Kwon et al. (1) demonstrated that an Internet-based blood glucose monitoring system, which provided frequent and responsive interactions between patients and their physicians online, can be as effective as face-to-face diabetes follow-ups. Routine medical services typically include face-to-face patient education, in which each patient receives his/her education materials (such as goals to achieve and the knowledge and skills for self-management). To extend patient education for a lasting effect, we have developed a patient-oriented education management (POEM) system (available at www.dmc.idv.tw) (2).
In the system, we reorganize each patient’s education materials, medication data, and laboratory test results at every visit and then present the information on the Web. The system also provides reminders for the next follow-up with e-mails and short messages via cell phone. This way, the patient or his/her family can easily access the materials after leaving the hospital and constantly review medical care data and education materials for improvement of his/her diabetes condition.
To evaluate the system, we conducted an 8-month follow-up study. A total of 274 patients with type 2 diabetes were randomly recruited from the hospital: 134 (57% men and 43% women) in the experimental group (using the POEM system) and 140 (46% men and 54% women) in the control group. Subjects were aged 66.0 ± 8.5 and 61.2 ± 12 years in the experimental and control groups, respectively. Diabetes duration was 5.28 ± 4.70 and 7.01 ± 5.44 years in the experimental and control groups, respectively. Improvements in diabetes condition were evaluated by laboratory test results, including fasting blood glucose, HbA1c (A1C), total cholesterol level, triglycerides, and HDL.
The test results (means ± SD) at the first visit for patients’ fasting blood glucose, A1C, total cholesterol level, triglycerides, and HDL were 187.54 ± 77.10 and 189.99 ± 73.49 mg/dl, 9.03 ± 2.79 and 8.95 ± 2.23%, 193.29 ± 47.93 and 202.52 ± 58.45 mg/dl, 152.48 ± 70.85 and 157.37 ± 74.88 mg/dl, and 44.97 ± 12.09 and 45.32 ± 12.08 mg/dl in the experimental and control groups, respectively. During 8-month follow-ups, the average results of their fasting blood glucose, A1C, total cholesterol level, triglycerides, and HDL were 114.87 ± 46.98 and 130.29 ± 42.31 mg/dl, 7.38 ± 1.37 and 8.03 ± 1.55%, 169.18 ± 29.46 and 180.50 ± 38.95 mg/dl, 129.06 ± 58.50 and 137.13 ± 64.65 mg/dl, and 45.09 ± 14.02 and 44.27 ± 11.67 mg/dl in the experimental and control groups, respectively.
We performed ANCOVA on the laboratory test results of two groups from the pre- to postintervention periods. The F values of fasting blood glucose, A1C, and total cholesterol level were 7.898 (P = 0.005), 7.345 (P = 0.007), and 4.139 (P = 0.043), respectively. The results showed significant changes between the two groups: patients in the experimental group had better control than those in the control group.
Additionally, we monitored the number of monthly logins by patients during this period. The number of logins started with 9.6 ± 2.9/month per patient, slowly decreased in the following 3 months to 8.5 ± 3.7, and thereafter remained at that level with slight changes. Therefore, the POEM system can motivate patients and enhance the effect of patient education. Consequently, patients can improve the management of their diabetes.
