Multifactorial intervention in diabetes care using real-time monitoring and tailored feedback in type 2 diabetes.

Abstract

In 2011, we demonstrated that an individualized health management system employing advanced medical information technology, designated ubiquitous (u)-healthcare, was helpful in achieving glycemic control without hypoglycemia in patients with diabetes. Following this, we generated a new multidisciplinary u-healthcare system by upgrading our clinical decision support system (CDSS) rule engine and integrating a physical activity-monitoring device and dietary feedback into a comprehensive package. In a randomized, controlled clinical trial, patients with type 2 diabetes aged over 60years were assigned randomly to a self-monitored blood glucose (SMBG) group (N=50) or u-healthcare group (N=50) for 6months. The primary endpoint was the proportion of patients achieving glycated hemoglobin (HbA1c) <7% without hypoglycemia. Changes in body composition and lipid profiles were also investigated. The u-healthcare group was educated to use a specially designed glucometer and an activity monitor that automatically transferred test results to a hospital-based server. An automated CDSS rule engine generated and sent patient-specific messages about glucose, diet, and physical activity to their mobile phones and a Web site. After 6months of follow-up, the HbA1c level was significantly decreased in the u-healthcare group [8.0±0.7% (64.2±8.8mmol/mol) to 7.3±0.9% (56.7±9.9mmol/mol)] compared with the SMBG group [8.1±0.8% (64.9±9.1mmol/mol) to 7.9±1.2% (63.2±12.3mmol/mol)] (P<0.01). The proportion of patients with HbA1c<7% without hypoglycemia was greater in the u-healthcare group (26%) than in the SMBG group (12%; P<0.05). Body fat mass decreased and lipid profiles improved in the u-healthcare group but not in the SMBG group. This u-healthcare service provided effective management for older patients with type 2 diabetes (ClinicalTrial.Gov: NCT01137058).