Objective : Self-blood glucose control is crucial to improving ling term ou
tcomes 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 clamp
ing were custom programmed for each patient. The objectives of the present
work were to determine what proportion of patients chose to use such suppor
t and whether users benefited from the effort compared to non-users.
Research design and methods : A single central computer system was used. Al
gorithms for home glucose clamping were custom programmed for each patient
by their physician who set glucose targets, clamping factors and safety con
straints. The systems were voice-interactive and required the remote patien
t to handle only a touch-tone telephone. Patients were free to access the s
ystem each day to report self-measured blood glucose levels or hypoglycemia
symptoms together with carbohydrate counting, planned exercise, stress, il
lness or other life-style events. Clinical experience was in patients follo
wed for 12 months in samples derived from three health-care environments.
Results: 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 benefit
ed from the 24 hours access. Those receiving algorithmic assistance for hom
e glucose clamping adjusted daily therapy more effectively: prevalence of h
yper-glycemia and hypo-glycemia fell similar to 2-fold (p < 0.05) and glyca
ted hemoglobin levels declined 1.3 % (p < 0.001).
Conclusions: Physicians and patients benefited. Patients with diabetes may
be receptive to computer assistance. Many can accomplish glucose clamping a
t home and meet targets set by their physicians for self-blood glucose cont
rol while reducing the incidence of diabetic crises. The centralized system
adds no costs for the patients and empowers physicians to provide safer an
d superior diabetes care.