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Proceedings of the AMIA Symposium logoLink to Proceedings of the AMIA Symposium
. 1998:295–299.

Computerized management of diabetes: a synthesis of controlled trials.

E A Balas 1, S A Boren 1, G Griffing 1
PMCID: PMC2232151  PMID: 9929229

Abstract

Computerized management of diabetes is the use of information technology to improve diabetic patient outcomes. The computer can be used to provide educational information to patients and facilitate the storage and transmittal of clinical data between patients and clinicians. The objective of this paper was to evaluate computerized management of diabetes in changing the health outcomes. Clinical trial reports were identified through systematic electronic database and manual searches. Four eligibility criteria were applied: diabetes clinical area; prospective, contemporaneously controlled clinical trial with random assignment of the intervention; computer generated information for patients in the intervention group and no similar intervention in the control group; and measurement of effect on the outcome of care (health status, social functioning, patient/family satisfaction). Data were abstracted using a standardized abstraction form and the quality of methodology was scored. Of 15 eligible clinical trials, 12 (80%) reported positive outcomes or significant benefits. A total of 48 outcome measures were reported, an average of 3.2/study. Significantly improved clinical outcomes included Hemoglobin A1c (HbA1c), blood glucose, and hypoglycemic events. Patient-computer interaction appears to be a valuable supplement to interaction with clinicians. Considering the need to enhance patient participation in the care of chronic illnesses, initial evidence indicates computers can play a more significant role in the future.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ahring K. K., Ahring J. P., Joyce C., Farid N. R. Telephone modem access improves diabetes control in those with insulin-requiring diabetes. Diabetes Care. 1992 Aug;15(8):971–975. doi: 10.2337/diacare.15.8.971. [DOI] [PubMed] [Google Scholar]
  2. Balas E. A., Austin S. M., Brown G. D., Mitchell J. A. Quality evaluation of controlled clinical information service trials. Proc Annu Symp Comput Appl Med Care. 1993:586–590. [PMC free article] [PubMed] [Google Scholar]
  3. Balas E. A., Austin S. M., Ewigman B. G., Brown G. D., Mitchell J. A. Methods of randomized controlled clinical trials in health services research. Med Care. 1995 Jul;33(7):687–699. doi: 10.1097/00005650-199507000-00005. [DOI] [PubMed] [Google Scholar]
  4. Balas E. A., Stockham M. G., Mitchell M. A., Austin S. M., West D. A., Ewigman B. G. The Columbia Registry of Information and Utilization Management Trials. J Am Med Inform Assoc. 1995 Sep-Oct;2(5):307–315. doi: 10.1136/jamia.1995.96073833. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Balint J., Shelton W. Regaining the initiative. Forging a new model of the patient-physician relationship. JAMA. 1996 Mar 20;275(11):887–891. doi: 10.1001/jama.275.11.887. [DOI] [PubMed] [Google Scholar]
  6. Billiard A., Rohmer V., Roques M. A., Joseph M. G., Suraniti S., Giraud P., Limal J. M., Fressinaud P., Marre M. Telematic transmission of computerized blood glucose profiles for IDDM patients. Diabetes Care. 1991 Feb;14(2):130–134. doi: 10.2337/diacare.14.2.130. [DOI] [PubMed] [Google Scholar]
  7. Chiarelli F., Tumini S., Morgese G., Albisser A. M. Controlled study in diabetic children comparing insulin-dosage adjustment by manual and computer algorithms. Diabetes Care. 1990 Oct;13(10):1080–1084. doi: 10.2337/diacare.13.10.1080. [DOI] [PubMed] [Google Scholar]
  8. Donabedian A. The quality of care. How can it be assessed? JAMA. 1988 Sep 23;260(12):1743–1748. doi: 10.1001/jama.260.12.1743. [DOI] [PubMed] [Google Scholar]
  9. Glasgow R. E., Toobert D. J., Hampson S. E. Effects of a brief office-based intervention to facilitate diabetes dietary self-management. Diabetes Care. 1996 Aug;19(8):835–842. doi: 10.2337/diacare.19.8.835. [DOI] [PubMed] [Google Scholar]
  10. Haynes R. B., Walker C. J. Computer-aided quality assurance. A critical appraisal. Arch Intern Med. 1987 Jul;147(7):1297–1301. [PubMed] [Google Scholar]
  11. Horan P. P., Yarborough M. C., Besigel G., Carlson D. R. Computer-assisted self-control of diabetes by adolescents. Diabetes Educ. 1990 May-Jun;16(3):205–211. doi: 10.1177/014572179001600311. [DOI] [PubMed] [Google Scholar]
  12. Laine C., Davidoff F. Patient-centered medicine. A professional evolution. JAMA. 1996 Jan 10;275(2):152–156. [PubMed] [Google Scholar]
  13. Marrero D. G., Kronz K. K., Golden M. P., Wright J. C., Orr D. P., Fineberg N. S. Clinical evaluation of computer-assisted self-monitoring of blood glucose system. Diabetes Care. 1989 May;12(5):345–350. doi: 10.2337/diacare.12.5.345. [DOI] [PubMed] [Google Scholar]
  14. Marrero D. G., Vandagriff J. L., Kronz K., Fineberg N. S., Golden M. P., Gray D., Orr D. P., Wright J. C., Johnson N. B. Using telecommunication technology to manage children with diabetes: the Computer-Linked Outpatient Clinic (CLOC) Study. Diabetes Educ. 1995 Jul-Aug;21(4):313–319. doi: 10.1177/014572179502100409. [DOI] [PubMed] [Google Scholar]
  15. Morrish N. J., Cohen D. L., Hicks B., Keen H. A controlled study of the effect of computer-aided analysis of home blood glucose monitoring on blood glucose control. Diabet Med. 1989 Sep-Oct;6(7):591–594. doi: 10.1111/j.1464-5491.1989.tb01234.x. [DOI] [PubMed] [Google Scholar]
  16. Peters A., Rübsamen M., Jacob U., Look D., Scriba P. C. Clinical evaluation of decision support system for insulin-dose adjustment in IDDM. Diabetes Care. 1991 Oct;14(10):875–880. doi: 10.2337/diacare.14.10.875. [DOI] [PubMed] [Google Scholar]
  17. Peterson C. M., Jovanovic L., Chanoch L. H. Randomized trial of computer-assisted insulin delivery in patients with type I diabetes beginning pump therapy. Am J Med. 1986 Jul;81(1):69–72. doi: 10.1016/0002-9343(86)90184-1. [DOI] [PubMed] [Google Scholar]
  18. Rosenfalck A. M., Bendtson I. The Diva System, a computerized diary, used in young type 1 diabetic patients. Diabete Metab. 1993 Jan-Feb;19(1):25–29. [PubMed] [Google Scholar]
  19. Ryff-de Lèche A., Engler H., Nützi E., Berger M., Berger W. Clinical application of two computerized diabetes management systems: comparison with the log-book method. Diabetes Res. 1992 Mar;19(3):97–105. [PubMed] [Google Scholar]
  20. Schrezenmeir J., Achterberg H., Bergeler J., Küstner E., Stümer W., Hutten H., Beyer J. Controlled study on the use of hand-held insulin dosage computers enabling conversion to and optimizing of meal-related insulin therapy regimens. Life Support Syst. 1985;3 (Suppl 1):561–567. [PubMed] [Google Scholar]
  21. Shultz E. K., Bauman A., Hayward M., Holzman R. Improved care of patients with diabetes through telecommunications. Ann N Y Acad Sci. 1992 Dec 17;670:141–145. doi: 10.1111/j.1749-6632.1992.tb26084.x. [DOI] [PubMed] [Google Scholar]
  22. Turnin M. C., Beddok R. H., Clottes J. P., Martini P. F., Abadie R. G., Buisson J. C., Soulé-Dupuy C., Bonneu M., Camaré R., Anton J. P. Telematic expert system Diabeto. New tool for diet self-monitoring for diabetic patients. Diabetes Care. 1992 Feb;15(2):204–212. doi: 10.2337/diacare.15.2.204. [DOI] [PubMed] [Google Scholar]

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