title: Improved glycemic control without hypoglycemia in elderly diabetic patients using the ubiquitous healthcare service, a new medical information system.
abstract: OBJECTIVE
  To improve quality and efficiency of care for elderly patients with type 2 diabetes, we introduced elderly-friendly strategies to the clinical decision support system (CDSS)-based ubiquitous healthcare (u-healthcare) service, which is an individualized health management system using advanced medical information technology.
  
  
  METHODS
  We conducted a 6-month randomized, controlled clinical trial involving 144 patients aged >60 years. Participants were randomly assigned to receive routine care (control, n = 48), to the self-monitored blood glucose (SMBG, n = 47) group, or to the u-healthcare group (n = 49). The primary end point was the proportion of patients achieving A1C <7% without hypoglycemia at 6 months. U-healthcare system refers to an individualized medical service in which medical instructions are given through the patient's mobile phone. Patients receive a glucometer with a public switched telephone network-connected cradle that automatically transfers test results to a hospital-based server. Once the data are transferred to the server, an automated system, the CDSS rule engine, generates and sends patient-specific messages by mobile phone.
  
  
  RESULTS
  After 6 months of follow-up, the mean A1C level was significantly decreased from 7.8 ± 1.3% to 7.4 ± 1.0% (P < 0.001) in the u-healthcare group and from 7.9 ± 1.0% to 7.7 ± 1.0% (P = 0.020) in the SMBG group, compared with 7.9 ± 0.8% to 7.8 ± 1.0% (P = 0.274) in the control group. The proportion of patients with A1C <7% without hypoglycemia was 30.6% in the u-healthcare group, 23.4% in the SMBG group (23.4%), and 14.0% in the control group (P < 0.05).
  
  
  CONCLUSIONS
  The CDSS-based u-healthcare service achieved better glycemic control with less hypoglycemia than SMBG and routine care and may provide effective and safe diabetes management in the elderly diabetic patients.
authors.affiliation: Department of Medical Informatics, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Soo
authors.initials: S
authors.lastname: Lim
authors.forename: Seon Mee
authors.initials: SM
authors.lastname: Kang
authors.forename: Hayley
authors.initials: H
authors.lastname: Shin
authors.forename: Hak Jong
authors.initials: HJ
authors.lastname: Lee
authors.forename: Ji
authors.initials: J
authors.lastname: Won Yoon
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Yu
authors.forename: So-Youn
authors.initials: SY
authors.lastname: Kim
authors.forename: Soo Young
authors.initials: SY
authors.lastname: Yoo
authors.forename: Hye Seung
authors.initials: HS
authors.lastname: Jung
authors.forename: Kyong Soo
authors.initials: KS
authors.lastname: Park
authors.forename: Jun Oh
authors.initials: JO
authors.lastname: Ryu
authors.forename: Hak C
authors.initials: HC
authors.lastname: Jang
mesh_terms: D000368:Aged; D015190:Blood Glucose Self-Monitoring; D040421:Cell Phone; D003195:Computer Communication Networks; D020000:Decision Support Systems, Clinical; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007003:Hypoglycemia / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human