Internet diabetic patient management using a short messaging service automatically produced by a knowledge matrix system.

L ifelong strict self-care is essential in the management of diabetes, along with easy access to the health care system (1–3). However, there is an evident limitation in fulfilling these conditions in the current health care system, which is oriented toward outpatient care (4–7). Thus, various strategies have been designed to improve the quality and efficiency of treating diabetic patients. Wireless technology is a worldwide communication system that allows a person to contact others anywhere at any time. Therefore, doctor-patient communication becomes possible anywhere with the use of this system (8). Currently, in civilized countries, nearly all adults and adolescences have their own cellular phones and use short message services (SMSs) in their daily lives. Moreover, numerous people are using ultra-fast Internet services at work or in the home. We designed an Internet-based diabetic patient management system using SMS that was automatically produced by a knowledge matrix. Subsequently, we compared biochemical profiles and clinical status between diabetic patients who used our system for 12 weeks and those who received the conventional outpatient management over the same time period. RESEARCH DESIGN AND METHODS — We developed a knowledge matrix containing information on proper diet and exercise for diabetic patients based on the Korea Staged Diabetes Management Guideline (Table 1). Moreover, with the technical assistance from ISU UBCare, we created a Web site program (http://yds.healthkorea.net) that was used to formulate appropriate messages through an automated algorithm. We also designed a device that had the dual function of a glucometer and a pedometer. By connecting this device to the patient’s cellular phone, the measured data on the device were automatically transmitted to his/her personal data sheet on the Web site. Patients were asked to keep a record on the Web site of how much and what kind of food they ate, as well as how much they exercised. When these data were sent to the main menu, our system automatically composed messages that were then sent to the patient. In addition, patients could check their clinical data by logging into the Web site where they could obtain various information on diabetes and incorporate the information into their daily lives for better self-management of diabetes. Eighty type 2 diabetic patients were recruited (mean age 48.1 9.6 years, duration of diabetes 7.8 6.7 years, 65.0% male). They were randomly divided into intervention and control groups equally. Patients were excluded if they had any concomitant disease that might affect the outcomes of the study or patient compliance (9). We measured anthropometric data, blood pressure, and biochemical profiles of the participants after 8 h of fasting at the start of the study and at 12 weeks. Patients in the intervention group were taught how to use our system for 12 weeks without any outpatient visits. Patients in the control group were provided with glucometers and received their usual outpatient management from their physicians. The protocol was approved by the local ethical committee.