title: Telemedicine-based KADIS combined with CGMS has high potential for improving outpatient diabetes care.
abstract: BACKGROUND
  The Karlsburg Diabetes Management System (KADIS) was developed over almost two decades by modeling physiological glucose-insulin interactions. When combined with the telemedicine-based communication system TeleDIAB and a continuous glucose monitoring system (CGMS), KADIS has the potential to provide effective, evidence-based support to doctors in their daily efforts to optimize glycemic control.
  
  
  METHODS
  To demonstrate the feasibility of improving diabetes control with the KADIS system, an experimental version of a telemedicine-based diabetes care network was established, and an international, multicenter, pilot study of 44 insulin-treated patients with type 1 and 2 diabetes was performed. Patients were recruited from five outpatient settings where they were treated by general practitioners or diabetologists. Each patient underwent CGMS monitoring under daily life conditions by a mobile monitoring team of the Karlsburg diabetes center at baseline and 3 months following participation in the KADIS advisory system and telemedicine-based diabetes care network. The current metabolic status of each patient was estimated in the form of an individualized "metabolic fingerprint." The fingerprint characterized glycemic status by KADIS-supported visualization of relationships between the monitored glucose profile and causal endogenous and exogenous factors and enabled evidence-based identification of "weak points" in glycemic control. Using KADIS-based simulations, physician recommendations were generated in the form of patient-centered decision support that enabled elimination of weak points. The analytical outcome was provided in a KADIS report that could be accessed at any time through TeleDIAB. The outcome of KADIS-based support was evaluated by comparing glycosylated hemoglobin (HbA1c) levels and 24-hour glucose profiles before and after the intervention.
  
  
  RESULTS
  Application of KADIS-based decision support reduced HbA1c by 0.62% within 3 months. The reduction was strongly related to the level of baseline HbA1c, diabetes type, and outpatient treatment setting. The greatest benefit was obtained in the group with baseline HbA1c levels >9% (1.22% reduction), and the smallest benefit was obtained in the group with baseline HbA1c levels of 6-7% (0.13% reduction). KADIS was more beneficial for patients with type 1 diabetes (0.79% vs 0.48% reduction) and patients treated by general practitioners (1.02% vs 0.26% reduction). Changes in HbA1c levels were paralleled by changes in mean daily 24-hour glucose profiles and fluctuations in daily glucose.
  
  
  CONCLUSIONS
  Application of KADIS in combination with CGMS and the telemedicine-based communication system TeleDIAB successfully improved outpatient diabetes care and management.
authors.affiliation: Institute of Diabetes Gerhardt Katsch Karlsburg, Germany. salzsied@diabetes-karlsburg.de
authors.forename: Eckhard
authors.initials: E
authors.lastname: Salzsieder
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: Peter
authors.initials: P
authors.lastname: Heinke
authors.forename: Ernst-Joachim
authors.initials: EJ
authors.lastname: Freyse
authors.forename: Abdel
authors.initials: A
authors.lastname: Azim Ahmed
authors.forename: Zakia
authors.initials: Z
authors.lastname: Metwali
authors.forename: Iman
authors.initials: I
authors.lastname: Salman
authors.forename: Omer
authors.initials: O
authors.lastname: Attef