title: The impact of a decision support tool linked to an electronic medical record on glycemic control in people with type 2 diabetes.
abstract: OBJECTIVE
  We retrospectively compared glycemic control and glycemic burden in type 2 diabetes patients treated by general physicians with access to decision support with those treated by general physicians without access to decision support.
  
  
  METHODS
  A total of 875 patients [471 (53.8%) males] aged 54.3 [standard deviation (SD) 13.1] years followed up over 84 months. A total of 342 patients (39%) were managed with decision support, and effects on glycosylated hemoglobin (HbA1c) were assessed.
  
  
  RESULTS
  There was no difference between groups in starting HbA1c [7.6 (SD 1.8) versus 7.5 (SD 1.5); p = not significant] at baseline. Patients treated with decision support were more likely to have planned review of HbA1c, adjustment of medication, prescription of statins, dietetic and nurse educator inputs (71.3% versus 58.5%; Chi squared = 14.7; p = .001). The mean HbA1c in the group treated with decision support was not significantly reduced within the first year [7.5% (SD 1.8) versus 7.6% (SD 1.5); p = not significant; 95% confidence interval (CI) -0.33 to 0.17], but statistically significant differences were apparent at year 2 [7.2% (SD 2.0) versus 8% (SD 3.4); p = .0001; 95% CI -1.3 to -0.5] and sustained through year 3 [7.2% (SD 2.0) versus 8.0% (SD 2.0); p = .0001; 95% CI -1.2 to -0.6], year 4 [7.2% (SD 2.3) versus 8.2% (SD 2.5); p = .0001; 95% CI -1.2 to -0.6], year 5 [7.0% (SD 2.3) versus 8.3% (SD 2.6); p = .001; 95% CI -1.5 to -0.8], year 6 [7.0% (SD 2.0) versus 8.2% (SD 2.4); p = .001; 95% CI -1.5 to -0.9], and year 7 [6.9% (SD 1.2) versus 8% (SD 1.8); p = .001; 95% CI -1.4 to -1.0].
  
  
  CONCLUSIONS
  Use of a decision support system showed benefits in adherence to clinical care pathways and achieving significant improvements in glycemic control.
authors.affiliation: Ministry of Health Sri Lanka, Colombo, Sri Lanka.
authors.forename: Waruna
authors.initials: W
authors.lastname: Gunathilake
authors.forename: Sajith
authors.initials: S
authors.lastname: Gunawardena
authors.forename: Ranga
authors.initials: R
authors.lastname: Fernando
authors.forename: George
authors.initials: G
authors.lastname: Thomson
authors.forename: Devaka
authors.initials: D
authors.lastname: Fernando
mesh_terms: D003661:Decision Support Techniques; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy; D057286:Electronic Health Records; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human