Utilization of a Cloud-Based Diabetes Management Program for Insulin Initiation and Titration Enables Collaborative Decision Making Between Healthcare Providers and Patients.

BACKGROUND: Overseeing proper insulin initiation and titration remains a challenging task in diabetes care. Recent advances in mobile technology have enabled new models of collaborative care between patients and healthcare providers (HCPs). We hypothesized that the adoption of such technology could help individuals starting basal insulin achieve better glycemic control compared with standard clinical practice. MATERIALS AND METHODS: This was a 12 ± 2-week randomized controlled study with 40 individuals with type 2 diabetes who were starting basal insulin due to poor glycemic control. The control group (n = 20) received standard face-to-face care and phone follow-up as needed in a tertiary center, whereas the intervention group (n = 20) received care through the cloud-based diabetes management program where regular communications about glycemic control and insulin doses were conducted via patient self-tracking tools, shared decision-making interfaces, secure text messages, and virtual visits (audio, video, and shared screen control) instead of office visits. RESULTS: By intention-to-treat analysis, the intervention group achieved a greater hemoglobin A1c decline compared with the control group (3.2 ± 1.5% vs. 2.0% ± 2.0%; P = 0.048). The Diabetes Treatment Satisfaction Questionnaire showed a significant improvement in the intervention group compared with the control group (an increase of 10.1 ± 11.7 vs. 2.1 ± 6.5 points; P = 0.01). HCPs spent less time with patients in the intervention group compared with those in the control group (65.9 min per subject vs. 81.6 min per subject). However, the intervention group required additional training time to use the mobile device. CONCLUSIONS: Mobile health technology could be an effective tool in sharing data, enhancing communication, and improving glycemic control while enabling collaborative decision making in diabetes care.

Analysis of the comparison of lancing devices for self-monitoring of blood glucose regarding lancing pain.

Reducing barriers to self-monitoring of blood glucose (SMBG) remains an ongoing goal. One major reported barrier is lancing pain. This analysis was written in response to the article by Kocher and associates in this issue of Journal of Diabetes Science and Technology in which 157 patients with diabetes experienced in the use of SMBG compared high market share blood glucose monitoring systems and lancing devices. Upon review of their findings, we found that their conclusions-Accu-check systems and lancing devices were preferred-were valid within the limitations of the study. However, we noted some factors that would warrant further study and possibly change the outcome. Information from this and other studies on the topic will be useful as a reference for patients and providers in working towards removing barriers to SMBG.