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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Telemedicine-Based KADIS® Combined with CGMS™ Has High Potential for Improving Outpatient Diabetes Care</title><author><name sortKey="Salzsieder, Eckhard" sort="Salzsieder, Eckhard" uniqKey="Salzsieder E" first="Eckhard" last="Salzsieder">Eckhard Salzsieder</name><affiliation><nlm:aff id="au1"><institution>Institute of Diabetes “Gerhardt Katsch” Karlsburg</institution>,<addr-line>Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Augstein, Petra" sort="Augstein, Petra" uniqKey="Augstein P" first="Petra" last="Augstein">Petra Augstein</name><affiliation><nlm:aff id="au1"><institution>Institute of Diabetes “Gerhardt Katsch” Karlsburg</institution>,<addr-line>Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Vogt, Lutz" sort="Vogt, Lutz" uniqKey="Vogt L" first="Lutz" last="Vogt">Lutz Vogt</name><affiliation><nlm:aff id="au1"><institution>Institute of Diabetes “Gerhardt Katsch” Karlsburg</institution>,<addr-line>Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Kohnert, Klaus Dieter" sort="Kohnert, Klaus Dieter" uniqKey="Kohnert K" first="Klaus-Dieter" last="Kohnert">Klaus-Dieter Kohnert</name><affiliation><nlm:aff id="au1"><institution>Institute of Diabetes “Gerhardt Katsch” Karlsburg</institution>,<addr-line>Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Heinke, Peter" sort="Heinke, Peter" uniqKey="Heinke P" first="Peter" last="Heinke">Peter Heinke</name><affiliation><nlm:aff id="au1"><institution>Institute of Diabetes “Gerhardt Katsch” Karlsburg</institution>,<addr-line>Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Freyse, Ernst Joachim" sort="Freyse, Ernst Joachim" uniqKey="Freyse E" first="Ernst-Joachim" last="Freyse">Ernst-Joachim Freyse</name><affiliation><nlm:aff id="au1"><institution>Institute of Diabetes “Gerhardt Katsch” Karlsburg</institution>,<addr-line>Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Azim Ahmed, Abdel" sort="Azim Ahmed, Abdel" uniqKey="Azim Ahmed A" first="Abdel" last="Azim Ahmed">Abdel Azim Ahmed</name><affiliation><nlm:aff id="au2"><institution>Ajman University of Science and Technology Network</institution>,<addr-line>Ajman, United Arab Emirates</addr-line></nlm:aff></affiliation></author><author><name sortKey="Metwali, Zakia" sort="Metwali, Zakia" uniqKey="Metwali Z" first="Zakia" last="Metwali">Zakia Metwali</name><affiliation><nlm:aff id="au2"><institution>Ajman University of Science and Technology Network</institution>,<addr-line>Ajman, United Arab Emirates</addr-line></nlm:aff></affiliation></author><author><name sortKey="Salman, Iman" sort="Salman, Iman" uniqKey="Salman I" first="Iman" last="Salman">Iman Salman</name><affiliation><nlm:aff id="au2"><institution>Ajman University of Science and Technology Network</institution>,<addr-line>Ajman, United Arab Emirates</addr-line></nlm:aff></affiliation></author><author><name sortKey="Attef, Omer" sort="Attef, Omer" uniqKey="Attef O" first="Omer" last="Attef">Omer Attef</name><affiliation><nlm:aff id="au2"><institution>Ajman University of Science and Technology Network</institution>,<addr-line>Ajman, United Arab Emirates</addr-line></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">19885114</idno><idno type="pmc">2769624</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769624</idno><idno type="RBID">PMC:2769624</idno><date when="2007">2007</date><idno type="wicri:Area/Pmc/Corpus">000386</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000386</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Telemedicine-Based KADIS® Combined with CGMS™ Has High Potential for Improving Outpatient Diabetes Care</title><author><name sortKey="Salzsieder, Eckhard" sort="Salzsieder, Eckhard" uniqKey="Salzsieder E" first="Eckhard" last="Salzsieder">Eckhard Salzsieder</name><affiliation><nlm:aff id="au1"><institution>Institute of Diabetes “Gerhardt Katsch” Karlsburg</institution>,<addr-line>Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Augstein, Petra" sort="Augstein, Petra" uniqKey="Augstein P" first="Petra" last="Augstein">Petra Augstein</name><affiliation><nlm:aff id="au1"><institution>Institute of Diabetes “Gerhardt Katsch” Karlsburg</institution>,<addr-line>Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Vogt, Lutz" sort="Vogt, Lutz" uniqKey="Vogt L" first="Lutz" last="Vogt">Lutz Vogt</name><affiliation><nlm:aff id="au1"><institution>Institute of Diabetes “Gerhardt Katsch” Karlsburg</institution>,<addr-line>Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Kohnert, Klaus Dieter" sort="Kohnert, Klaus Dieter" uniqKey="Kohnert K" first="Klaus-Dieter" last="Kohnert">Klaus-Dieter Kohnert</name><affiliation><nlm:aff id="au1"><institution>Institute of Diabetes “Gerhardt Katsch” Karlsburg</institution>,<addr-line>Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Heinke, Peter" sort="Heinke, Peter" uniqKey="Heinke P" first="Peter" last="Heinke">Peter Heinke</name><affiliation><nlm:aff id="au1"><institution>Institute of Diabetes “Gerhardt Katsch” Karlsburg</institution>,<addr-line>Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Freyse, Ernst Joachim" sort="Freyse, Ernst Joachim" uniqKey="Freyse E" first="Ernst-Joachim" last="Freyse">Ernst-Joachim Freyse</name><affiliation><nlm:aff id="au1"><institution>Institute of Diabetes “Gerhardt Katsch” Karlsburg</institution>,<addr-line>Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Azim Ahmed, Abdel" sort="Azim Ahmed, Abdel" uniqKey="Azim Ahmed A" first="Abdel" last="Azim Ahmed">Abdel Azim Ahmed</name><affiliation><nlm:aff id="au2"><institution>Ajman University of Science and Technology Network</institution>,<addr-line>Ajman, United Arab Emirates</addr-line></nlm:aff></affiliation></author><author><name sortKey="Metwali, Zakia" sort="Metwali, Zakia" uniqKey="Metwali Z" first="Zakia" last="Metwali">Zakia Metwali</name><affiliation><nlm:aff id="au2"><institution>Ajman University of Science and Technology Network</institution>,<addr-line>Ajman, United Arab Emirates</addr-line></nlm:aff></affiliation></author><author><name sortKey="Salman, Iman" sort="Salman, Iman" uniqKey="Salman I" first="Iman" last="Salman">Iman Salman</name><affiliation><nlm:aff id="au2"><institution>Ajman University of Science and Technology Network</institution>,<addr-line>Ajman, United Arab Emirates</addr-line></nlm:aff></affiliation></author><author><name sortKey="Attef, Omer" sort="Attef, Omer" uniqKey="Attef O" first="Omer" last="Attef">Omer Attef</name><affiliation><nlm:aff id="au2"><institution>Ajman University of Science and Technology Network</institution>,<addr-line>Ajman, United Arab Emirates</addr-line></nlm:aff></affiliation></author></analytic><series><title level="j">Journal of diabetes science and technology (Online)</title><idno type="eISSN">1932-2968</idno><imprint><date when="2007">2007</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The Karlsburg Diabetes Management System (KADIS®) was developed over almost two decades by modeling physiological glucose–insulin interactions. When combined with the telemedicine-based communication system TeleDIAB® and a continuous glucose monitoring system (CGMS™), KADIS has the potential to provide effective, evidence-based support to doctors in their daily efforts to optimize glycemic control.</p></sec><sec sec-type="methods"><title>Methods</title><p>To demonstrate the feasibility of improving diabetes control with the KADIS system, an experimental version of a telemedicine-based diabetes care network was established, and an international, multicenter, pilot study of 44 insulin-treated patients with type 1 and 2 diabetes was performed. Patients were recruited from five outpatient settings where they were treated by general practitioners or diabetologists. Each patient underwent CGMS monitoring under daily life conditions by a mobile monitoring team of the Karlsburg diabetes center at baseline and 3 months following participation in the KADIS advisory system and telemedicine-based diabetes care network. The current metabolic status of each patient was estimated in the form of an individualized “metabolic fingerprint.” The fingerprint characterized glycemic status by KADIS-supported visualization of relationships between the monitored glucose profile and causal endogenous and exogenous factors and enabled evidence-based identification of “weak points” in glycemic control. Using KADIS-based simulations, physician recommendations were generated in the form of patient-centered decision support that enabled elimination of weak points. The analytical outcome was provided in a KADIS report that could be accessed at any time through TeleDIAB. The outcome of KADIS-based support was evaluated by comparing glycosylated hemoglobin (HbA1c) levels and 24-hour glucose profiles before and after the intervention.</p></sec><sec><title>Results</title><p>Application of KADIS-based decision support reduced HbA1c by 0.62% within 3 months. The reduction was strongly related to the level of baseline HbA1c, diabetes type, and outpatient treatment setting. The greatest benefit was obtained in the group with baseline HbA1c levels >9% (1.22% reduction), and the smallest benefit was obtained in the group with baseline HbA1c levels of 6–7% (0.13% reduction). KADIS was more beneficial for patients with type 1 diabetes (0.79% vs 0.48% reduction) and patients treated by general practitioners (1.02% vs 0.26% reduction). Changes in HbA1c levels were paralleled by changes in mean daily 24-hour glucose profiles and fluctuations in daily glucose.</p></sec><sec><title>Conclusion</title><p>Application of KADIS in combination with CGMS and the telemedicine-based communication system TeleDIAB successfully improved outpatient diabetes care and management.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Diabetes Sci Technol</journal-id><journal-id journal-id-type="publisher-id">dst</journal-id><journal-title-group><journal-title>Journal of diabetes science and technology (Online)</journal-title></journal-title-group><issn pub-type="epub">1932-2968</issn><publisher><publisher-name>Diabetes Technology Society</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">19885114</article-id><article-id pub-id-type="pmc">2769624</article-id><article-id pub-id-type="publisher-id">dst.1.4.0511</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject></subj-group></article-categories><title-group><article-title>Telemedicine-Based KADIS® Combined with CGMS™ Has High Potential for Improving Outpatient Diabetes Care</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Salzsieder</surname><given-names>Eckhard</given-names></name><degrees>Ph.D.</degrees><xref ref-type="aff" rid="au1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Augstein</surname><given-names>Petra</given-names></name><degrees>Ph.D.</degrees><xref ref-type="aff" rid="au1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Vogt</surname><given-names>Lutz</given-names></name><degrees>Ph.D.</degrees><xref ref-type="aff" rid="au1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Kohnert</surname><given-names>Klaus-Dieter</given-names></name><degrees>M.D., Ph.D.</degrees><xref ref-type="aff" rid="au1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Heinke</surname><given-names>Peter</given-names></name><degrees>B.S.</degrees><xref ref-type="aff" rid="au1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Freyse</surname><given-names>Ernst-Joachim</given-names></name><degrees>M.D., Ph.D.</degrees><xref ref-type="aff" rid="au1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Azim Ahmed</surname><given-names>Abdel</given-names></name><degrees>Ph.D.</degrees><xref ref-type="aff" rid="au2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Metwali</surname><given-names>Zakia</given-names></name><degrees>M.D., Ph.D.</degrees><xref ref-type="aff" rid="au2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Salman</surname><given-names>Iman</given-names></name><degrees>B.S.</degrees><xref ref-type="aff" rid="au2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Attef</surname><given-names>Omer</given-names></name><degrees>Ph.D.</degrees><xref ref-type="aff" rid="au2"><sup>2</sup></xref></contrib></contrib-group><aff id="au1"><label>1</label><institution>Institute of Diabetes “Gerhardt Katsch” Karlsburg</institution>,<addr-line>Germany</addr-line></aff><aff id="au2"><label>2</label><institution>Ajman University of Science and Technology Network</institution>,<addr-line>Ajman, United Arab Emirates</addr-line></aff><author-notes><corresp>Correspondence to: Eckhard Salzsieder, Ph.D., Institute of Diabetes “Gerhardt Katsch” Karlsburg, Greifswalder Str.11e, D-17495 Karlsburg, Germany; email address <email>salzsied@diabetes-karlsburg.de</email></corresp></author-notes><pub-date pub-type="epub"><month>7</month><year>2007</year></pub-date><pub-date pub-type="collection"><month>7</month><year>2007</year></pub-date><volume>1</volume><issue>4</issue><fpage>511</fpage><lpage>521</lpage><permissions><copyright-statement>© 2007 Diabetes Technology Society</copyright-statement></permissions><abstract><sec><title>Background</title><p>The Karlsburg Diabetes Management System (KADIS®) was developed over almost two decades by modeling physiological glucose–insulin interactions. When combined with the telemedicine-based communication system TeleDIAB® and a continuous glucose monitoring system (CGMS™), KADIS has the potential to provide effective, evidence-based support to doctors in their daily efforts to optimize glycemic control.</p></sec><sec sec-type="methods"><title>Methods</title><p>To demonstrate the feasibility of improving diabetes control with the KADIS system, an experimental version of a telemedicine-based diabetes care network was established, and an international, multicenter, pilot study of 44 insulin-treated patients with type 1 and 2 diabetes was performed. Patients were recruited from five outpatient settings where they were treated by general practitioners or diabetologists. Each patient underwent CGMS monitoring under daily life conditions by a mobile monitoring team of the Karlsburg diabetes center at baseline and 3 months following participation in the KADIS advisory system and telemedicine-based diabetes care network. The current metabolic status of each patient was estimated in the form of an individualized “metabolic fingerprint.” The fingerprint characterized glycemic status by KADIS-supported visualization of relationships between the monitored glucose profile and causal endogenous and exogenous factors and enabled evidence-based identification of “weak points” in glycemic control. Using KADIS-based simulations, physician recommendations were generated in the form of patient-centered decision support that enabled elimination of weak points. The analytical outcome was provided in a KADIS report that could be accessed at any time through TeleDIAB. The outcome of KADIS-based support was evaluated by comparing glycosylated hemoglobin (HbA1c) levels and 24-hour glucose profiles before and after the intervention.</p></sec><sec><title>Results</title><p>Application of KADIS-based decision support reduced HbA1c by 0.62% within 3 months. The reduction was strongly related to the level of baseline HbA1c, diabetes type, and outpatient treatment setting. The greatest benefit was obtained in the group with baseline HbA1c levels >9% (1.22% reduction), and the smallest benefit was obtained in the group with baseline HbA1c levels of 6–7% (0.13% reduction). KADIS was more beneficial for patients with type 1 diabetes (0.79% vs 0.48% reduction) and patients treated by general practitioners (1.02% vs 0.26% reduction). Changes in HbA1c levels were paralleled by changes in mean daily 24-hour glucose profiles and fluctuations in daily glucose.</p></sec><sec><title>Conclusion</title><p>Application of KADIS in combination with CGMS and the telemedicine-based communication system TeleDIAB successfully improved outpatient diabetes care and management.</p></sec></abstract><kwd-group><kwd>advisory system</kwd><kwd>continuous glucose monitoring</kwd><kwd>decision support</kwd><kwd>HbA1c</kwd><kwd>KADIS</kwd><kwd>outpatient diabetes care</kwd><kwd>telemedicine</kwd></kwd-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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