OBJECTIVE -To investigate the long-term effectiveness of the Internet-based glucose monitoring system (IBGMS) on glucose control in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS -We conducted a prospective, randomized, controlled trial in 80 patients with type 2 diabetes for 30 months. The intervention group was treated with the IBGMS, while the control group made conventional office visits only. HbA 1c (A1C) was performed at 3-month intervals. For measuring of the stability of glucose control, the SD value of A1C levels for each subject was used as the A1C fluctuation index (HFI).RESULTS -The mean A1C and HFI were significantly lower in the intervention group (n ϭ 40) than in the control group (n ϭ 40). (A1C [mean Ϯ SD] 6.9 Ϯ 0.9 vs. 7.5 Ϯ 1.0%, P ϭ 0.009; HFI 0.47 Ϯ 0.23 vs. 0.78 Ϯ 0.51, P ϭ 0.001; intervention versus control groups, respectively). Patients in the intervention group with a basal A1C Ն7% (n ϭ 27) had markedly lower A1C levels than corresponding patients in the control group during the first 3 months and maintained more stable levels throughout the study (P ϭ 0.022). Control patients with a basal A1C Ͻ7% (n ϭ 15) showed the characteristic bimodal distribution of A1C levels, whereas the A1C levels in the intervention group remained stable throughout the study with low HFI.CONCLUSIONS -Long-term use of the IBGMS has proven to be superior to conventional diabetes care systems based on office visits for controlling blood glucose and achieving glucose stability. Diabetes Care 29:2625-2631, 2006M any controlled clinical trials have shown that prolonged maintenance of the appropriate HbA 1c (A1C) level reduces the risk of developing diabetes complications in individuals with type 1 and type 2 diabetes (1-3). However, data from the National Health and Nutrition Examination Surveys in the U.S. showed that overall glycemic control did not improve between the assessment periods of 1988 -1994 and 1999 -2000 (4,5). Similar findings have been reported in other countries (6,7).Therefore, to achieve and maintain the target level of A1C, new approaches for a medical delivery system are necessary. For this purpose, different strategies using electronic technologies or educational programs have been proposed to improve the quality and efficiency of care for people with diabetes (8 -15). In our previous study (16), we introduced a new bidirectional communication tool for diabetes management referred to as the Internet-based glucose monitoring system (IBGMS) and demonstrated its short-term effects over 3 months. The IBGMS comprises an electronically organized circuit for diabetes management that includes both online and offline systems. This management system provides a close doctor-patient relationship, offers more educational opportunities, and enhances patient feedback.In this study, we demonstrated the long-term effectiveness of the IBGMS on glucose stability and A1C reduction.RESEARCH DESIGN AND METHODS -Initially, 120 individuals with type 2 diabetes were screened by a review of their medical reco...

OBJECTIVE -The Internet is used worldwide as a communication tool. To improve the quality of diabetes control, we investigated the effectiveness of an Internet-based blood glucose monitoring system (IBGMS) on controlling the changes in HbA 1c levels.RESEARCH DESIGN AND METHODS -We conducted a randomized clinical trial involving 110 patients who visited the outpatient clinic at the Kangnam St. Mary's Hospital for 3 months. The study subjects were treated with IBGMS for 12 weeks, and the control group received the usual outpatient management over the same period. HbA 1c and other laboratory tests were performed twice, once at the beginning of the study and again at the end of the study.RESULTS -The test results from the beginning of the study established that there were no significant differences between the two groups with respect to age, sex, diabetes duration, BMI, blood pressure, HbA 1c , and other laboratory data. On follow-up examination 12 weeks later, HbA 1c levels were significantly decreased from 7.59 to 6.94% within the intervention group (P Ͻ 0.001). At the end of the study, HbA 1c levels in the intervention group were significantly lower than in the control group after adjusting the baseline HbA 1c (6.94 vs. 7.62%; P Ͻ 0.001, respectively). Among patients with baseline HbA 1c Ͻ7.0%, the patients in the intervention group had lower HbA 1c than those in the control group (6.38 vs. 6.99%; P Ͻ 0.05). Among the patients with a baseline HbA 1c Ն7.0%, the difference between the two groups appeared more obvious: HbA 1c levels at the end of the study were 8.12%.CONCLUSIONS -This new IBGMS resulted in a significant reduction of HbA 1c during the study period. We propose that this IBGMS be used as a method for improving diabetes control. Diabetes Care 27:478 -483, 2004T he importance of tight blood glucose control for the subsequent prevention of diabetes complication is well established (1,2). In addition, improving glucose control will also reduce the enormous economic burden associated with the disease (3,4). Therefore, various strategies for diabetes management have been designed to improve the quality and efficiency of care for patients with diabetes. To promote adherence for patients and providers to follow practical guidelines, studies have been carried out to establish educational programs for patients and health care workers. Other studies, including giving feedback to the providers as well as programs that remind providers and their patients of these guidelines, have been experimented with (5-8). Recently, a small number of computer-based or electronic management systems have been reported to improve diabetes care (9 -11). However, many barriers are recognized in providing this care system into the community health care system (12,13). Diabetes care means managing vulnerable patients with chronic disease consistently in the outpatient setting. Chin et al. (13) reported that providers in health care centers indicated a need to enhance behavioral changes in diabetic patients to improve the health care de...

This study was designed to investigate the relationship between adipokines in metabolic syndrome and insulin resistance. Sixty male and female subjects with or without metabolic syndrome and type 2 diabetes were included. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Compared with lean control subjects, patients with metabolic syndrome and type 2 diabetes had lower circulating levels of total adiponectin and high molecular weight (HMW) adiponectin, and higher levels of leptin and interleukin-6 (IL-6). Total and HMW adiponectin and the adiponectin/leptin (A/L) ratio were negatively correlated with HOMA-IR. After adjusting for age and sex, leptin, IL-6 and tumour necrosis factor-alpha (TNF-alpha) were positively correlated with HOMA-IR. After also adjusting for body mass index, HOMA-IR was found to be independently associated with leptin, A/L ratio and TNF-alpha levels. In conclusion, decreased total adiponectin and HMW adiponectin and increased leptin and IL-6 levels are characteristic of patients with metabolic syndrome and type 2 diabetes.

Both circulating adiponectin levels and the portion present as the most active HMW form are reduced in PCOS, with differences related to the degree of glucose intolerance and insulin resistance.