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Present and Future of Digital Health in Diabetes and Metabolic Disease
Sang Youl Rhee, Chiweon Kim, Dong Wook Shin, Steven R. Steinhubl
Diabetes Metab J. 2020;44(6):819-827.   Published online December 23, 2020
DOI: https://doi.org/10.4093/dmj.2020.0088
  • 10,991 View
  • 312 Download
  • 23 Web of Science
  • 23 Crossref
AbstractAbstract PDFPubReader   ePub   
The use of information and communication technology (ICT) in medical and healthcare services goes beyond everyday life. Expectations of a new medical environment, not previously experienced by ICT, exist in the near future. In particular, chronic metabolic diseases such as diabetes and obesity, have a high prevalence and high social and economic burden. In addition, the continuous evaluation and monitoring of daily life is important for effective treatment and management. Therefore, the wide use of ICTbased digital health systems is required for the treatment and management of these diseases. In this article, we compiled a variety of digital health technologies introduced to date in the field of diabetes and metabolic diseases.

Citations

Citations to this article as recorded by  
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    International Journal of Behavioral Medicine.2024; 31(6): 959.     CrossRef
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  • Weight Management Health Note, a Mobile Health Platform for Obesity Management Developed by the Korean Society for the Study of Obesity
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    Journal of Obesity & Metabolic Syndrome.2024; 33(1): 1.     CrossRef
  • Effectiveness of a Social Networking Site Based Automatic Mobile Message Providing System on Glycemic Control in Patients with Type 2 Diabetes Mellitus
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    Endocrinology and Metabolism.2024; 39(2): 344.     CrossRef
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    Camila Maciel de Oliveira, Luiza Borcony Bolognese, Mercedes Balcells, Davi Casale Aragon, Roberto Luis Zagury, Clemente Nobrega, Chunyu Liu, Dured Dardari
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    Frontiers in Endocrinology.2023;[Epub]     CrossRef
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    JMIR mHealth and uHealth.2023; 11: e47407.     CrossRef
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    World Journal of Diabetes.2023; 14(12): 1721.     CrossRef
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    Clínica y Salud.2022; 33(1): 35.     CrossRef
  • Prevalence of Hyperuricemia Among Chinese Adults: Findings From Two Nationally Representative Cross-Sectional Surveys in 2015–16 and 2018–19
    Mei Zhang, Xiaoxia Zhu, Jing Wu, Zhengjing Huang, Zhenping Zhao, Xiao Zhang, Yu Xue, Weiguo Wan, Chun Li, Wenrong Zhang, Linhong Wang, Maigeng Zhou, Hejian Zou, Limin Wang
    Frontiers in Immunology.2022;[Epub]     CrossRef
  • Blood Pressure Monitoring as a Digital Health Tool for Improving Diabetes Clinical Outcomes: Retrospective Real-world Study
    ‪Yifat Fundoiano-Hershcovitz, Dror Bacher, Marilyn D Ritholz, David L Horwitz, Omar Manejwala, Pavel Goldstein
    Journal of Medical Internet Research.2022; 24(2): e32923.     CrossRef
  • The effectiveness of a structured group education programme for people with established type 2 diabetes in a multi-ethnic population in primary care: A cluster randomised trial
    Helen Dallosso, Panna Mandalia, Laura J. Gray, Yogini V. Chudasama, Sopna Choudhury, Shahrad Taheri, Naina Patel, Kamlesh Khunti, Melanie J. Davies
    Nutrition, Metabolism and Cardiovascular Diseases.2022; 32(6): 1549.     CrossRef
  • Efficacy of Personalized Diabetes Self-care Using an Electronic Medical Record–Integrated Mobile App in Patients With Type 2 Diabetes: 6-Month Randomized Controlled Trial
    Eun Young Lee, Seon-Ah Cha, Jae-Seung Yun, Sun-Young Lim, Jin-Hee Lee, Yu-Bae Ahn, Kun-Ho Yoon, Min Kyung Hyun, Seung-Hyun Ko
    Journal of Medical Internet Research.2022; 24(7): e37430.     CrossRef
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    Journal of Public Health Research.2022;[Epub]     CrossRef
  • Innovations in Cardio-oncology Resulting from the COVID-19 Pandemic
    Lavanya Kondapalli, Garima Arora, Riem Hawi, Efstathia Andrikopoulou, Courtney Estes, Nirav Patel, Carrie G. Lenneman
    Current Treatment Options in Oncology.2022; 23(9): 1288.     CrossRef
  • Effects of peer support and mobile application-based walking programme on physical activity and physical function in rural older adults: a cluster randomized controlled trial
    Xue Cai, Shanhu Qiu, Dan Luo, Ruxue Li, Chengyu Liu, Yanhui Lu, Cuirong Xu, Mingzi Li
    European Geriatric Medicine.2022; 13(5): 1187.     CrossRef
Original Articles
Clinical Diabetes and Therapeutics
Hospital-Based Korean Diabetes Prevention Study: A Prospective, Multi-Center, Randomized, Open-Label Controlled Study
Sang Youl Rhee, Suk Chon, Kyu Jeung Ahn, Jeong-Taek Woo
Diabetes Metab J. 2019;43(1):49-58.   Published online November 2, 2018
DOI: https://doi.org/10.4093/dmj.2018.0033
  • 6,494 View
  • 145 Download
  • 13 Web of Science
  • 14 Crossref
AbstractAbstract PDFPubReader   
Background

The prevalence of diabetes mellitus (DM) continues to increase, and the disease burden is the highest of any medical condition in Korea. However, large-scale clinical studies have not yet conducted to establish the basis for diabetes prevention in Korea.

Methods

The hospital-based Korean Diabetes Prevention Study (H-KDPS) is a prospective, multi-center, randomized, open-label controlled study conducted at university hospitals for the purpose of gathering data to help in efforts to prevent type 2 DM. Ten university hospitals are participating, and 744 subjects will be recruited. The subjects are randomly assigned to the standard care group, lifestyle modification group, or metformin group, and their clinical course will be observed for 36 months.

Results

All intervention methodologies were developed, validated, and approved by Korean Diabetes Association (KDA) multi-disciplinary team members. The standard control group will engage in individual education based on the current KDA guidelines, and the lifestyle modification group will participate in a professionally guided healthcare intervention aiming for ≥5% weight loss. The metformin group will begin dosing at 250 mg/day, increasing to a maximum of 1,000 mg/day. The primary endpoint of this study is the cumulative incidence of DM during the 3 years after randomization.

Conclusion

The H-KDPS study is the first large-scale clinical study to establish evidence-based interventions for the prevention of type 2 DM in Koreans. The evidence gathered by this study will be useful for enhancing the health of Koreans and improving the stability of the Korean healthcare system (Trial registration: CRIS KCT0002260, NCT02981121).

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    Joon Ha, Stephanie T. Chung, Max Springer, Joon Young Kim, Phil Chen, Aaryan Chhabra, Melanie G. Cree, Cecilia Diniz Behn, Anne E. Sumner, Silva A. Arslanian, Arthur S. Sherman
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Clinical Care/Education
Impact of Socioeconomic Status on Health Behaviors, Metabolic Control, and Chronic Complications in Type 2 Diabetes Mellitus
So Hun Kim, Seung Youn Lee, Chei Won Kim, Young Ju Suh, Seongbin Hong, Seong Hee Ahn, Da Hae Seo, Moon-Suk Nam, Suk Chon, Jeong-Taek Woo, Sei Hyun Baik, Yongsoo Park, Kwan Woo Lee, Young Seol Kim
Diabetes Metab J. 2018;42(5):380-393.   Published online June 29, 2018
DOI: https://doi.org/10.4093/dmj.2017.0102
  • 5,986 View
  • 87 Download
  • 16 Web of Science
  • 19 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   
Background

The aim of the study was to assess the impact of socioeconomic status (SES) on health behaviors, metabolic control, and chronic complications in people with type 2 diabetes mellitus (T2DM) from South Korea, a country with universal health insurance coverage and that has experienced rapid economic and social transition.

Methods

A total of 3,294 Korean men and women with T2DM aged 30 to 65 years, participating in the Korean National Diabetes Program (KNDP) cohort who reported their SES and had baseline clinical evaluation were included in the current cross-sectional analysis. SES included the level of education and monthly household income.

Results

Lower education level and lower income level were closely related, and both were associated with older age in men and women. Women and men with lower income and education level had higher carbohydrate and lower fat intake. After adjustment for possible confounding factors, higher education in men significantly lowered the odds of having uncontrolled hyperglycemia (glycosylated hemoglobin ≥7.5%) (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.43 to 0.91 for highest education; Ptrend=0.048), while higher household income in men significantly lowered the odds of having diabetic retinopathy (OR, 0.59; 95% CI, 0.37 to 0.95 for highest income level; Ptrend=0.048). In women, lower income was associated with a higher stress level.

Conclusion

Men with lower SES had higher odds of having diabetic retinopathy and uncontrolled hyperglycemia, showing the need to improve care targeted to this population.

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Clinical Care/Education
Patient Understanding of Hypoglycemia in Tertiary Referral Centers
Nan Hee Cho, Nam Kyung Kim, Eugene Han, Jun Hwa Hong, Eon Ju Jeon, Jun Sung Moon, Mi Hae Seo, Ji Eun Lee, Hyun-Ae Seo, Mi-Kyung Kim, Hye Soon Kim
Diabetes Metab J. 2018;42(1):43-52.   Published online February 23, 2018
DOI: https://doi.org/10.4093/dmj.2018.42.1.43
  • 5,604 View
  • 82 Download
  • 5 Web of Science
  • 5 Crossref
AbstractAbstract PDFPubReader   
Background

Hypoglycemia is an important complication in the treatment of patients with diabetes. We surveyed the insight by patients with diabetes into hypoglycemia, their hypoglycemia avoidance behavior, and their level of worry regarding hypoglycemia.

Methods

A survey of patients with diabetes, who had visited seven tertiary referral centers in Daegu or Gyeongsangbuk-do, Korea, between June 2014 and June 2015, was conducted. The survey contained questions about personal history, symptoms, educational experience, self-management, and attitudes about hypoglycemia.

Results

Of 758 participants, 471 (62.1%) had experienced hypoglycemia, and 250 (32.9%) had experienced hypoglycemia at least once in the month immediately preceding the study. Two hundred and forty-two (31.8%) of the participants had received hypoglycemia education at least once, but only 148 (19.4%) knew the exact definition of hypoglycemia. Hypoglycemic symptoms identified by the participants were dizziness (55.0%), sweating (53.8%), and tremor (40.8%). They mostly chose candy (62.1%), chocolate (37.7%), or juice (36.8%) as food for recovering hypoglycemia. Participants who had experienced hypoglycemia had longer duration of diabetes and a higher proportion of insulin usage. The mean scores for hypoglycemia avoidance behavior and worry about hypoglycemia were 21.2±10.71 and 23.38±13.19, respectively. These scores tended to be higher for participants with higher than 8% of glycosylated hemoglobin, insulin use, and experience of emergency room visits.

Conclusion

Many patients had experienced hypoglycemia and worried about it. We recommend identifying patients that are anxious about hypoglycemia and educating them about what to do when they develop hypoglycemic symptoms, especially those who have a high risk of hypoglycemia.

Citations

Citations to this article as recorded by  
  • Severe Hypoglycemia Increases Dementia Risk and Related Mortality: A Nationwide, Population-based Cohort Study
    Eugene Han, Kyung-do Han, Byung-Wan Lee, Eun Seok Kang, Bong-Soo Cha, Seung-Hyun Ko, Yong-ho Lee
    The Journal of Clinical Endocrinology & Metabolism.2022; 107(5): e1976.     CrossRef
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  • Response: Patient Understanding of Hypoglycemia in Tertiary Referral Centers (Diabetes Metab J 2018;42:43-52)
    Nan Hee Cho, Hye Soon Kim
    Diabetes & Metabolism Journal.2018; 42(2): 175.     CrossRef
  • Letter: Patient Understanding of Hypoglycemia in Tertiary Referral Centers (Diabetes Metab J 2018;42:43-52)
    Jae-Han Jeon
    Diabetes & Metabolism Journal.2018; 42(2): 173.     CrossRef
Review
Clinical Diabetes & Therapeutics
Recent Updates on Type 1 Diabetes Mellitus Management for Clinicians
Ahmed Iqbal, Peter Novodvorsky, Simon R. Heller
Diabetes Metab J. 2018;42(1):3-18.   Published online February 23, 2018
DOI: https://doi.org/10.4093/dmj.2018.42.1.3
  • 8,145 View
  • 109 Download
  • 20 Web of Science
  • 20 Crossref
AbstractAbstract PDFPubReader   

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune condition that requires life-long administration of insulin. Optimal management of T1DM entails a good knowledge and understanding of this condition both by the physician and the patient. Recent introduction of novel insulin preparations, technological advances in insulin delivery and glucose monitoring, such as continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring and improved understanding of the detrimental effects of hypoglycaemia and hyperglycaemia offer new opportunities and perspectives in T1DM management. Evidence from clinical trials suggests an important role of structured patient education. Our efforts should be aimed at improved metabolic control with concomitant reduction of hypoglycaemia. Despite recent advances, these goals are not easy to achieve and can put significant pressure on people with T1DM. The approach of physicians should therefore be maximally supportive. In this review, we provide an overview of the recent advances in T1DM management focusing on novel insulin preparations, ways of insulin administration and glucose monitoring and the role of metformin or sodium-glucose co-transporter 2 inhibitors in T1DM management. We then discuss our current understanding of the effects of hypoglycaemia on human body and strategies aimed at mitigating the risks associated with hypoglycaemia.

Citations

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Sulwon Lecture 2016
Clinical Care/Education
Comprehensive Approach for Managing the Older Person with Diabetes Mellitus
Hyung Joon Yoo
Diabetes Metab J. 2017;41(3):155-159.   Published online May 18, 2017
DOI: https://doi.org/10.4093/dmj.2017.41.3.155
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AbstractAbstract PDFPubReader   

Care of the elderly population with diabetes may not be restricted to the management of hyperglycemia, associated risk factors, and specific diabetic complications. An integrated approach should also include the assessment and management of gerontological problems. Both diabetes mellitus and aging interact toward the direction of the increased incidence of geriatric syndromes. Education is a common element of both diabetes control and geriatric syndrome care. However, it has been perceived that conventional education programs for diabetics are not as effective for the elderly. We have designed geriatric reinforced education (GRE) for application in older diabetics with geriatric syndromes. We observed that the application of GRE improved the glucose control and the status of geriatric syndromes in older adults with diabetes. In summary, in terms of integrating the care of coexisting diabetes and geriatric problems, GRE may be a beneficial tool for the management of older adults with diabetes.

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    Burçin AKÇAY, Tuğba KURU ÇOLAK, Sultan İĞREK, Bahar ÖZGÜL, Adnan APTI
    Bandırma Onyedi Eylül Üniversitesi Sağlık Bilimleri ve Araştırmaları Dergisi.2023; 5(2): 162.     CrossRef
  • Evaluation of diabetes self-management education in geriatrics with type 2 diabetes in Turkey
    Emre S. SAYGILI, Ersen KARAKILIÇ, Serap YASA, Emine ŞEN
    Minerva Endocrinology.2022;[Epub]     CrossRef
  • Treatment Goals for Glycemia in Older Patients with Diabetes Mellitus
    Jung Ah Lim
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Original Articles
Clinical Care/Education
Physician-Directed Diabetes Education without a Medication Change and Associated Patient Outcomes
Hun-Sung Kim, Hyunah Kim, Hae-Kyung Yang, Eun Young Lee, Yoo Jin Jeong, Tong Min Kim, So Jung Yang, Seo Yeon Baik, Seung-Hwan Lee, Jae Hyoung Cho, In Young Choi, Hyeon Woo Yim, Bong-Yun Cha
Diabetes Metab J. 2017;41(3):187-194.   Published online May 12, 2017
DOI: https://doi.org/10.4093/dmj.2017.41.3.187
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AbstractAbstract PDFPubReader   
Background

When patients with diabetes mellitus (DM) are first referred to a hospital from primary health care clinics, physicians have to decide whether to administer an oral hypoglycemic agent (OHA) immediately or postpone a medication change in favor of diabetes education regarding diet or exercise. The aim of this study was to determine the effect of diabetes education alone (without alterations in diabetes medication) on blood glucose levels.

Methods

The study was conducted between January 2009 and December 2013 and included patients with DM. The glycosylated hemoglobin (HbA1c) levels were evaluated at the first visit and after 3 months. During the first medical examination, a designated doctor also conducted a diabetes education session that mainly covered dietary management.

Results

Patients were divided into those who received no diabetic medications (n=66) and those who received an OHA (n=124). Education resulted in a marked decrease in HbA1c levels in the OHA group among patients who had DM for <1 year (from 7.0%±1.3% to 6.6%±0.9%, P=0.0092) and for 1 to 5 years (from 7.5%±1.8% to 6.9%±1.1%, P=0.0091). Those with DM >10 years showed a slightly lower HbA1c target achievement rate of <6.5% (odds ratio, 0.089; P=0.0024).

Conclusion

For patients who had DM for more than 5 years, higher doses or changes in medication were more effective than intensive active education. Therefore, individualized and customized education are needed for these patients. For patients with a shorter duration of DM, it may be more effective to provide initial intensive education for diabetes before prescribing medicines, such as OHAs.

Citations

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  • Management Status of Patients with Type 2 Diabetes Mellitus at General Hospitals in Korea: A 5-Year Follow-Up Study
    Jin Hee Jung, Jung Hwa Lee, Hyang Mi Jang, Young Na, Hee Sun Choi, Yeon Hee Lee, Yang Gyo Kang, Na Rae Kim, Jeong Rim Lee, Bok Rye Song, Kang Hee Sim
    The Journal of Korean Diabetes.2022; 23(1): 64.     CrossRef
  • Effect of Voluntary Participation on Mobile Health Care in Diabetes Management: Randomized Controlled Open-Label Trial
    Da Young Lee, Seung-Hyun Yoo, Kyong Pil Min, Cheol-Young Park
    JMIR mHealth and uHealth.2020; 8(9): e19153.     CrossRef
  • Developing a multi-center clinical data mart of ACEI and ARB for real-world evidence (RWE)
    Hun-Sung Kim, Sue Hyun Lee, Tong Min Kim, Ju Han Kim
    Clinical Hypertension.2018;[Epub]     CrossRef
Clinical Care/Education
Factors Associated with Participation in Diabetes Education: The Korea National Health and Nutrition Examination Survey 2007 to 2009
Jung Min Kim, Jae Won Hong, Jung Hyun Noh, Dong-Jun Kim
Diabetes Metab J. 2016;40(6):447-453.   Published online September 20, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.6.447
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AbstractAbstract PDFPubReader   
Background

A recent study revealed that the participation rate in diabetes education among diabetic patients was only about 50% in Korea. We investigated the factors associated with participation in diabetes education.

Methods

The study included 1,255 patients (≥19 years old) diagnosed with diabetes drawn from the total Korea National Health and Nutrition Examination Survey 2007 to 2009 population comprising 30,705 individuals. We compared age, sex, and age- and sex-adjusted clinical characteristics in patients who had received diabetes education versus those who had not.

Results

Of the 1,255 patients, 19.8% (n=248) had received diabetes education. Patients in the group who received diabetes education were younger, diagnosed at an earlier age, had a longer diabetes duration and were more likely to be using insulin therapy compared with the group who did not receive diabetes education (P<0.001). The group who received diabetes education included fewer manual workers (P<0.001) but more college graduates (P=0.004) compared with the group who did not receive diabetes education. Logistic regression analysis revealed that longer diabetes duration increased the likelihood of receiving diabetes education (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01 to 1.06; P=0.004). Junior high school (OR, 0.47; 95% CI, 0.24 to 0.91; P=0.026) and elementary school education levels (OR, 0.34; 95% CI, 0.17 to 0.65; P=0.001) versus college graduation were inversely correlated with participation in diabetes self-management education. Non-insulin therapy reduced the likelihood of receiving diabetes education (OR, 0.37; 95% CI, 0.21 to 0.64; P<0.001).

Conclusion

Longer diabetes duration, insulin therapy, and higher education level were positively associated with the completion of diabetes education.

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  • Changes in insulin utilization in China from 2020 to 2022
    Chen Chen, Xingyu Liu, Jieqiong Zhang, Shuchen Hu, Jinwei Zhang, Xiaoyong Liu, Caijun Yang, Yu Fang
    Diabetes, Obesity and Metabolism.2024; 26(12): 5681.     CrossRef
  • Management Status of Patients with Type 2 Diabetes Mellitus at General Hospitals in Korea: A 5-Year Follow-Up Study
    Jin Hee Jung, Jung Hwa Lee, Hyang Mi Jang, Young Na, Hee Sun Choi, Yeon Hee Lee, Yang Gyo Kang, Na Rae Kim, Jeong Rim Lee, Bok Rye Song, Kang Hee Sim
    The Journal of Korean Diabetes.2022; 23(1): 64.     CrossRef
  • Team-based multicomponent care improved and sustained glycaemic control in obese people with type 2 diabetes (T2D) in a Diabetes Centre setting: A quality improvement program with quasi-experimental design
    Lee-Ling Lim, Eric S.H. Lau, Risa Ozaki, Tammy T.Y. So, Rebecca Y.M. Wong, Elaine Y.K. Chow, Ronald C.W. Ma, Andrea O.Y. Luk, Juliana C.N. Chan, Alice P.S. Kong
    Diabetes Research and Clinical Practice.2022; 194: 110138.     CrossRef
  • Socio-economic determinants of attendance at diabetes self-management education program: using Andersen’s behavioral model
    Javad Javan-Noughabi, Seyed Saeed Tabatabaee, Sajad Vahedi, Tahere Sharifi
    BMC Health Services Research.2022;[Epub]     CrossRef
  • Sociodemographic Factors Associated with Participation in Diabetes Education among Community-Dwelling Adults with Diabetes
    Young-Hoon Lee
    Yonsei Medical Journal.2020; 61(2): 169.     CrossRef
  • Influence of health education on clinical parameters in type 2 diabetic subjects with and without hypertension: A longitudinal, comparative analysis in routine primary care settings
    Xiu-Jing Hu, Hua-Feng Wu, Yu-Ting Li, Yi Wang, Hui Cheng, Jia-Ji Wang, Bedru H. Mohammed, Isabella Tan, Harry H.X. Wang
    Diabetes Research and Clinical Practice.2020; 170: 108539.     CrossRef
  • Disparities in Diabetes Education Program Use by Disability Status Among People with Diabetes: Findings from Behavioral Risk Factor Surveillance System 2015
    Junrong Shi, Yong Li
    American Journal of Health Education.2019; 50(1): 6.     CrossRef
  • Factors Influencing Preferences of Adults With Type 2 Diabetes for Diabetes Self-Management Education Interventions
    Lifeng Fan, Souraya Sidani
    Canadian Journal of Diabetes.2018; 42(6): 645.     CrossRef
  • Antihyperglycemic agent therapy for adult patients with type 2 diabetes mellitus 2017: a position statement of the Korean Diabetes Association
    Seung-Hyun Ko, Kyu-Yeon Hur, Sang Youl Rhee, Nan-Hee Kim, Min Kyong Moon, Seok-O Park, Byung-Wan Lee, Hyun Jin Kim, Kyung Mook Choi, Jin Hwa Kim
    The Korean Journal of Internal Medicine.2017; 32(6): 947.     CrossRef
  • Antihyperglycemic Agent Therapy for Adult Patients with Type 2 Diabetes Mellitus 2017: A Position Statement of the Korean Diabetes Association
    Seung-Hyun Ko, Kyu-Yeon Hur, Sang Youl Rhee, Nan-Hee Kim, Min Kyong Moon, Seok-O Park, Byung-Wan Lee, Hyun Jin Kim, Kyung Mook Choi, Jin Hwa Kim
    Diabetes & Metabolism Journal.2017; 41(5): 337.     CrossRef
Clinical Care/Education
Clinical Evaluation of OneTouch Diabetes Management Software System in Patients with Type 2 Diabetes Mellitus
Jung Min Kim, Hey Jean Lee, Keum Ok Kim, Jong Chul Won, Kyung Soo Ko, Byung Doo Rhee
Diabetes Metab J. 2016;40(2):129-139.   Published online April 5, 2016
DOI: https://doi.org/10.4093/dmj.2016.40.2.129
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AbstractAbstract PDFPubReader   
Background

OneTouch Diabetes Management Software (OTDMS) is an efficient way to track and monitor the blood glucose level. It is possible to download data from the OneTouch Ultra via the meter's data port, and to transform the numbers of the blood glucose level into a graph, a chart, or statistics. The objectives of this study were to evaluate whether the use of OTDMS in consultation hours would improve patients' knowledge of diabetes mellitus (DM), compliance, satisfaction with doctor and medical treatment, doctor-patient reliability, and glucose control.

Methods

All patients were randomized into either the OTDMS group using OneTouch Ultra or the control groups not using it. Both groups had conventional DM education and only the OTDMS group used data from OTDMS as explanation materials during consultation hours. At enrollment and after 6 months, we performed a questionnaire survey consisting of the diabetes knowledge test, items for compliance of treatment, patient's satisfaction, doctor-patient reliability, and glycosylated hemoglobin (HbA1c).

Results

We analyzed 6-month follow-up data from 92 patients (OTDMS 42 vs. control 50). Both groups showed significant improvements in HbA1c, diabetes knowledge, compliance, reliability, and satisfaction after 6 months. However, there were no significant differences between OTDMS and control groups overall. Only "weekly frequency of checking blood glucose level" of compliance and "trying to follow doctor's order" of reliability showed better results in the OTDMS group.

Conclusion

Using the OTDMS system for explanation during consultation hours seems to be more helpful to improve patient's compliance and reliability, especially for checking blood glucose level and trying to follow the doctor's order.

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    Kristin J Konnyu, Sharlini Yogasingam, Johanie Lépine, Katrina Sullivan, Mostafa Alabousi, Alun Edwards, Michael Hillmer, Sathya Karunananthan, John N Lavis, Stefanie Linklater, Braden J Manns, David Moher, Sameh Mortazhejri, Samir Nazarali, P. Alison Pap
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Intensive Individualized Reinforcement Education Is Important for the Prevention of Hypoglycemia in Patients with Type 2 Diabetes
Yun-Mi Yong, Kyung-Mi Shin, Kang-Min Lee, Jae-Young Cho, Sun-Hye Ko, Min-Hyang Yoon, Tae-Won Kim, Jong-Hyun Jeong, Yong-Moon Park, Seung-Hyun Ko, Yu-Bae Ahn
Diabetes Metab J. 2015;39(2):154-163.   Published online March 10, 2015
DOI: https://doi.org/10.4093/dmj.2015.39.2.154
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AbstractAbstract PDFSupplementary MaterialPubReader   
Background

We investigated whether an intensive individualized reinforcement education program could influence the prevention of hypoglycemic events in patients with type 2 diabetes.

Methods

From March 2013 to September 2013, patients aged 35 to 75 years with type 2 diabetes who had not previously participated in diabetes education, and treated with insulin or a sulfonylurea-containing regimen were included in the study. After structured group education, the patients assigned to the intensive individualized education group (IT) were requested to visit for reinforcement. All subjects in the IT were encouraged to self-manage dose adjustments. Participants in both groups (control group [CG, group education only; n=22] and IT [n=24]) attended follow-up visits at 2, 8, 12, and 24 weeks. At each visit, all patients were asked whether they had experienced hypoglycemia.

Results

The total study population consisted of 20 men (43.5%; mean age and diabetic duration of 55.9±11.0 and 5.1±7.3 years, respectively). At 24 weeks, there were no significant differences in hemoglobin A1c values between the CG and IT. The total number of hypoglycemic events per patient was 5.26±6.5 in the CG and 2.58±2.3 times in the IT (P=0.004). Adherence to lifestyle modification including frequency of exercise, self-monitoring of blood glucose, or dietary habit was not significantly different between the groups. However, adherence to hypoglycemia management, especially the dose adjustment of medication, was significantly higher in the IT compared with the CG.

Conclusion

Compared with the structured group education, additional IT resulted in additional benefits in terms of avoidance of hypoglycemia and treating hypoglycemia in patients with type 2 diabetes.

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    Jun Sung Moon, Shinae Kang, Jong Han Choi, Kyung Ae Lee, Joon Ho Moon, Suk Chon, Dae Jung Kim, Hyun Jin Kim, Ji A Seo, Mee Kyoung Kim, Jeong Hyun Lim, Yoon Ju Song, Ye Seul Yang, Jae Hyeon Kim, You-Bin Lee, Junghyun Noh, Kyu Yeon Hur, Jong Suk Park, Sang
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    Jin Hee Jung, Jung Hwa Lee, Hyang Mi Jang, Young Na, Hee Sun Choi, Yeon Hee Lee, Yang Gyo Kang, Na Rae Kim, Jeong Rim Lee, Bok Rye Song, Kang Hee Sim
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    Ahmed Iqbal, Simon R. Heller
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  • Insulin therapy for adult patients with type 2 diabetes mellitus: a position statement of the Korean Diabetes Association, 2017
    Byung-Wan Lee, Jin Hwa Kim, Seung-Hyun Ko, Kyu Yeon Hur, Nan-Hee Kim, Sang Youl Rhee, Hyun Jin Kim, Min Kyong Moon, Seok-O Park, Kyung Mook Choi
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  • Physician-Directed Diabetes Education without a Medication Change and Associated Patient Outcomes
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  • Antihyperglycemic agent therapy for adult patients with type 2 diabetes mellitus 2017: a position statement of the Korean Diabetes Association
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Education as Prescription for Patients with Type 2 Diabetes Mellitus: Compliance and Efficacy in Clinical Practice
Mi Yeon Kim, Sunghwan Suh, Sang-Man Jin, Se Won Kim, Ji Cheol Bae, Kyu Yeon Hur, Sung Hye Kim, Mi Yong Rha, Young Yun Cho, Myung-Shik Lee, Moon Kyu Lee, Kwang-Won Kim, Jae Hyeon Kim
Diabetes Metab J. 2012;36(6):452-459.   Published online December 12, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.6.452
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AbstractAbstract PDFPubReader   
Background

Diabetes self-management education has an important role in diabetes management. The efficacy of education has been proven in several randomized trials. However, the status of diabetes education programs in real Korean clinical practice has not yet been evaluated in terms of patient compliance with the education prescription.

Methods

We retrospectively analyzed clinical and laboratory data from all patients who were ordered to undergo diabetes education during 2009 at Samsung Medical Center, Seoul, Korea (n=2,291). After excluding ineligible subjects, 588 patients were included in the analysis.

Results

Among the 588 patients, 433 received education. The overall compliance rate was 73.6%, which was significantly higher in the subjects with a short duration or living in a rural area compared to those with a long duration (85.0% vs. 65.1%, respectively; P<0.001) or living in an urban area (78.2% vs. 70.4%, respectively; P=0.037). The hemoglobin A1c decreased greater in the compliant group (from 7.84±1.54 at baseline to 6.79±1.06 at 3 months and 6.97±1.20 at 12 months after prescription in the compliant group vs. from 7.74±1.25 to 7.14±1.02 and 7.24±1.24 in the non-compliant group; P=0.001). The decrease in hemoglobin A1c was greater in the subjects with a short duration (P=0.032).

Conclusion

In our study a large percent of patients refuse to get education despite having a prescription from their physician. This refusal rate was higher in the patients with long-standing diabetes or in urban residence. Furthermore, education was more effective in patients with a short duration of diabetes in clinical practice.

Citations

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Influence of the Duration of Diabetes on the Outcome of a Diabetes Self-Management Education Program
Seung-Hyun Ko, Sin-Ae Park, Jae-Hyoung Cho, Sun-Hye Ko, Kyung-Mi Shin, Seung-Hwan Lee, Ki-Ho Song, Yong-Moon Park, Yu-Bae Ahn
Diabetes Metab J. 2012;36(3):222-229.   Published online June 14, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.3.222
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AbstractAbstract PDFPubReader   
Background

Diabetes education and lifestyle modification are critical components in controlling blood glucose levels of people with type 2 diabetes. Until now, available data on the effectiveness of education with respect to the duration of diabetes are limited. We investigated whether adherence to lifestyle behavior modification prompted by diabetes education was influenced by the duration of diabetes.

Methods

Two hundred and twenty-five people with type 2 diabetes were recruited for an intensive, collaborative, group-based diabetes education program with annual reinforcement. We divided the patients into two groups based on the duration of their diabetes prior to the education program (≤1 year [≤1Y] vs. ≥3 years [≥3Y]). Dietary habits, physical activity, and the frequency of blood glucose self-monitoring were evaluated with a questionnaire prior to education and at the follow-up endpoint.

Results

The mean follow-up period was 32.2 months. The mean hemoglobin A1c (A1C) value was significantly lower in the ≤1Y group. Self-care behaviors, measured by scores for dietary habits (P=0.004) and physical activity (P<0.001), were higher at the endpoint in the ≤1Y group than in the ≥3Y group. Logistic regression analysis revealed that a longer diabetes duration before education was significantly associated with mean A1C levels greater than or equal to 7.0% (53 mmol/mol).

Conclusion

Diabetes duration influenced the effectiveness of diabetes education on lifestyle behavior modification and glycemic control. More-intense, regular, and sustained reinforcement with encouragement may be required for individuals with longstanding type 2 diabetes.

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Perception of Clinicians and Diabetic Patients on the Importance of Postprandial Glucose Control and Diabetes Education Status: A Cross Sectional Survey
Ji Hun Choi, Cheol Young Park, Bong Soo Cha, In Joo Kim, Tae Sun Park, Joong Yeol Park, Kyung Soo Park, Kun Ho Yoon, In Kyu Lee, Sung Woo Park
Diabetes Metab J. 2012;36(2):120-127.   Published online April 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.2.120
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AbstractAbstract PDFPubReader   
Background

Recent studies have shown the importance of postprandial glucose (PPG) in the development of diabetes complications. This study was conducted in order to survey the perceptions of clinicians and diabetic patients with respect to PPG management and the current status of diabetes education.

Methods

This was a cross-sectional study involving face-to-face interviews and an open questionnaire survey conducted in Korea. A total of 300 patients and 130 clinicians completed questionnaires, which included current education status, self monitoring of blood glucose (SMBG), criteria of diagnosis and management, and perceptions relating to PPG management.

Results

While there was a significantly higher perceived need for diabetes education, the sufficiency of the current education was considered to be severely lacking. Fasting plasma glucose (FPG), PPG, and glycosylated hemoglobin (HbA1c) were all important considerations for clinicians when making a diagnosis of diabetes, although PPG was considered less important than FPG or HbA1c in the treatment of diabetes. Most clinicians and patients were aware of the importance of PPG, but actual education on the importance of PPG was not actively being delivered.

Conclusion

Our study showed that the current status of diabetes education is insufficient to meet the needs of the Korean population. A considerable gap was found to exist between awareness and what was actually taught in the current education program in regard to the importance of PPG. These results suggest that clinicians need to be more active in patient education, especially in regard to the importance of PPG.

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Review
Improving Patients' Adherence to Physical Activity in Diabetes Mellitus: A Review
Shan-hu Qiu, Zi-lin Sun, Xue Cai, Lili Liu, Bingquan Yang
Diabetes Metab J. 2012;36(1):1-5.   Published online February 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.1.1
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AbstractAbstract PDFPubReader   

Regular physical activity (PA) is a key element in the prevention and management of type 2 diabetes mellitus (T2DM). Participation in regular PA improves blood glucose control and can prevent or delay T2DM and its complications, along with positively affecting lipids, blood pressure, cardiovascular events, mortality, and quality of life. However, most people with T2DM are not active and show poor adherence. This paper reviews the possible barriers to PA and strategies to improve the adherence to PA. Based on the currently available literature, it is concluded that self-efficacy and social support from family, friends, and health care providers play the important role in adoption and maintenance of regular PA. Here we also highlight some new modern and innovative interventions that facilitate exercise participation and improve the adherence.

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Original Article
Effect on Glycemic, Blood Pressure, and Lipid Control according to Education Types
Mi-Ju Choi, Seung-Hyun Yoo, Kum-Rae Kim, Yoo-Mi Bae, Sun-Hee Ahn, Seong-Shin Kim, Seong-Ah Min, Jin-Sun Choi, Seung-Eun Lee, Yeo-Jin Moon, Eun Jung Rhee, Cheol-Young Park, Won Young Lee, Ki Won Oh, Sung Woo Park, Sun Woo Kim
Diabetes Metab J. 2011;35(6):580-586.   Published online December 26, 2011
DOI: https://doi.org/10.4093/dmj.2011.35.6.580
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AbstractAbstract PDFPubReader   
Background

Diabetes self-management education and reinforcement are important for effective management of the disease. We investigated the effectiveness of interactive small-group education on glycemic, blood pressure, and lipid levels.

Methods

For this study, 207 type 2 diabetes patients with suboptimal glycemic control (HbA1c levels >6.5%) were enrolled. The conventional education group received an existing education program from April to November in 2006, and the interactive education group received a new small-group education program from December 2006 to July 2007. The two groups were comparatively analyzed for changes in blood sugar, glycated hemoglobin, lipid, and blood pressure at baseline, 3, 6, and 12 months and the proportion of patients achieving target goals at 12 months.

Results

After 12 months of follow-up, HbA1c levels in the interactive education group were significantly lower than in the conventional education group (6.7% vs. 6.4%, P<0.001). Fasting and 2 hour postprandial glucose concentrations, total cholesterol, and low density lipoprotein cholesterol were significantly lower in the interactive education group than in the conventional education group. The proportion of patients that achieved target goals was significantly higher in the interactive education group.

Conclusion

The small-group educational method improved and re-established the existing group educational method. This finding suggests that the importance of education appears to be related to the method by which it is received rather than the education itself. Thus, the use of small-group educational methods to supplement existing educational methods established for diverse age levels should be considered in the future.

Citations

Citations to this article as recorded by  
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Diabetes Metab J : Diabetes & Metabolism Journal
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