Abstract
Objective:
The aim of this study was to evaluate the impact of personalized decision support (PDS) on metabolic control in people with diabetes and cardiovascular disease.
Research Design and Methods:
The German health insurance fund BKK TAUNUS offers to its insured people with diabetes and cardiovascular disease the possibility to participate in the Diabetiva® program, which includes PDS. Personalized decision support is generated by the expert system KADIS® using self-control data and continuous glucose monitoring (CGM) as its data source. The physician of the participating person receives the PDS once a year, decides about use or nonuse, and reports his/her decision in a questionnaire. Metabolic control of participants treated by use or nonuse of PDS for one year and receiving CGM twice was analyzed in a retrospective observational study. The primary outcome was hemoglobin A1c (HbA1c); secondary outcomes were mean sensor glucose (MSG), glucose variability, and hypoglycemia.
Results:
A total of 323 subjects received CGM twice, 289 had complete data sets, 97% (280/289) were type 2 diabetes patients, and 74% (214/289) were treated using PDS, resulting in a decrease in HbA1c [7.10 ± 1.06 to 6.73 ± 0.82%; p < .01; change in HbA1c t0-t12 months −0.37 (95% confidence interval −0.46 to −0.28)] and MSG (7.7 ± 1.6 versus 7.4 ± 1.2 mmol/liter; p = .003) within one year. Glucose variability was also reduced, as indicated by lower high blood glucose index (p = .001), Glycemic Risk Assessment Diabetes Equation (p = .009), and time of hyperglycemia (p = .003). Low blood glucose index and time spent in hypoglycemia were not affected. In contrast, nonuse of PDS (75/289) resulted in increased HbA1c (p < .001). Diabetiva outcome was strongly related to baseline HbA1c (HbA1c t0; p < .01) and use of PDS (p < .01). Acceptance of PDS was dependent on HbA1c t0 (p = .049).
Conclusions:
Personalized decision support has potential to improve metabolic outcome in routine diabetes care.