Efficacy of a New Medical Information system, Ubiquitous Healthcare Service with Voice Inception Technique in Elderly Diabetic Patients

Kyoung Min Kim, Kyeong Seon Park, Hyun Ju Lee, Yun Hee Lee, Ji Seon Bae, Young Joon Lee, Sung Hee Choi, Hak Chul Jang, Soo Lim, Kyoung Min Kim, Kyeong Seon Park, Hyun Ju Lee, Yun Hee Lee, Ji Seon Bae, Young Joon Lee, Sung Hee Choi, Hak Chul Jang, Soo Lim

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).

Figures

Figure 1. Scheme of the u-healthcare service…
Figure 1. Scheme of the u-healthcare service using a voice inception IT solution.
The participants in the u-healthcare group are educated about how to use the u-healthcare service. They are instructed to input their self-measured glucose levels into the u-healthcare service system using two alternative channels. (1) Channel 1 uses a mobile phone or landline, and it is possible to enter the health data through voice with ARS or touch pad tone. (2) Channel 2 uses the Web site in a conventional way, in which the user logs in to the disease-management Web site by typing the information directly into the patient’s administration page. Data input is automatically transmitted to the main server in the u-healthcare center and then tailored messages automatically generated from the CDSS rule engine are transmitted back to their phones instantly as a voice service or to their personal page on the Web site and stored in the u-healthcare system. For dietary feedback, participants are educated to give information on their food intake via phone. They are also able to upload a food diary or a picture of a food on the health data input page on the Web site. In the Web site, a list of each participant’s favorite food is uploaded by a dietician to help patient click on what and how much they eat. Nutritionists directly analyze the customer-specific dietary problems through the analysis program called CAN-Pro 4.0 (Korean nutrition Society). The results from the CAN-Pro software are displayed automatically on the Web site, and the participants can find detailed information about their dietary pattern or, if necessary, a nutritionist directly provides direct consultations via the phone.
Figure 2. Comparison of glycemic control and…
Figure 2. Comparison of glycemic control and hypoglycemia between the u-healthcare and standard care groups.
(A) Changes in HbA1c levels over the 6 months of the study in the u-healthcare and standard care groups. The data were expressed as the mean ± SD. (B) Percentages of patients who achieved the target level of HbA1c ≤7.5% or ≤8.0% without hypoglycemia at 6 months. (C) Percentages of patients whose HbA1c decreased by ≥1% with and without severe hypoglycemia during the study period. (D) Percentages of patients experiencing all and severe hypoglycemic events during the 3 and 6 months.
Figure 3. Seven-points SMBG for 3 days…
Figure 3. Seven-points SMBG for 3 days before and after the intervention (A,B) and glucose fluctuation assessed by the modified mean amplitude of glycemic excursion (MAGE) using the SMBG profiles.
The data were expressed as the mean ± SD.

References

    1. Ding H., Moodley Y., Kanagasingam Y. & Karunanithi M. A mobile-health system to manage chronic obstructive pulmonary disease patients at home. Conf Proc IEEE Eng Med Biol Soc 2012, 2178–2181 (2012).
    1. Steventon A. et al. Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial. BMJ 344, e3874 (2012).
    1. de Jongh T. et al. Mobile phone messaging for facilitating self-management of long-term illnesses. Cochrane Database Syst Rev 12, Cd007459 (2012).
    1. Alasaarela E. & Oliver N. S. Wireless solutions for managing diabetes: A review and future prospects. Technol Health Care 17, 353–367 (2009).
    1. Perez-Ferre N. et al. A Telemedicine system based on Internet and short message service as a new approach in the follow-up of patients with gestational diabetes. Diabetes Res Clin Pract 87, e15–17 (2010).
    1. Mulvaney S. A. et al. An internet-based program to improve self-management in adolescents with type 1 diabetes. Diabetes Care 33, 602–604 (2010).
    1. Cho J. H. et al. Long-term effect of the Internet-based glucose monitoring system on HbA1c reduction and glucose stability: a 30-month follow-up study for diabetes management with a ubiquitous medical care system. Diabetes Care 29, 2625–2631 (2006).
    1. Lim S. et al. Improved glycemic control without hypoglycemia in elderly diabetic patients using the ubiquitous healthcare service, a new medical information system. Diabetes Care 34, 308–313 (2011).
    1. Kang S. M. et al. Ubiquitous healthcare service has the persistent benefit on glycemic control and body weight in older adults with diabetes. Diabetes Care 35, e19 (2012).
    1. Hu F. B. et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med 345, 790–797 (2001).
    1. Knowler W. C. et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346, 393–403 (2002).
    1. Li G. et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet 371, 1783–1789 (2008).
    1. Wing R. R. et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med 369, 145–154 (2013).
    1. Gerstein H. C. et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 358, 2545–2559 (2008).
    1. Patel A. et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 358, 2560–2572 (2008).
    1. Munshi M. N., Maguchi M. & Segal A. R. Treatment of type 2 diabetes in the elderly. Curr Diab Rep 12, 239–245 (2012).
    1. Lim S. et al. Multifactorial intervention in diabetes care using real-time monitoring and tailored feedback in type 2 diabetes. Acta Diabetol, 10.1007/s00592-015-0754-8. (2015).
    1. World Medical Association declaration of Helsinki. Recommendations guiding physicians in biomedical research involving human subjects. JAMA 277, 925–926 (1997).
    1. Ko S.-H. et al. 2011 Clinical practice guidelines for type 2 diabetes in Korea. Diabetes & Metabolism Journal 35, 431–436 (2011).
    1. Standards of medical care in diabetes–2014. Diabetes Care 37 Suppl 1, S14-80 (2014).
    1. Cui H. S. et al. Dietary pattern and nutrient intake of korean children with atopic dermatitis. Ann Dermatol 26, 570–575 (2014).
    1. Huang I. C. et al. Diabetes-specific or generic measures for health-related quality of life? Evidence from psychometric validation of the D-39 and SF-36. Value Health 11, 450–461 (2008).
    1. Han C. W. et al. Development of the Korean version of Short-Form 36-Item Health Survey: health related QOL of healthy elderly people and elderly patients in Korea. Tohoku J Exp Med 203, 189–194 (2004).
    1. Toobert D. J., Hampson S. E. & Glasgow R. E. The summary of diabetes self-care activities measure: results from 7 studies and a revised scale. Diabetes Care 23, 943–950 (2000).
    1. Fitzgerald J. T. et al. The reliability and validity of a brief diabetes knowledge test. Diabetes Care 21, 706–710 (1998).
    1. Service F. J. et al. Mean amplitude of glycemic excursions, a measure of diabetic instability. Diabetes 19, 644–655 (1970).
    1. Snell-Bergeon J. K. & Wadwa R. P. Hypoglycemia, diabetes, and cardiovascular disease. Diabetes Technol Ther 14 Suppl 1, S51–58 (2012).
    1. McCoy R. G. et al. Increased mortality of patients with diabetes reporting severe hypoglycemia. Diabetes Care 35, 1897–1901 (2012).
    1. Bremer J. P. et al. Hypoglycemia unawareness in older compared with middle-aged patients with type 2 diabetes. Diabetes Care 32, 1513–1517 (2009).
    1. Lee H. J. et al. Ubiquitous healthcare service using Zigbee and mobile phone for elderly patients. Int J Med Inform 78, 193–198 (2009).
    1. Yoo H. J. et al. A Ubiquitous Chronic Disease Care system using cellular phones and the internet. Diabet Med 26, 628–635 (2009).
    1. Kim Y. J. et al. A Smartphone Application Significantly Improved Diabetes Self-Care Activities with High User Satisfaction. Diabetes Metab J 39, 207–217 (2015).
    1. McMahon G. T. et al. Web-based care management in patients with poorly controlled diabetes. Diabetes Care 28, 1624–1629 (2005).

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