Improved Glycemic Control Without Hypoglycemia in Elderly Diabetic Patients Using the Ubiquitous Healthcare Service, a New Medical Information System
- Soo Lim, MD, PHD1,2,3,
- Seon Mee Kang, MD1,2,3,
- Hayley Shin, BS4,
- Hak Jong Lee, MD1,5,
- Ji Won Yoon, MD1,2,3,
- Sung Hoon Yu, MD6,
- So-Youn Kim, RN1,
- Soo Young Yoo, PHD1,
- Hye Seung Jung, MD3,
- Kyong Soo Park, MD3,
- Jun Oh Ryu, MD7 and
- Hak C. Jang, MD, PHD1,2,3
- 1Department of Medical Informatics, Seoul National University Bundang Hospital, Seongnam, Korea
- 2Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- 3Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- 4Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- 5Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
- 6Department of Internal Medicine, Hangang Sacred Heart Hospital, Seoul, Korea
- 7Allmedicus Research Institute, Allmedicus Co., Ltd., Seoul, Korea
- Corresponding author: Hak C. Jang, .
OBJECTIVE To improve quality and efficiency of care for elderly patients with type 2 diabetes, we introduced elderly-friendly strategies to the clinical decision support system (CDSS)-based ubiquitous healthcare (u-healthcare) service, which is an individualized health management system using advanced medical information technology.
RESEARCH DESIGN AND METHODS We conducted a 6-month randomized, controlled clinical trial involving 144 patients aged >60 years. Participants were randomly assigned to receive routine care (control, n = 48), to the self-monitored blood glucose (SMBG, n = 47) group, or to the u-healthcare group (n = 49). The primary end point was the proportion of patients achieving A1C <7% without hypoglycemia at 6 months. U-healthcare system refers to an individualized medical service in which medical instructions are given through the patient’s mobile phone. Patients receive a glucometer with a public switched telephone network-connected cradle that automatically transfers test results to a hospital-based server. Once the data are transferred to the server, an automated system, the CDSS rule engine, generates and sends patient-specific messages by mobile phone.
RESULTS After 6 months of follow-up, the mean A1C level was significantly decreased from 7.8 ± 1.3% to 7.4 ± 1.0% (P < 0.001) in the u-healthcare group and from 7.9 ± 1.0% to 7.7 ± 1.0% (P = 0.020) in the SMBG group, compared with 7.9 ± 0.8% to 7.8 ± 1.0% (P = 0.274) in the control group. The proportion of patients with A1C <7% without hypoglycemia was 30.6% in the u-healthcare group, 23.4% in the SMBG group (23.4%), and 14.0% in the control group (P < 0.05).
CONCLUSIONS The CDSS-based u-healthcare service achieved better glycemic control with less hypoglycemia than SMBG and routine care and may provide effective and safe diabetes management in the elderly diabetic patients.
S.L. and S.M.K. contributed equally to this work.
This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc10-1447/-/DC1.
Clinical trial reg. no. NCT01137058, clinicaltrials.gov.
- Received July 29, 2010.
- Accepted November 5, 2010.
- © 2011 by the American Diabetes Association.
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