title: Outpatient assessment of Karlsburg Diabetes Management System-based decision support.
abstract: OBJECTIVE
  We sought to assess the benefit of the Karlsburg Diabetes Management System (KADIS) in conjunction with the continuous glucose monitoring system (CGMS) in an outpatient setting.
  
  
  METHODS
  A multicentric trial was performed in insulin-treated outpatients (n = 49), aged 21-70 years, with a mean diabetes duration of 14.2 years. Subjects were recruited from five outpatient centers and randomized for CGMS- or CGMS/KADIS-based decision support and followed up for 3 months. After two CGMS monitorings, the outcome parameters A1C (%), mean sensor glucose of the CGMS profile (MSG) (mmol/l), and duration of hyperglycemia (h/day) were evaluated.
  
  
  RESULTS
  In contrast with the CGMS group (0.27 +/- 0.67%), mean change in A1C decreased in the CGMS/KADIS group during the follow-up (-0.34 +/- 0.49%; P < 0.01). MSG levels were not affected in the CGMS group (7.75 +/- 1.33 vs. 8.45 +/- 2.46 mmol/l) but declined in the CGMS/KADIS group (8.43 +/- 1.33 vs. 7.59 +/- 1.47 mmol/l; P < 0.05). Net KADIS effect (-0.60 [95% CI -0.96 to - 0.25%]; P < 0.01) was associated with reduced duration of hyperglycemia (4.6 vs. 1.0 h/day; P < 0.01) without increasing hypoglycemia. Multiple regression revealed that the A1C outcome was dependent on KADIS-based decision support. Age, sex, physician's specialty, diabetes type, and BMI had no measurable effect.
  
  
  CONCLUSIONS
  If physicians were supported by CGMS/KADIS in therapeutic decisions, they achieved better glycemic control for their patients compared with support by CGMS alone. KADIS is a suitable decision support tool for physicians in outpatient diabetes care and has the potential to improve evidence-based management of diabetes.
authors.affiliation: Institute of Diabetes Gerhardt Katsch Karlsburg e.V., Greifswalder Str.11e, 17495 Karlsburg, Germany. augstein@diabetes-karlsburg.de
authors.forename: Petra
authors.initials: P
authors.lastname: Augstein
authors.forename: Lutz
authors.initials: L
authors.lastname: Vogt
authors.forename: Klaus-Dieter
authors.initials: KD
authors.lastname: Kohnert
authors.forename: Ernst-Joachim
authors.initials: EJ
authors.lastname: Freyse
authors.forename: Peter
authors.initials: P
authors.lastname: Heinke
authors.forename: Eckhard
authors.initials: E
authors.lastname: Salzsieder
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D015190:Blood Glucose Self-Monitoring; D016022:Case-Control Studies; D020000:Decision Support Systems, Clinical; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D010346:Patient Care Management / Q000379:methods*; D011446:Prospective Studies