Albisser A M
Disease Management Division BCMC Better Control Medical Computers, Inc. 1413 20th Street Unit 207, Miami Beach, FL 33139, USA.
Ann Endocrinol (Paris). 2001 Feb;62(1 Pt 1):11-8.
Self-blood glucose control is crucial to improving long term outcomes in diabetes. To facilitate this task, we offered patients access to a remote computer continuously online for data collection, dosing decision support, and medical monitoring. Imbedded algorithms for home glucose clamping were custom programmed for each patient. The objectives of the present work were to determine what proportion of patients chose to use such support and whether users benefited from the effort compared to non-users.
A single central computer system was used. Algorithms for home glucose clamping were custom programmed for each patient by their physician who set glucose targets, clamping factors and safety constraints. The systems were voice-interactive and required the remote patient to handle only a touch-tone telephone. Patients were free to access the system each day to report self-measured blood glucose levels or hypoglycemia symptoms together with carbohydrate counting, planned exercise, stress, illness or other life-style events. Clinical experience was in patients followed for 12 months in samples derived from three health-care environments.
Some 388 patients were offered access to the system. Sixty percent of patients (N=231) actively used the system. Among the 3 study centers, over 104,000 blood glucose measurements were received during the start-up year. Each call was processed instantly and automatically. Patients benefited from the 24 hours access. Those receiving algorithmic assistance for home glucose clamping adjusted daily therapy more effectively: prevalence of hyper-glycemia and hypo-glycemia fell ~ 2-fold (p<0.05) and glycated hemoglobin levels declined 1.3% (p<0.001).
Physicians and patients benefited. Patients with diabetes may be receptive to computer assistance. Many can accomplish glucose clamping at home and meet targets set by their physicians for self-blood glucose control while reducing the incidence of diabetic crises. The centralized system adds no costs for the patients and empowers physicians to provide safer and superior diabetes care.
自我血糖控制对于改善糖尿病患者的长期预后至关重要。为便于完成此项任务，我们为患者提供了一台持续在线的远程计算机，用于数据收集、剂量决策支持及医疗监测。针对每位患者定制编写了用于家庭血糖钳夹的嵌入式算法。本研究的目的在于确定选择使用此类支持的患者比例，以及与未使用者相比，使用者是否从中获益。
使用单一的中央计算机系统。由医生为每位患者定制编写用于家庭血糖钳夹的算法，医生设定血糖目标、钳夹因子及安全限制。这些系统具有语音交互功能，远程患者只需操作按键式电话即可。患者可每天自由访问该系统，报告自我测量的血糖水平或低血糖症状，以及碳水化合物计数、计划的运动、压力、疾病或其他生活方式事件。临床经验来自于在三个医疗环境中随访12个月的患者样本。
约388名患者获得了使用该系统的权限。60%的患者（N = 231）积极使用该系统。在3个研究中心中，启动年期间共收到超过104,000次血糖测量数据。每次呼叫均即时自动处理。患者从24小时可访问中获益。接受家庭血糖钳夹算法辅助的患者能更有效地调整每日治疗：高血糖和低血糖的发生率下降约2倍（p < 0.05），糖化血红蛋白水平下降1.3%（p < 0.001）。
医生和患者均从中受益。糖尿病患者可能乐于接受计算机辅助。许多患者能够在家中完成血糖钳夹，并达到医生设定的自我血糖控制目标，同时降低糖尿病危机的发生率。该集中式系统未给患者增加成本，并使医生能够提供更安全、更优质的糖尿病护理。
