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BMJ UPDATES

Research question

Web based enhancements to self monitoring improve glycaemic control for payments with type 2 diabetes?

Answer

Yes. Glucose monitoring and feedback via the web help reduce concentrations of haemoglobin A1c compared with traditional face to face consultations.

Why did the authors do the Study?

Tight glycaemic control helps prevent complications in patients with type 2 diabetes, who mainly combine self monitoring with visits to a diabetic clinic or primary care doctor. These authors wanted to test a new system based on monitoring and feedback via the internet.

What did they do?

Eighty Korean adults with type 2 diabetes took part in a randomized controlled trial over two and a half years. All participants monitored their own serum concentrations of glucose regularly at home, and visited a diabetic outpatient clinic every three months for blood tests and advice. Forty of them (the intervention group) also uploaded their results regularly on to a website. "Clinical Instructors" accessed the website daily and gave feedback and advice to each participant fortnightly.

The authors compared glycaemic control between intervention and control groups over 30 months, Using intention to treat analysis. They also looked at the stability of control using a fluctuation index-the standard deviation of each participants haemoglobin A1c (HbA1c) concentrations.

What did they find?

Adults using the internet based system of monitoring and feedback had lower mean concentrations of HbA1c during the study than did controls (mean over the whole study period 6.9% v 7.5%, P=0.009). They were also more stable, as measured by the standard deviation of each individual's results (HbA1c fluctuation index 0.47 v 0.78, P=0.001). The benefits were evident in subgroups with both higher HbA1c concentrations (>7%) and lower concentrations (<7%) at baseline.

What does it mean?

This relatively small trial suggests that self monitoring combined with regular feedback over the internet can help patients with type 2 diabetes improve their glycaemic control-possibly because the web based system gave them faster and more timely access to advice from doctors and dieticians. Glycaemic control was better for the intervention group from about three months and the difference persisted for the full two and half years of the study. Most of the time the doctors simply gave encouragement, but about 12% of web based interactions led to charges in drug regimen. Another 12% were about lifestyle issues.

All the participants in this study had access to the internet and knew how to use it. The system may not work so well for patients who are less computer literate.

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BMJ | 20 JANUARY 2007 | VOLUME 334



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