Abstract
We have demonstrated previously that an individualized health management system using advanced medical information technology, named ubiquitous (u)-healthcare, was helpful in achieving better glycemic control than routine care. Recently, we generated a new u-healthcare system using a voice inception technique for elderly diabetic patients to communicate information about their glucose control, physical activity, and diet more easily. In a randomized clinical trial, 70 diabetic patients aged 60–85 years were assigned randomly to a standard care group or u-healthcare group for 6 months. The primary end points were the changes in glycated hemoglobin (HbA1c) and glucose fluctuation assessed by the mean amplitude glycemic excursion (MAGE). Changes in body weight, lifestyle, and knowledge about diabetes were also investigated. After 6 months, the HbA1c levels decreased significantly in the u-healthcare group (from 8.6 ± 1.0% to 7.5 ± 0.6%) compared with the standard care group (from 8.7 ± 0.9% to 8.2 ± 1.1%, P < 0.01). The MAGE decreased more in the u-healthcare group than in the standard care group. Systolic blood pressure and body weight decreased and liver functions improved in the u-healthcare group, but not in the standard care group. The u-healthcare system with voice inception technique was effective in achieving glycemic control without hypoglycemia in elderly diabetic patients (Clinicaltrials.gov: NCT01891474).
Highlights
All patients were educated on the symptoms of hypoglycemia in detail
The Summary of Diabetes Self-Care Activities (SDSCA) is a questionnaire used to assess the level of self-care in adults with diabetes by measuring the frequency of performing diabetes self-care activities, including diet, exercise, blood glucose testing, foot care, and tobacco use, over the preceding 7 days[24]
Hypoglycemia and severe hypoglycemia were defined as a blood glucose concentration < 72 mg/dl (< 4 mmol/l) with hypoglycemic symptoms and < 50 mg/dl (< 2.78 mmol/l) and requiring the assistance of another party, respectively
Summary
Patients with type 2 diabetes mellitus, aged 60–85 years with a glycated hemoglobin (HbA1c) level of 7.0–11.0% (53–97 mmol/mol) were recruited from the outpatient clinic of the Seoul National University Bundang Hospital (SNUBH) from August 2013 to April 2014. The exclusion criteria were patients with type 1 diabetes or those needing multiple insulin injections; regular use of systemic corticosteroid within the preceding 6 months; a history of myocardial ischemia, heart failure of the New York Heart Association Class III-IV, thyroid disease with an abnormal thyroid function test, or severe liver or kidney disease; and the use of antiobesity drugs within the preceding 3 months. Because the use of a mobile device and the Internet was essential in this study, patients who were unable to use text messaging or to access the Internet were excluded
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