The use of patient-centred health information systems in type 2 diabetes mellitus

Liliana Laranjo* §, Ana Rita Pedro§

* USF Villa Longa, § Portuguese School of Public Health

Type 2 diabetes mellitus (DM) is a challenging health problem worldwide1 2 and there is an increasing need for changes in the delivery of DM care. Patient-centred health informationsystems (PCHIS) may be seen as an innovative solution to improve DM self-management and may assist General Practitioners (GPs), who play a central role in DM care, in effectivelymanaging diabetes, beyond clinical visits.

Introduction

Review the published literature concerning the use of PCHIS in type 2 DMself-management and assess their effect on metabolic control, amongother outcomes.

Aims

Two electronic databases were searched using several terms related to PCHIS. The search was limited toliterature published between January 2005 and June 2010. The three characteristics that wereconsidered to define a PCHIS were: being patient-centered, functioning as a data repository, andproviding health information/education or self-management resources. Published experimental studiesthat evaluated the use of PCHIS by type 2 diabetics were selected and grouped according to theiroutcomes. Finally, a narrative synthesis was undertaken.

Methods

Results

This review suggests that PCHIS might be useful in DM self-management, as they seem to have the potential to improve glycemic control and other outcomes, but the number of studiesavailable in this area is still insufficient. More quality research is needed, so that solid evidence can lead to practical implications for patients and GPs, as well as other caregivers.

References

Conclusion

1.Wild, S., et al., Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care, 2004. 27(5): p. 1047-53. 2.Shaw, J.E., R.A. Sicree, and P.Z. Zimmet, Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract, 2010. 87(1): p. 4-14. 3.Kim, S.I. and H.S. Kim, Effectiveness of mobile and internet intervention in patients with obese type 2 diabetes. Int J Med Inform, 2008. 77(6): p. 399-404. 4.Cho, J.H., et al., Long-term effect of the Internet-based glucose monitoring system on HbA1c reduction and glucose stability: a 30-month follow-up study for diabetes management with a ubiquitous medical care system. Diabetes Care, 2006. 29(12): p. 2625-31. 5. Cho, J.H., et al., Mobile communication using a mobile phone with a glucometer for glucose control in Type 2 patients with diabetes: as effective as an Internet-based glucose monitoring system. J Telemed Telecare, 2009. 15(2): p. 77-82. 6.Grant, R.W., et al., Practice-linked online personal health records for type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med, 2008. 168(16): p. 1776-82. 7. McMahon, G.T., et al., Web-based care management in patients with poorly controlled diabetes. Diabetes Care, 2005. 28(7): p. 1624-9. 8.Ralston, J.D., et al., Web-based collaborative care for type 2 diabetes: a pilot randomized trial. Diabetes Care, 2009. 32(2): p. 234-9. 9.Quinn, C.C., et al., WellDoc mobile diabetes management randomized controlled trial: change in clinical and behavioral outcomes and patient and physician satisfaction. Diabetes Technol Ther, 2008. 10(3): p. 160-8. 10. Bond, G.E., et al., The effects of a web-based intervention on psychosocial well-being among adults aged 60 and older with diabetes: a randomized trial. Diabetes Educ, 2010. 36(3): p. 446-56.

A total of 828 articles were retrieved and 8 satisfied the inclusion criteria (Figure 1, Table 1).

The systems used in the reviewed studies varied considerably, from being solely web-based interventions, toinvolving the use of a mobile phone, isolated or combined with the internet. Only one study evaluated the useof a Personal Health Record.

Seven studies measured glycemic control 3,4, 5,6,8,9,10; other outcomes were analysed less often.

The majority of the interventions had a positive impact on overall glycemic control (6 studies showed astatistical significant decrease in HbA1c levels3,4,5,8,9,10 versus baseline/control group).

Blood pressure (BP) was evaluated in 3 studies6,8,9; one showed a significant decline in systolic BP inhypertensive patients (versus control group)8.

No statistical significant decreases were found in total cholesterol5,9 and LDL cholesterol5,6,8. HDL cholesterolwas improved versus baseline (p<0.05)8 in one of the two studies that measured it5,8. Triglyceride levels wereimproved versus baseline (p<0.01)8 in one of two studies5,8.

Patients’ satisfaction was reported in two studies, where the majority of patients (79% and 91%, respectively)was shown to be satisfied with the new management opportunities offered by the interventions5,10.One study evaluated quality of life and self-efficacy, showing statistical significant improvements in both,versus the control group7.One study focused on self-care skills, demonstrating an improvement in diet-related skills, versus the controlgroup (p=0.036)10.

First author, year

of publication

Study

design

Mean Age

Intervention /

Control

% men:

Intervention /

Control

Duration

(mo)

Sample size:

Intervention /

Control

Diabetes duration

Intervention /

Control

(years)

Baseline HbA1c

Intervention /

Control

Drop-out

rate (%) Location

Kim, 20083 QES 45.5 / 48.5 43.8 / 50.0 12 20 / 20 7.8 / 4.6 8.16 / 7.66 15 Korea

Cho, 20064 RCT 51.3 / 54.6 65.0 / 57.5 30 40 / 40 NR 7.7 / 7.5 11.25 Korea

Cho, 20095 RCT (NIT) 51.1 / 45.2 80.0 / 76.5 3 38 / 37 NR 8.3 / 7.6 8 Korea

Grant, 20086 RCT 58.8 / 53.3 57.0 / 44.0 12 126 / 118 NR 7.3 / 7.4 NR USA

Bond, 20107 RCT 66.2 / 68.2 58.0 / 52.0 6 31 / 31 8.9 / 9.9 NR NR USA

McMahon, 20058 RCT 64 / 63 99.0 / 100.0 12 52 / 52 NR 10 / 9.9 NR USA

Ralston, 20099 RCT 57 / 57.6 52.4 / 48.8 12 42 / 41 NR 8.2 / 7.9 10.84 USA

Quinn, 200810 RCT NR 30.8 / 38.5 3 13 / 13 7.6 / 11 9.51 / 9.05 15.39 USA

mo, months; NIT, non-inferiority trial; NR, not reported; QES, quasi-experimental study; RCT, randomized control trial

Table 1: Summary of characteristics of the included studies

Figure 1. Flow diagram of the literature search and review process