Multifactorial intervention in diabetes care using real-time monitoring and tailored feedback in type 2 diabetes

Abstract

• Aims:In 2011, we demonstrated that an individualized health management system employing advanced medical information technology, designated ubiquitous (u)-healthcare, was helpful in achieving glycemic control without hypoglycemia in patients with diabetes. Following this, we generated a new multidisciplinary u-healthcare system by upgrading our clinical decision support system (CDSS) rule engine and integrating a physical activity-monitoring device and dietary feedback into a comprehensive package.
• Methods:In a randomized, controlled clinical trial, patients with type 2 diabetes aged over 60 years were assigned randomly to a self-monitored blood glucose (SMBG) group (N = 50) or u-healthcare group (N = 50) for 6 months. The primary endpoint was the proportion of patients achieving glycated hemoglobin (HbA1c) <7 % without hypoglycemia. Changes in body composition and lipid profiles were also investigated. The u-healthcare group was educated to use a specially designed glucometer and an activity monitor that automatically transferred test results to a hospital-based server. An automated CDSS rule engine generated and sent patient-specific messages about glucose, diet, and physical activity to their mobile phones and a Web site.
• Results:After 6 months of follow-up, the HbA1c level was significantly decreased in the u-healthcare group [8.0 ± 0.7 % (64.2 ± 8.8 mmol/mol) to 7.3 ± 0.9 % (56.7 ± 9.9 mmol/mol)] compared with the SMBG group [8.1 ± 0.8 % (64.9 ± 9.1 mmol/mol) to 7.9 ± 1.2 % (63.2 ± 12.3 mmol/mol)] (P < 0.01). The proportion of patients with HbA1c < 7 % without hypoglycemia was greater in the u-healthcare group (26 %) than in the SMBG group (12 %; P < 0.05). Body fat mass decreased and lipid profiles improved in the u-healthcare group but not in the SMBG group.
• Conclusion:This u-healthcare service provided effective management for older patients with type 2 diabetes

Summary

First Review

This is a review for the article co-authored by Soo Lim, Seon Mee Kang,Kyoung Min Kim, Jae Hoon Moon,Sung Hee Choi, Hee Hwang, Hye Seung Jung, Kyong Soo Park, Jun Oh Ryu and Hak Chul Jang, Multifactorial intervention in diabetes care using real-time monitoring and tailored feedback in type 2 diabetes

Background and Purpose

Type 2 diabetes is a chronic disease that can be hard to manage, especially in older people. Patients have to be vigilant with what they eat and exercise regularly to properly control glycemic levels. In a randomized clinical trial, patients suffering from type 2 diabetes and over the age of 60 were assigned to two groups: a self monitored blood glucose group (SMBG) and a group that was educated to use a specially designed glucometer and an activity monitor, both of which automatically transmitted data to a hospital based server (u-healthcare). A CDSS system used the information sent to the server and clinical knowledge to send information specific to each patient about glucose levels, diet and physical activities. The information could be viewed via a mobile or web interface.

Result

The number of patients with HbA1c < 7 % without hypoglycemia was greater in the u-healthcare group (26 %) than in the SMBG group (12 %; P < 0.05). Body fat mass decreased and lipid profiles improved in the u-healthcare group but not in the SMBG group.

Comments

It seems using real time technological tools can be extremely helpful in helping diabetes patients properly manage their condition. This technology can also be applied to other chronic diseases and could be integrated with PHR applications.

Second Review

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