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05.05.2015 | Original Article | Ausgabe 2/2016

Acta Diabetologica 2/2016

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

Zeitschrift:
Acta Diabetologica > Ausgabe 2/2016
Autoren:
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, Hak Chul Jang
Wichtige Hinweise
Managed by Massimo Porta.

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00592-015-0754-8) contains supplementary material, which is available to authorized users.

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 (ClinicalTrial.Gov: NCT01137058).

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