1. 1 Establishment of Blood Glucose Monitoring System Using the Internet Diabetes Care 27:478–483, 2004 Long-Term effect of the Internet-Based Glucose Monitoring System on HbA 1 c Reduction and Glucose Stability Diabetes Care 29:2625–2631, 2006 HYUK-SANG KWON, MD1JAE-HYOUNG CHO, MD1HEE-SOO KIM, MD1BOK-RE SONG, RN2SEUNG-HYUN KO, MD, PHD1JUNG-MIN LEE, MDSUNG-RAE KIM, CHA, MD, PHD1KWANG-WOO LEE, MD, PHD1HO-YOUNG SON, MD, PHD1JIN- HEE LEE, MS3WON-CHUL LEE, MD, PHD3KUN-HO YOON, MD, PHD1 Kyunghee University College of Medicine Department of Internal Medicine R3 Ha Sung Hyung

2. 2 Background The importance of tight blood glucose control for the subsequent prevention of diabetes complication is well established.  various strategies for diabetes management have been designed to improve the quality and efficiency of care for patients with diabetes. New approaches for a medical delivery system are necessary. Small number of computer based or electronic management systems have been reported to improve diabetes care.

3. 3 Internet-based blood glucose monitoring system (IBGMS) New patient communication system that can facilitate the patient’s behavioral change and allow accessible, efficient, and continued medical advice and prescriptions is needed. Diabetic patient can contact physicians online, provide information to physicians, and receive suitable recommendations from the physicians unhindered by location or time. 40 대 여성 박선희 씨 ( 가명 ) 는 두 달에 한 번씩 당뇨로 꾸준히 병원을 다녔다． 그런데 지난해 말부터는 병원 가는 횟수가 부쩍 줄었다． 병원에 갈 때마다 꼭꼭 챙겨야했던 당뇨수첩도 더이상 쓸 필요가 없다． 박 씨는 요즘 매일 주치의로부터 관리를 잘하고 있다는 칭찬의 메시지를 받는다

4. 4 RESERCH DESIGN AND METHODS - Type 2 DM for 1 yr were recruited from the outpatient clinic of Kangnam St. Mary’s Hospital Diabetes Center. - >30 years of age. - Excluded… if they had any significant diseases that were likely to affect the outcome and compliance of this study. ( heart failure, hepatic dysfunction, S-Cr level > 1.5 mg/dl, insulin pumps…)

5. 5 RESERCH DESIGN AND METHODS Study 1 - Intervention group ; 51 pt. - Control group ; 50 pt. - 12 week period (2001.9 ~ 2001.12) - The i ntervention group were taught how to use the IBGMS and used this for 12 weeks without outpatient management visits. - Participants in the control group met the professor two or three times during the 12 weeks. Study 2 - Intervention group ; 40 pt. - Control group ; 40 pt. - 30 month period (2002.2 ~ 2004.8) - Pt. visited the outpatient clinic every 3months. And except this, they communicated only via the internet. - The control pt. used a conventional note-keeping record system.

6. 6 RESULTS Establishment of Blood Glucose Monitoring System Using the Internet Diabetes Care 27:478–483, 2004

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12. 12 RESULTS Long-Term effect of the Internet-Based Glucose Monitoring System on HbA 1 c Reduction and Glucose Stability Diabetes Care 29:2625–2631, 2006

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15. 15 Fig 1. The effects of intervention(IBGMS) on change of A1C and glucose stability.

16. 16 Fig 1. The effects of intervention(IBGMS) on change of A1C and glucose stability.

17. 17 Fig 2. Role of SMBG in A1C change and glucose stability.

18. 18 Fig 2. Role of SMBG in A1C change and glucose stability.

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20. 20 DISCUSSION New delivery system of diabetic control using the Internet has revealed great efficacy in glucose control. The Study 1 showed that marked decrease in HbA1c levels after 12 weeks of follow-up versus the baseline levels. The Study 2. showed similar result during 30 months.

21. 21 DISCUSSION There were more subjects with a mean A1C <6.5% in the intervention(37%) than in the control (17%) group. Basal A1C <7% showed a bimodal curve of 6.3-7.4% in the control group and 6.1-6.5% in the intervention group. Through IBGMS, physician’s contact time was relatively reduced compared with face to face interview in the office. High frequency of SMBG showed some beneficial effects on glucose stability in control.

22. 22 CONCLUSIONS the long term effectiveness We have confirmed the long term effectiveness of the IBGMS of the IBGMS on glucose stability and A1C reduction. IBGMS We exepect that the IBGMS will contribute to reducing complication and improving the quality of life for patients with diabetes.