Lim Soo, Kang Seon Mee, Kim Kyoung Min, Moon Jae Hoon, Choi Sung Hee, Hwang Hee, Jung Hye Seung, Park Kyong Soo, Ryu Jun Oh, Jang Hak Chul
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300, Gumi-dong, Bundang-gu, Seongnam, 463-707, Korea.
Department of Medical Informatics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Acta Diabetol. 2016 Apr;53(2):189-98. doi: 10.1007/s00592-015-0754-8. Epub 2015 May 5.
In 2011, we demonstrated that an individualized health management system employing advanced medical information technology, designated ubiquitous (u)-healthcare, was helpful in achieving glycemic control without hypoglycemia in patients with diabetes. Following this, we generated a new multidisciplinary u-healthcare system by upgrading our clinical decision support system (CDSS) rule engine and integrating a physical activity-monitoring device and dietary feedback into a comprehensive package.
In a randomized, controlled clinical trial, patients with type 2 diabetes aged over 60 years were assigned randomly to a self-monitored blood glucose (SMBG) group (N = 50) or u-healthcare group (N = 50) for 6 months. The primary endpoint was the proportion of patients achieving glycated hemoglobin (HbA1c) <7 % without hypoglycemia. Changes in body composition and lipid profiles were also investigated. The u-healthcare group was educated to use a specially designed glucometer and an activity monitor that automatically transferred test results to a hospital-based server. An automated CDSS rule engine generated and sent patient-specific messages about glucose, diet, and physical activity to their mobile phones and a Web site.
After 6 months of follow-up, the HbA1c level was significantly decreased in the u-healthcare group [8.0 ± 0.7 % (64.2 ± 8.8 mmol/mol) to 7.3 ± 0.9 % (56.7 ± 9.9 mmol/mol)] compared with the SMBG group [8.1 ± 0.8 % (64.9 ± 9.1 mmol/mol) to 7.9 ± 1.2 % (63.2 ± 12.3 mmol/mol)] (P < 0.01). The proportion of patients with HbA1c < 7 % without hypoglycemia was greater in the u-healthcare group (26 %) than in the SMBG group (12 %; P < 0.05). Body fat mass decreased and lipid profiles improved in the u-healthcare group but not in the SMBG group.
This u-healthcare service provided effective management for older patients with type 2 diabetes (ClinicalTrial.Gov: NCT01137058).
2011年，我们证明了一种采用先进医学信息技术的个性化健康管理系统，即泛在（u）-医疗保健系统，有助于糖尿病患者在不发生低血糖的情况下实现血糖控制。在此之后，我们通过升级临床决策支持系统（CDSS）规则引擎，并将身体活动监测设备和饮食反馈整合到一个综合方案中，生成了一个新的多学科u-医疗保健系统。
在一项随机对照临床试验中，将60岁以上的2型糖尿病患者随机分为自我监测血糖（SMBG）组（N = 50）或u-医疗保健组（N = 50），为期6个月。主要终点是糖化血红蛋白（HbA1c）<7%且无低血糖的患者比例。还研究了身体成分和血脂谱的变化。u-医疗保健组接受培训使用专门设计的血糖仪和活动监测器，这些设备会自动将检测结果传输到医院服务器。自动化的CDSS规则引擎生成并向患者手机和网站发送有关血糖、饮食和身体活动的个性化信息。
随访6个月后，与SMBG组相比，u-医疗保健组的HbA1c水平显著降低[从8.0±0.7%（64.2±8.8 mmol/mol）降至7.3±0.9%（56.7±9.9 mmol/mol）]，而SMBG组从8.1±0.8%（64.9±9.1 mmol/mol）降至7.9±1.2%（63.2±12.3 mmol/mol）（P<0.01）。u-医疗保健组中HbA1c<7%且无低血糖的患者比例（26%）高于SMBG组（12%；P<0.05）。u-医疗保健组的体脂量减少，血脂谱改善，而SMBG组则没有。
这种u-医疗保健服务为老年2型糖尿病患者提供了有效的管理（ClinicalTrial.Gov：NCT01137058）。
