Improved Glycemic Control Without Hypoglycemia in Elderly Diabetic Patients Using the Ubiquitous Healthcare Service, a New Medical Information System

Abstract

OBJECTIVETo 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 METHODSWe 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.RESULTSAfter 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).CONCLUSIONSThe 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.

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

“…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).…”

“…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. 74,76,78 Twelve of the 18 studies reported measures of variability.…”

“…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. 74,76,78 Twelve of the 18 studies reported measures of variability. 4,49,61,62,69,72,73,74,76,78,80,82 Most (66 %) of these studies showed no statistically significant differences between groups (N=8) 49,61,69,73,74,78,80,82 ; however, studies had limited power due to small numbers of events.…”

“…74,76,78 Twelve of the 18 studies reported measures of variability. 4,49,61,62,69,72,73,74,76,78,80,82 Most (66 %) of these studies showed no statistically significant differences between groups (N=8) 49,61,69,73,74,78,80,82 ; however, studies had limited power due to small numbers of events. Three of the remaining four studies showed significantly less hypoglycemia in the intervention groups, 4,72,76 while one study showed significantly less hypoglycemia in the usual care group.…”

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

“…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.…”