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Kopanz J, Mader JK, Donsa K, Libiseller A, Aberer F, Pandis M, Reinisch-Gratzer J, Ambrosch GC, Lackner B, Truskaller T, Sinner FM, Pieber TR, Lichtenegger KM. Digital algorithm-guided insulin therapy in home healthcare for elderly persons with type 2 diabetes: A proof-of-concept study. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:986672. [PMID: 36992745 PMCID: PMC10012122 DOI: 10.3389/fcdhc.2022.986672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/02/2022] [Indexed: 11/13/2022]
Abstract
GlucoTab@MobileCare, a digital workflow and decision support system with integrated basal and basal-plus insulin algorithm was investigated for user acceptance, safety and efficacy in persons with type 2 diabetes receiving home health care by nurses. During a three months study nine participants (five female, age 77 ± 10 years, HbA1c 60 ± 13 mmol/mol (study start) vs. 57 ± 12 mmol/mol (study end) received basal or basal-plus insulin therapy as suggested by the digital system. In total 95% of all suggested tasks (blood glucose (BG) measurements, insulin dose calculations, insulin injections) were performed according to the digital system. Mean morning BG was 171 ± 68 mg/dL in the first study month vs. 145 ± 35 mg/dL in the last study month, indicating a reduced glycemic variability of 33 mg/dL (standard deviation). No hypoglycemic episode < 54 mg/dL occurred. User’s adherence was high and the digital system supported a safe and effective treatment. Larger scale studies are needed to confirm findings under routine care.German Clinical Trials Register IDDRKS00015059
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Affiliation(s)
- Julia Kopanz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Julia K. Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Klaus Donsa
- JOANNEUM RESEARCH Forschungsgesellschaft mbH, HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
- *Correspondence: Klaus Donsa, ;
| | - Angela Libiseller
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Felix Aberer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Marlene Pandis
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | | | - Bettina Lackner
- JOANNEUM RESEARCH Forschungsgesellschaft mbH, HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Thomas Truskaller
- JOANNEUM RESEARCH Forschungsgesellschaft mbH, HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Frank Michael Sinner
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- JOANNEUM RESEARCH Forschungsgesellschaft mbH, HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Thomas R. Pieber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- JOANNEUM RESEARCH Forschungsgesellschaft mbH, HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Katharina M. Lichtenegger
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- JOANNEUM RESEARCH Forschungsgesellschaft mbH, HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
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Pichardo-Lowden AR. Clinical Decision Support for Diabetes Care in the Hospital: A Time for Change Toward Improvement of Management and Outcomes. J Diabetes Sci Technol 2022; 16:771-774. [PMID: 33412952 PMCID: PMC9294585 DOI: 10.1177/1932296820982661] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The increasing prevalence of diabetes permeates hospitals and dysglycemia is associated with poor clinical and economic outcomes. Despite endorsed guidelines, barriers to optimal management and gaps in care prevail. Providers' limitations on knowledge, attitudes, and decision-making about hospital diabetes management are common. This adds to the complexity of dispersed glucose and insulin dosing data within medical records. This creates a dichotomy as safe and effective care are key objectives of healthcare organizations. This perspective highlights evidence of the benefits of clinical decision support (CDS) in hospital glycemic management. It elaborates on barriers CDS can help resolve, and factors driving its success. CDS represents a resource to individualize care and improve outcomes. It can help overcome a multifactorial problem impacting patients' lives on a daily basis.
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Affiliation(s)
- Ariana R. Pichardo-Lowden
- Department of Medicine, Division
of Endocrinology, Diabetes and Metabolism, Milton S. Hershey Medical Center.
Penn State Health, Penn State College of Medicine, Hershey, PA, USA
- Ariana R Pichardo-Lowden, MD, MEd,
MSc, Associate Professor of Medicine, Department of Medicine, Division
of Endocrinology, Diabetes and Metabolism, Milton S. Hershey Medical
Center, Penn State Health, Penn State College of Medicine, 500
University Drive, Hershey, PA 17033 USA.
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Aberer F, Hochfellner DA, Mader JK. Application of Telemedicine in Diabetes Care: The Time is Now. Diabetes Ther 2021; 12:629-639. [PMID: 33474646 PMCID: PMC7816834 DOI: 10.1007/s13300-020-00996-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/24/2020] [Indexed: 11/16/2022] Open
Abstract
The utilization of telemedicine solutions to reduce outpatient clinic visits and visits to physicians' offices, thus saving financial and personal resources as well as time, has gained substantial importance in recent years. The COVID19 pandemic has made it necessary to abruptly adjust outpatient care methods in various medical settings that needlessly require consultations in person to monitor and change the disease management of patients in specific risk groups. People with diabetes represent a vulnerable population who need to be protected from avoidable outpatient clinic visits, particularly in times of influenza or other pandemic outbreaks. However, the treatment and care of patients with diabetes and its comorbidities require careful and regular monitoring and therapy adjustments by medical staff. Advanced age or cognitive impairment and insufficient access to the health care system due to low socioeconomic status can complicate the use of possible alternatives to in-person consultations in outpatient clinics or physicians' offices. Telemedicine solutions may offer suitable alternatives to standard face-to-face consultations in outpatient settings and provide sufficient access to appropriate diabetes care. Nevertheless, telemedicine methods for monitoring diabetes issues are yet to find widespread use due to numerous barriers, such as a lack of acceptance and doubt about its time- and cost-effectiveness, availability, and potential technical and regulatory issues. This article offers an overview of existing applications that provide telemedicine diabetes care. Furthermore, it discusses potential ways to restructure and revolutionize diabetes outpatient care.
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Affiliation(s)
- Felix Aberer
- Department of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
| | - Daniel A Hochfellner
- Department of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Julia K Mader
- Department of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
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