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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>
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