A Ubiquitous Chronic Disease Care system using cellular phones and the internet

Yoo, Han-Wook; Park, M. S.; Kim, Tae Nyun; Yang, So Jung; Cho, Geum-Joon; Hwang, Taik Gun; Baik, Sei-Hyun; Choi, Dong Seop; Park, Gil-Hong; Choi, Kyung Mook

doi:10.1111/j.1464-5491.2009.02732.x

Cited by 149 publications

(212 citation statements)

References 28 publications

(38 reference statements)

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“…The strength of the evidence for short-term mortality was graded as moderate, given that results were precise, direct, and had low risk of bias (Table 2). Table 7), 4,21,49,61,62,69,[72][73][74][75][76][77][78][79][80][81][82][83] showing no clear differences between groups in hypoglycemia. The strength of evidence was graded as low, given the inconsistency and imprecision of the results (Table 2).…”

Section: Safetymentioning

confidence: 99%

“…The strength of evidence was graded as low, given the inconsistency and imprecision of the results (Table 2). Most studies reported hypoglycemia as total hypoglycemic events [75][76][77] (N=5) or p a r t i c i p a n t s e x p e r i e n c i n g h y p o g l y c e m i a ( N = 8). 61,62,69,73,74,78,80,82 Hypoglycemic outcomes were defined heterogeneously, with some studies based on self report 4,21,62,72,73,77,82 and others on glucose readings.…”

Section: Safetymentioning

confidence: 99%

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Effectiveness and Safety of Patient Activation Interventions for Adults with Type 2 Diabetes: Systematic Review, Meta-Analysis, and Meta-regression

et al. 2014

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BACKGROUND: Patient activation interventions (PAIs) engage patients in care by promoting increased knowledge, confidence, and/or skills for disease self-management. However, little is known about the impact of these interventions on a wide range of outcomes for adults with type 2 diabetes (DM2), or which of these interventions, if any, have the greatest impact on glycemic control. METHODS: Electronic databases were searched from inception through November 2011. Of 16,290 citations, two independent reviewers identified 138 randomized trials comparing PAIs to usual care/control groups in adults with DM2 that reported intermediate or longterm outcomes or harms. For meta-analyses of continuous outcomes, we used a random-effects model to derive pooled weighted mean differences (WMD). For allcause mortality, we calculated the pooled odds ratio (OR) using Peto's method. We assessed statistical heterogeneity using the I 2 statistic and conducted meta-regression using a random-effects model when I 2 >50 %. A priori meta-regression primary variables included: intervention strategies, intervention leader, baseline outcome value, quality, and study duration. RESULTS: PAIs modestly reduced intermediate outcomes [A1c: WMD 0.37 %, CI 0.28-0.45 %, I 2 83 %; SBP: WMD 2.2 mmHg, CI 1.0-3.5 mmHg, I 2 72 %; body weight: WMD 2.3 lbs, CI 1.3-3.2 lbs, I 2 64 %; and LDLc: WMD 4.2 mg/dL, CI 1.5-6.9 mg/dL, I 2 64 %]. The evidence was moderate for A1c, low/very low for other intermediate outcomes, low for long-term mortality and very low for complications. Interventions had no effect on hypoglycemia (evidence: low) or short-term mortality (evidence: moderate). Higher baseline A1c, pharmacistled interventions, and longer follow-up were associated with larger A1c improvements. No intervention strategy outperformed any other in adjusted meta-regression. CONCLUSIONS: PAIs modestly improve A1c in adults with DM2 without increasing short-term mortality. These results support integration of these interventions into primary care for adults with uncontrolled glycemia, and provide evidence to insurers who do not yet cover these programs. INTRODUCTIONType 2 diabetes is common and contributes to excess morbidity, mortality, and health care costs, accounting for approximately one in five U.S. health care dollars. 1,2 Behavioral interventions are one important way to improve patient outcomes, 3 yet less is known about a subset of novel behavioral interventions focused on engaging patients in care 4-6 (often termed "patient activation" 7,8 ). Hibbard et al. 7,9 have described patient activation interventions as those that promote motivation, knowledge, and disease self-management skills. 7,9 Despite the growing evidence suggesting improved patient outcomes by engaging patients, 4-6,10 these interventions are often not integrated into practice due to uncertainty about benefit, lack of resources needed for integration, lack of health insurance coverage across insurers, and lack of clarity on the best strategies to incorporate. 11,12 Understanding the imp...

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Section: Safetymentioning

confidence: 99%

Section: Safetymentioning

confidence: 99%

Effectiveness and Safety of Patient Activation Interventions for Adults with Type 2 Diabetes: Systematic Review, Meta-Analysis, and Meta-regression

et al. 2014

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“…age and BMI were 46 (±6) years and 32 (±3) kg m À2 , respectively. Of the 22 studies that provided the study-specific minimum BMI to define overweight or obesity, the value was X25 kg m À2 to o 30 kg m À2 except in three studies 26,35,38 that used a BMI o25 kg m À2 cut-off value for being overweight and three studies 28,32,36 that exclusively targeted participants with a BMI X30 kg m À2 . Most of the studies (17 studies) used an intent-to-treat analysis.…”

Section: Data Synthesismentioning

confidence: 99%

“…Table 2 shows details of the obesity treatment programs in each included study. To summarize the study-specific Webbased programs in terms of the role of the Internet, 16 studies [18][19][20][23][24][26][27][28][30][31][33][34][35][36][38][39] used the Internet as an adjunct to the non-Web-based obesity care support provided in both control and experimental groups. One study 25 used it as a substitute for face-to-face counseling.…”

Section: Data Synthesismentioning

confidence: 99%

Effect of web-based lifestyle modification on weight control: a meta-analysis

et al. 2011

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Objective: Web-based treatment programs are attractive in primary care because of their ability to reach numerous individuals at low cost. Our aim of this meta-analysis is to systematically review the weight loss or maintenance effect of the Internet component in obesity treatment programs. Methods: MEDLINE and EMBASE literature searches were conducted to identify studies investigating the effect of Web-based individualized advice on lifestyle modification on weight loss. Randomized controlled trials that consisted of a Web-user experimental and non-Web user control group were included. Weight changes in the experimental group in comparison with the control group were pooled with a random-effects model. Results: A total of 23 studies comprising 8697 participants were included. Overall, using the Internet had a modest but significant additional weight-loss effect compared with non-Web user control groups (À0.68 kg, P ¼ 0.03). In comparison with the control group, stratified analysis indicated that using the Internet as an adjunct to obesity care was effective (À1.00 kg, Po0.001), but that using it as a substitute for face-to-face support was unfavorable ( þ 1.27 kg, P ¼ 0.01). An additional effect on weight control was observed when the aim of using the Internet was initial weight loss (À1.01 kg; P ¼ 0.03), but was not observed when the aim was weight maintenance ( þ 0.68 kg; P ¼ 0.26). The relative effect was diminished with longer educational periods (P-trend ¼ 0.04) and was insignificant (À0.20 kg; P ¼ 0.75) in studies with educational periods of 12 months or more. Conclusion: The current meta-analysis indicates that the Internet component in obesity treatment programs has a modest effect on weight control. However, the effect was inconsistent, largely depending on the type of usage of the Internet or the period of its use.

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“…The mean age of all participants ranged from 46 to 71 years. Ten studies (13,14,15,16,17,18,19,20,21,22) limited inclusion criteria to participants 1240 records identified through searches 899 records after duplicates removed 800 excluded based on abstracts.…”

Section: Study Characteristicsmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Effects of telecare intervention on glycemic control in type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials

Huang

Hong

Meng

et al. 2015

European Journal of Endocrinology

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Objective: To review the published literature on the effects of telecare intervention in patients with type 2 diabetes and inadequate glycemic control. Design and methods: A review of randomized controlled trials on telecare intervention in patients with type 2 diabetes, and a search of electronic databases such as The Cochrane Library, PubMed, EBSCO, CINAHL, Science Direct, Journal of Telemedicine and Telecare, and China National Knowledge Infrastructure (CNKI), were conducted from December 8 to 16, 2013. Two evaluators independently selected and reviewed the eligible studies. Changes in HbA1c, fasting plasma glucose (FPG), post-prandial plasma glucose (PPG), BMI, and body weight were analyzed. Results: An analysis of 18 studies with 3798 subjects revealed that telecare significantly improved the management of diabetes. Mean HbA1c values were reduced by K0.54 (95% CI, K0.75 to K0.34; P!0.05), mean FPG levels by K9.00 mg/dl (95% CI, K17.36 to K0.64; PZ0.03), and mean PPG levels reduced by K52.86 mg/dl (95% CI, K77.13 to K28.58; P!0.05) when compared with the group receiving standard care. Meta-regression and subgroup analyses indicated that study location, sample size, and treatment-monitoring techniques were the sources of heterogeneity. Conclusions: Patients monitored by telecare showed significant improvement in glycemic control in type 2 diabetes when compared with those monitored by routine follow-up. Significant reduction in HbA1c levels was associated with Asian populations, small sample size, and telecare, and with those patients with baseline HbA1c greater than 8.0%.

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A Ubiquitous Chronic Disease Care system using cellular phones and the internet

Abstract: The novel UCDC system presented in this paper improved multiple metabolic parameters simultaneously in overweight patients with both Type 2 diabetes and hypertension.

Cited by 149 publications

References 28 publications

Effectiveness and Safety of Patient Activation Interventions for Adults with Type 2 Diabetes: Systematic Review, Meta-Analysis, and Meta-regression

Effectiveness and Safety of Patient Activation Interventions for Adults with Type 2 Diabetes: Systematic Review, Meta-Analysis, and Meta-regression

Effect of web-based lifestyle modification on weight control: a meta-analysis

MANAGEMENT OF ENDOCRINE DISEASE: Effects of telecare intervention on glycemic control in type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials

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