Computerized information management systems are becoming a vital component of quality diabetes care. For instance, they can prompt doctors to conduct recommended diabetes care monitoring tests such as eye and foot checks. They can enhance patient self-management of diabetes, for example, via use of pocket-size insulin dosage computers. Use of such systems can improve diabetes-related outcomes, according to a recent systematic review of randomized clinical trials of computer-assisted interventions in diabetes care. The review was supported in part by the Agency for Healthcare Research and Quality (HS10472).
E. Andrew Balas, M.D., Ph.D., of St. Louis University, and his colleagues grouped 40 eligible studies into three categories: computerized prompting of diabetes care, use of home glucose records in computer-assisted insulin dose adjustment, and computer-assisted diabetes patient education. They found that computerized systems significantly improved patients' glycated hemoglobin (measure of overall blood sugar control over the past 2 to 3 months) and blood glucose levels (measured at the time of the test) in seven and six trials, respectively. Computerized prompting substantially improved physician compliance with diabetes care guidelines in six of eight studies. Overall compliance with recommended diabetes care procedures, for example, eye and foot examinations and blood-sugar measurements, was 71 to 227 percent higher among doctors prompted by computer systems to perform the procedures compared with doctors who did not receive the prompts.
Three of four pocket-sized insulin dosage computers reduced hypoglycemic events (abnormally low blood sugar levels that can lead to convulsions or coma) and insulin doses. Meta-analysis of studies using home glucose records in insulin dose adjustment (patients collected and transmitted the data electronically) documented a mean decrease in glycated hemoglobin of 1.4 mmol/L and a decrease in blood glucose of .33 mmol/L. Several computerized educational programs improved diet and metabolic indicators of diabetes control.
See "Computerized knowledge management in diabetes care," by Dr. Balas, Santosh Krishna, Ph.D., Rainer A. Kretschmer, M.D., and others, in the June 2004 Medical Care 42(6), pp. 610-621.