title: Safety of a web-based insulin titration system for patients with type 2 diabetes mellitus - pilot study.
abstract: The treatment of type 2 diabetes patients with insulin requires active dose titration to obtain optimal glycemic control. We developed a web-based decision support system to guide patients in performing the titration task autonomously, at their homes. The system is based on a clinically validated algorithm. The aim of this study was to test the safety of the system in a pilot implementation in clinical practice. Patients were blinded from the advice given by the system and instead received insulin dosing advice given by caregivers. At the end of the pilot, advice of the system were evaluated on safety by an expert panel. In this pilot study six patients used the web-based system at their home. In total, 48 advice were logged in the system resulting in eighteen deviating systems dosing advice as compared to the advice of the caregiver. Evaluation of the eighteen deviating systems advice lead to the detection of one unsafe advice indicating a need to extend the algorithm with an additional safety decision rule.
authors.affiliation: Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: A C R
authors.initials: AC
authors.lastname: Simon
authors.forename: F
authors.initials: F
authors.lastname: Holleman
authors.forename: W T
authors.initials: WT
authors.lastname: Gude
authors.forename: J B L
authors.initials: JB
authors.lastname: Hoekstra
authors.forename: N
authors.initials: N
authors.lastname: Peek
mesh_terms: D020000:Decision Support Systems, Clinical; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000188:drug therapy*; D004360:Drug Therapy, Computer-Assisted / Q000379:methods*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects*; D020407:Internet; D061214:Patient Safety; D010865:Pilot Projects; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin