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Automating the Consensus Guidelines in Diabetes Care May Impact on Clinical Inertia.
Endocr Pract. 2010 Jun 21;:1-25
Authors: Albisser AM, Inhaber F
Objective - Consensus guidelines and mandated targets (CG&MT) govern clinical management in diabetes. Glycemic control is crucial to the prevention of long-term eye, nerve and kidney complications. Yet, current practice largely fails to meet mandated targets in glycemia, A1c, and body weight while often increasing rates of hypoglycemia. A tendency to over-treatment may lead to body weight gain or frustrate attempts at its reduction. Our objective was to rectify this by automating the CG&MT.Methods - (i) A simplified method for capturing diabetes outcomes at home was devised. (ii) Relevant portions of the CG&MT were translated into computer code and automated. (iii) Algorithms were applied to transform SMBG data into circadian profiles and A1c levels. (iv) The resulting procedures were integrated into a USB memory drive for use by providers at the point-of-care.Results - (i) Input from Patients - A simple form is used to capture diabetes outcomes data including SMBG, medication, and life-style events in a structured fashion.(ii) Input from Providers - At each encounter, the patients' data are transferred into the device and become available to assist in identifying where mandated targets are unmet, significant hypoglycemia is risked, and what prescription changes are indicated.(iii) Outcomes - Observations from a community support group dedicated to glycemic control are summarized.Conclusions - Acting on the gathered information, the automation supports the provider at the point-of-care to achieve better, safer outcomes and practice evidence-based medicine entirely in lockstep with the CG&MT. This overcomes clinical inertia.
PMID: 20570811 [PubMed - as supplied by publisher]
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