So Jung Yang

Efficacy of the smartphone-based glucose management application stratified by user satisfaction.

Background We aimed to assess the efficacy of the smartphone-based health application for glucose control and patient satisfaction with the mobile network system used for glucose self-monitoring. Methods Thirty-five patients were provided with a smartphone device, and self-measured blood glucose data were automatically transferred to the medical staff through the smartphone application over the course of 12 weeks. The smartphone user group was divided into two subgroups (more satisfied group vs. less satisfied group) based on the results of questionnaire surveys regarding satisfaction, comfort, convenience, and functionality, as well as their willingness to use the smartphone application in the future. The control group was set up via a review of electronic medical records by group matching in terms of age, sex, doctor in charge, and glycated hemoglobin (HbA1c). Results Both the smartphone group and the control group showed a tendency towards a decrease in the HbA1c level after 3 months (7.7%±0.7% to 7.5%±0.7%, P=0.077). In the more satisfied group (n=27), the HbA1c level decreased from 7.7%±0.8% to 7.3%±0.6% (P=0.001), whereas in the less satisfied group (n=8), the HbA1c result increased from 7.7%±0.4% to 8.1%±0.5% (P=0.062), showing values much worse than that of the no-smartphone control group (from 7.7%±0.5% to 7.7%±0.7%, P=0.093). Conclusion In addition to medical feedback, device and network-related patient satisfaction play a crucial role in blood glucose management. Therefore, for the smartphone app-based blood glucose monitoring to be effective, it is essential to provide the patient with a well-functioning high quality tool capable of increasing patient satisfaction and willingness to use.

Randomized, Open-Label, Parallel Group Study to Evaluate the Effect of Internet-Based Glucose Management System on Subjects with Diabetes in China

OBJECTIVE Large amounts of time and effort are needed to implement an Internet-based glucose monitoring system (IBGMS) in the clinical setting. This study was designed using research experience that was developed while implementing an IBGMS in Korea, and the research platform was modified to evaluate the efficacy of an IBGMS in controlling blood sugar in the Chinese population. METHODS A randomized, open-label, parallel group design was used to evaluate the efficacy of an IBGMS among Chinese subjects with type 2 diabetes. Over a 6-month period, 182 subjects were evaluated in the IBGMS (n = 92) or control (n = 90) groups. RESULTS After 3 months, the control groups HbA1c levels were reduced from 8.0% ± 0.8% to 7.3% ± 1.2% (p < 0.001) and the IBGMS group experienced a reduction from 7.9% ± 0.8% to 6.9% ± 0.7% (p < 0.001); the IBGMS groups end value was significantly lower (p = 0.014). The intragroup changes in the control and IBGMS groups were significant at the 3-month (p = 0.002) and 6-month (p < 0.01) follow-ups. Over this period, the HbA1c levels in the control group increased slightly (7.3% ± 1.1% to 7.4% ± 1.3%, p = 0.605), and the HbA1c levels in the IBGMS group decreased slightly (6.9% ± 0.7% to 6.7% ± 0.7%, p = 0.081). CONCLUSIONS The IBGMS was effective in improving blood sugar levels among patients with diabetes. Therefore, IBGMS experience can be effectively transferred between institutions and countries.

Development of Clinical Data Mart of HMG-CoA Reductase Inhibitor for Varied Clinical Research

Background The increasing use of electronic medical record (EMR) systems for documenting clinical medical data has led to EMR data being increasingly accessed for clinical trials. In this study, a database of patients who were prescribed statins for the first time was developed using EMR data. A clinical data mart (CDM) was developed for cohort study researchers. Methods Seoul St. Marys Hospital implemented a clinical data warehouse (CDW) of data for ~2.8 million patients, 47 million prescription events, and laboratory results for 150 million cases. We developed a research database from a subset of the data on the basis of a study protocol. Data for patients who were prescribed a statin for the first time (between the period from January 1, 2009 to December 31, 2015), including personal data, laboratory data, diagnoses, and medications, were extracted. Results We extracted initial clinical data of statin from a CDW that was established to support clinical studies; the data was refined through a data quality management process. Data for 21,368 patients who were prescribed statins for the first time were extracted. We extracted data every 3 months for a period of 1 year. A total of 17 different statins were extracted. It was found that statins were first prescribed by the endocrinology department in most cases (69%, 14,865/21,368). Conclusion Study researchers can use our CDM for statins. Our EMR data for statins is useful for investigating the effectiveness of treatments and exploring new information on statins. Using EMR is advantageous for compiling an adequate study cohort in a short period.

Use of Moderate-Intensity Statins for Low-Density Lipoprotein Cholesterol Level above 190 mg/dL at Baseline in Koreans

The ACC/AHA 2013 guideline recommends high‐intensity statin therapy for a decrease in low‐density lipoprotein cholesterol (LDL‐C) level by >50% among patients with baseline values of ≥190 mg/dL (approximately 4.872 mmol/L); however, this value should be modified before applying it to Korean populations. We investigated the statin‐specific LDL‐C‐lowering effects in Korean patients with baseline LDL‐C value ≥4.872 mmol/L. Data of patients prescribed a statin for the first time from January 2009 to December 2013 were assessed. In patients with baseline LDL‐C value ≥4.872 mmol/L, laboratory data for a maximum of 6 months from the date of first statin prescription were collected. Among 33,721 patients who were prescribed a statin for the first time, 655 patients had a baseline LDL‐C value ≥4.872 mmol/L (1.9%). Of these, 179 patients were analysed. Patients receiving moderate‐intensity statins were divided into two groups based on LDL‐C reduction rate (p = 0.0002), defined as moderate–high‐intensity (atorvastatin 20 mg, rosuvastatin 10 mg, simvastatin 20 mg) and moderate–low‐intensity (atorvastatin 10 mg, pitavastatin 2 mg, pravastatin 40 mg) statin groups. LDL‐C reduction rates did not significantly differ between the moderate–high‐ and high‐intensity statin groups (p = 0.4895). We found that some moderate‐intensity statins demonstrated a LDL‐C‐lowering effect of more than 50% in Korean patients with a baseline LDL‐C value ≥4.872 mmol/L. Our results reflect the need of a large‐scale, randomized, controlled trial on partial reclassification of statins for patients with baseline LDL‐C value ≥4.872 mmol/L before adopting ACC/AHC guidelines in Korea.

The differences in the incidence of diabetes mellitus and prediabetes according to the type of HMG-CoA reductase inhibitors prescribed in Korean patients

Very few studies conducted in Korea have investigated the relationship between statins and the incidence of diabetes. Therefore, we analyzed the progression from normal blood glucose to prediabetes and then to diabetes mellitus (DM) according to the type, intensity, and dose of statin prescribed.

Analysis and comparison of the cost-effectiveness of statins according to the baseline low-density lipoprotein cholesterol level in Korea

There are a few Korean studies on the economics of statins based on reduction in low‐density lipoprotein cholesterol (LDL‐C) data from other countries. This study aimed to analyse and compare the cost‐effectiveness of statins according to the baseline LDL‐C level in Korea.

Comparative analysis of the efficacy of omega-3 fatty acids for hypertriglyceridaemia management in Korea.

This study aimed to compare the ability of statin monotherapy (ST group), omega‐3 fatty acid monotherapy (OM_A group) and combination therapy with omega‐3 fatty acids and a statin (OM_S group), to reduce triglyceride (TG) levels in patients with hypertriglyceridaemia.

Clinical experiences and case review of angiotensin II receptor blocker-related angioedema in Korea

Although angiotensin‐converting enzyme inhibitor‐related angioedema is well known, angiotensin II receptor blocker (ARB)‐related angioedema has not been extensively studied because of its lower incidence. Therefore, ARB‐related angioedema is likely to be overlooked in the clinical setting. We analysed the medical records of adults who had been prescribed ARB and diagnosed with angioedema between 2009 and 2015. All adults over the age of 18 years who were initially administered ARB between 1 January 2009 and 31 December 2015 were selected as participants in this study. To confirm whether the angioedema was actually due to the administration of ARB, we conducted a chart review. A total of 35 584 patients were prescribed ARB for the first time when visiting the Seoul St. Marys Hospital during the study period. Twenty‐four patients diagnosed with angioedema for other reasons prior to their first prescription of ARB were excluded from this study. ARB‐related angioedema was suspected in six of 35 560 patients (0.02%) who were initially prescribed ARB during the study period. The manifestation of ARB‐related angioedema ranged from several days (1/6 case) to several years (3/6 cases). Some patients continued taking ARB with intermittent antihistamine or steroid therapy. In such cases, angioedema symptoms improved but did not completely resolve. Its diagnosis can be delayed and the symptoms may be recurrent as symptoms improve with antihistamine use. In some cases, the same person had different reactions depending on the type of ARB. Definitively diagnosing ARB‐related angioedema is difficult, and physicians often overlook angioedema without suspecting that it is an adverse effect of ARB. Close attention of physicians and improved patient education can reduce the incidence of ARB‐related angioedema.

Physician-Directed Diabetes Education without a Medication Change and Associated Patient Outcomes

Background When patients with diabetes mellitus (DM) are first referred to a hospital from primary health care clinics, physicians have to decide whether to administer an oral hypoglycemic agent (OHA) immediately or postpone a medication change in favor of diabetes education regarding diet or exercise. The aim of this study was to determine the effect of diabetes education alone (without alterations in diabetes medication) on blood glucose levels. Methods The study was conducted between January 2009 and December 2013 and included patients with DM. The glycosylated hemoglobin (HbA1c) levels were evaluated at the first visit and after 3 months. During the first medical examination, a designated doctor also conducted a diabetes education session that mainly covered dietary management. Results Patients were divided into those who received no diabetic medications (n=66) and those who received an OHA (n=124). Education resulted in a marked decrease in HbA1c levels in the OHA group among patients who had DM for <1 year (from 7.0%±1.3% to 6.6%±0.9%, P=0.0092) and for 1 to 5 years (from 7.5%±1.8% to 6.9%±1.1%, P=0.0091). Those with DM >10 years showed a slightly lower HbA1c target achievement rate of <6.5% (odds ratio, 0.089; P=0.0024). Conclusion For patients who had DM for more than 5 years, higher doses or changes in medication were more effective than intensive active education. Therefore, individualized and customized education are needed for these patients. For patients with a shorter duration of DM, it may be more effective to provide initial intensive education for diabetes before prescribing medicines, such as OHAs.

Satisfaction Survey on Information Technology-Based Glucose Monitoring System Targeting Diabetes Mellitus in Private Local Clinics in Korea

Background Private local clinics in Korea have little experience with information technology (IT)-based glucose monitoring (ITGM). Our aim is to examine user satisfaction and the possibility of using ITGM service practically. Methods Patients sent their blood glucose levels to physicians in local clinics. The physicians reviewed the blood glucose values online and provided personal consultations through text messaging or phone calls. Thereafter, a satisfaction survey on the ITGM service, the modified Morisky scale, and patient assessment of chronic illness care were administered. Results One hundred and seventy patients from seven private local clinics used the ITGM. Overall satisfaction, including that about the ITGM service, the device, and its usefulness, was rated higher than “mostly satisfied” (score 4.2±0.8 out of 5.0) and even higher among the elderly. Satisfaction was positively associated with age, especially in those older than 60 years. The main reason for intent for future use of the service was the time/place flexibility. Highly motivated patients tended to answer positively regarding information satisfaction (P=0.0377). Conclusion Our study is the first to investigate ITGM satisfaction in private local clinics. The feasibility of users utilizing ITGM should be clarified, and future clinical research on the services clinical effects and cost-benefit analysis is needed.