A Mobile Computerized Decision Support System to Prevent Hypoglycemia in Hospitalized Patients With Type 2 Diabetes Mellitus.
Diabetes management requires complex and interdisciplinary cooperation of health care professionals (HCPs). To support this complex process, IT-support is recommended by clinical guidelines. The aim of this article is to report on results from a clinical feasibility study testing the prototype of a mobile, tablet-based client-server system for computerized decision and workflow support (GlucoTab®) and to discuss its impact on hypoglycemia prevention.



The system was tested in a monocentric, open, noncontrolled intervention study in 30 patients with type 2 diabetes mellitus (T2DM). The system supports HCPs in performing a basal-bolus insulin therapy. Diabetes therapy, adverse events, software errors and user feedback were documented. Safety, efficacy and user acceptance of the system were investigated.



Only 1.3% of blood glucose (BG) measurements were <70 mg/dl and only 2.6% were >300 mg/dl. The availability of the system (97.3%) and the rate of treatment activities documented with the system (>93.5%) were high. Only few suggestions from the system were overruled by the users (>95.7% adherence). Evaluation of the 3 anonymous questionnaires showed that confidence in the system increased over time. The majority of users believed that treatment errors could be prevented by using this system.



Data from our feasibility study show a significant reduction of hypoglycemia by implementing a computerized system for workflow and decision support for diabetes management, compared to a paper-based process. The system was well accepted by HCPs, which is shown in the user acceptance analysis and that users adhered to the insulin dose suggestions made by the system.
1 Health-Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbh, Graz, Austria.
Stephan
S
Spat
1 Health-Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbh, Graz, Austria.
Klaus
K
Donsa
1 Health-Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbh, Graz, Austria.|2 decide Clinical Software GmbH, Graz, Austria.
Peter
P
Beck
1 Health-Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbh, Graz, Austria.
Bernhard
B
Höll
3 Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Julia K
JK
Mader
3 Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Lukas
L
Schaupp
1 Health-Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbh, Graz, Austria.
Thomas
T
Augustin
4 Computational Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas, Crete, Greece.
Franco
F
Chiarugi
3 Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Katharina M
KM
Lichtenegger
3 Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Johannes
J
Plank
1 Health-Institute for Biomedicine and Health Sciences, Joanneum Research Forschungsgesellschaft mbh, Graz, Austria.|3 Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Thomas R
TR
Pieber
D034201:Computers, Handheld; D020000:Decision Support Systems, Clinical; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D063731:Mobile Applications; D057188:Workflow
D007004:Hypoglycemic Agents; D007328:Insulin
basal-bolus insulin therapy; best practice; computerized decision support; diabetes mellitus type 2; hypoglycemia; medication management system