Insulin dose titration system in diabetes patients using a short messaging service automatically produced by a knowledge matrix.
BACKGROUND
We designed a system for diabetes patients treated with glargine, a long-acting insulin, to make an automatic adjustment of insulin dose based on glucose level data and to provide the patients with the needed insulin dose by using a short message service (SMS). We also compared diabetes patients who used our system with patients who received the conventional titration scheme.


METHODS
Included were 100 type 2 diabetes patients whose blood glucose was suboptimally controlled on their previous antidiabetes treatment. Each participant was assigned to either the intervention or control group, each with 50 patients, using adaptive randomization. We applied our system to the intervention group for 12 weeks, whereas the control group received a conventional titration scheme, seeking a target fasting blood glucose of <120 mg/dL.


RESULTS
The fasting and postprandial glucose levels of the intervention group declined earlier than those of the control group. Lastly, a greater (P = 0.023) reduction in hemoglobin A(1C) from baseline to the end point was observed in the intervention group (from 9.8 +/- 1.3% to 7.4 +/- 0.7%) than in the control group (from 9.8 +/- 1.2% to 7.8 +/- 0.8%). The incidence of symptomatic, asymptomatic, and nocturnal hypoglycemia was similar in both groups. There was a small increase in body weight from baseline to the end point with both the intervention (2.4 +/- 3.0 kg) and control (2.2 +/- 2.8 kg) groups.


CONCLUSIONS
This study demonstrated that SMS based on our specialized Internet-supported system is an effective and safe approach to long-acting insulin dose adjustments in patients with type 2 diabetes.
Kim
Chul Sik
CS
Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical College, Dongan-gu, Anyang, Republlic of Korea. ironeat@hallym.ac.kr
Park
So Young
SY
Kang
Jun Goo
JG
Lee
Seong Jin
SJ
Ihm
Sung Hee
SH
Choi
Moon Gi
MG
Yoo
Hyung Joon
HJ
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; D008297:Male; D008875:Middle Aged; D019518:Postprandial Period / Q000502:physiology; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
D001786:Blood Glucose; D007328:Insulin; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine