Development of web-based diabetic patient management system using short message service (SMS)

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Abstract

We developed a blood glucose management system using the Internet and short message service (SMS) which can lessen the social economic burden and materialize an individualized diabetes mellitus management. A total of 185 diabetic patients participated in this study and their mean age was 42.4 years old (8–79 year-old). Participants sent their self-measured blood glucose levels, medication and its dosages, amount of meal, and degree of exercise to their health providers in this specialized web-based diabetes management system for 3 months. The health providers consisting of endocrinology specialists, dietitians, and nurses sent recommendations for individualized diabetes management according to the data on the web. Laboratory tests including lipid profiles and glycated hemoglobin (HbA1c), and a survey of satisfaction about this system were performed before and after the study period. The mean HbA1c improved from 7.5 ± 1.5 to 7.0 ± 1.1% after using the management program (P = 0.003). The mean serum triglyceride and HDL–cholesterol levels turned for the better also. HbA1c improved from 8.4 ± 1.2 to 7.5 ± 1.0% after applying this program to patients with the HbA1c of 7% or higher at baseline (P = 0.010). We propose this web-based diabetic patient management system as a new tool for communication between health care providers and patients.

Introduction

The incidence of diabetes mellitus and its chronic complications been on the increase for decades. And the economic burden of managing for diabetic patients has become a big social issue [1], [2], [3]. Recently, many evidences have supported that chronic diabetic complications can be prevented through strict blood glucose control [4], [5]. However, in order to achieve such good level of glycemic control in diabetic patients, intimate doctor–patient relationship and individualized care and education are essential. And this relationship and care system for the patients with diabetes should be lifelong and consistent. To maintain normal range of blood glucose and prevent diabetic complications, patients ought to contact more frequently with their heath care providers, but this will in turn increase health care expenditure.

The Internet is a world-wide communication system that allows a person to contact with others anywhere at anytime. So, whenever diabetic patients want to contact their health care providers, the patients can acquire information using the Internet. Korea is one of the most developed countries in the fields of Internet-networking. Nearly all the families have their own computers and can access the Internet via modem or high speed network system in Korea. So, we designed a web-based diabetic patient management system that could take the place of the standard face-to-face doctor–patient interviews in the hospital.

Section snippets

Subjects

Patients who were diagnosed as diabetes mellitus for at least 1 year were recruited from the home page of Kangnam St. Mary’s Hospital on the web from July to September, 2000. Only those with Internet access available in their homes for web-based diabetes management system were chosen as participants. Patients were excluded if they had any significant disease that could affect the outcome of the study, such as hepatic or renal failure. Written informed consent was obtained from each participant.

Results

A total of 185 diabetic patients (male; 132, female; 53) participated, and the mean age of the participants was 42.4 year-old (4–79 year-old). Mean duration of diabetes in our participants was 5.0 ± 5.9 years (0–30 years). Classification of the diabetes mellitus of the participants (% of participants) was as follows: type 1 diabetes mellitus consisted 16.2%, type 2 diabetes mellitus 82.7%, and secondary diabetes mellitus 1.1% (Table 1). Modalities of treatment for diabetes mellitus were as

Discussion

We developed a specialized web-based diabetic patient management system and applied it to the field of clinical practice. Although the duration of the study was very short, glycated hemoglobin decreased significantly and triglycerides, HDL–cholesterol levels were also improved. Most participants in our study were satisfied with this system and compliance to this program was not poor.

We recruited study subjects from our hospital homepage, and there was a limitation for participating in this

Acknowledgements

This study was supported by a grant from the Korea Health 21 R&D Project (00-PJ3-PG6-GN07-001) and the Korea Health and Promotion Research Program, Ministry of Health and Welfare, Republic of Korea.

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