title: Utilization of a Cloud-Based Diabetes Management Program for Insulin Initiation and Titration Enables Collaborative Decision Making Between Healthcare Providers and Patients.
abstract: BACKGROUND
  Overseeing proper insulin initiation and titration remains a challenging task in diabetes care. Recent advances in mobile technology have enabled new models of collaborative care between patients and healthcare providers (HCPs). We hypothesized that the adoption of such technology could help individuals starting basal insulin achieve better glycemic control compared with standard clinical practice.
  
  
  METHODS
  This was a 12 ± 2-week randomized controlled study with 40 individuals with type 2 diabetes who were starting basal insulin due to poor glycemic control. The control group (n = 20) received standard face-to-face care and phone follow-up as needed in a tertiary center, whereas the intervention group (n = 20) received care through the cloud-based diabetes management program where regular communications about glycemic control and insulin doses were conducted via patient self-tracking tools, shared decision-making interfaces, secure text messages, and virtual visits (audio, video, and shared screen control) instead of office visits.
  
  
  RESULTS
  By intention-to-treat analysis, the intervention group achieved a greater hemoglobin A1c decline compared with the control group (3.2 ± 1.5% vs. 2.0% ± 2.0%; P = 0.048). The Diabetes Treatment Satisfaction Questionnaire showed a significant improvement in the intervention group compared with the control group (an increase of 10.1 ± 11.7 vs. 2.1 ± 6.5 points; P = 0.01). HCPs spent less time with patients in the intervention group compared with those in the control group (65.9 min per subject vs. 81.6 min per subject). However, the intervention group required additional training time to use the mobile device.
  
  
  CONCLUSIONS
  Mobile health technology could be an effective tool in sharing data, enhancing communication, and improving glycemic control while enabling collaborative decision making in diabetes care.
authors.affiliation: 1 Joslin Diabetes Center, Harvard Medical School , Boston, Massachusetts.
authors.forename: William C
authors.initials: WC
authors.lastname: Hsu
authors.affiliation: 1 Joslin Diabetes Center, Harvard Medical School , Boston, Massachusetts.
authors.forename: Ka Hei Karen
authors.initials: KH
authors.lastname: Lau
authors.affiliation: 2 Harvard T.H. Chan School of Public Health , Boston, Massachusetts; E-Da Hospital and I-Shou University, School of Medicine, Kaohsiung, Taiwan .
authors.forename: Ruyi
authors.initials: R
authors.lastname: Huang
authors.affiliation: 1 Joslin Diabetes Center, Harvard Medical School , Boston, Massachusetts.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Ghiloni
authors.affiliation: 3 University of Massachusetts Medical School , Worcester, Massachusetts.
authors.forename: Hung
authors.initials: H
authors.lastname: Le
authors.affiliation: 4 MIT Media Lab , Cambridge, Massachusetts.
authors.forename: Scott
authors.initials: S
authors.lastname: Gilroy
authors.affiliation: 1 Joslin Diabetes Center, Harvard Medical School , Boston, Massachusetts.
authors.forename: Martin
authors.initials: M
authors.lastname: Abrahamson
authors.affiliation: 4 MIT Media Lab , Cambridge, Massachusetts.
authors.forename: John
authors.initials: J
authors.lastname: Moore
mesh_terms: D000066491:Clinical Decision-Making / Q000379:methods*; D003657:Decision Making; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D061385:Insulins / Q000008:administration & dosage; D057194:Intention to Treat Analysis; D020407:Internet; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D061385:Insulins; C517652:hemoglobin A1c protein, human