data we’re downloading will be the first attempt ever to compare elite athletes with recreational riders over 13 days of riding. Look for the first research results in a few months.

Lauren Sarno is the marketing manager for the mHealth Grand Tour. She welcomes your contribution to this blog!