以安全憑證及快速回應模式建構糖尿病人之網路健康服務系統

Building a Certificate-Based Secure and Quick Response Telemedical Health-care System for Diabetic Patients

簡銘男(Ming-Nan Chien) ； 劉立(Li Liu) ； 江琇琴(Hsiu-Ching Chiang) ； 吳啓誠(Chi-Chen Wu) ； 李燕晉(Yann-Jinn Lee) ； 黃千玲(Chen-Ling Huang) ； 梁清香(Chun-Chuan Lee) ； 李淳權(Ching-Hsiang Leung) ； 王朝弘(Chao-Hung Wang)

《內科學誌》 17卷2期 (2006/04) Pp. 61-72

https://doi.org/10.6314/JIMT.2006.17(2).03

摘要

The internet has begun to play a greater role in many health-care processes. To improve the quality of diabetes control while safeguarding and keeping the patients information confidential, a certificate-based and quick response telemedical health-care system can be used to devise a program which allows patients with diabetes to transmit their self-monitored blood glucose data directly from their personal glucometer device to their diabetes care provider over the internet. The system can integrate the remotely transmitted glycemic data to a secure database for retrieval by physician to analyze at a later time. If unusual or alarming trends are detected by an intelligent agent (IA) system, both the physician and patient are notified of the occurrence. Patients are also allowed to access clinical data through web-based interface. We hope that this initiative can improve the quality of diabetic care. The aim of this study was to evaluate the effectiveness of a quick response telemedical health-care model to biomonitor type 2 diabetic patients attending the diabetic OPD of Mackay Memorial Hospital and Taipei Medical University Hospital. A total of 134 unrelated type 2 diabetic patients were included in a 6-month prospective study. They were categorized into either the experimental or the control group. The experimental group was monitored using our telemedical health-care system for 6 months. The control group received the usual outpatient management over the same period. We compared the differences in HbA1c and fasting plasma glucose levels before and at the end of the study, both in each group as well as between the experimental group and the control group. Initially, there is no significant difference in either fasting glucose levels or HbA1c between the experimental group and control group. At the end of the study (6 months later), there were significant changes in fasting plasma glucose when compared with the initial data, both in the experimental group (179±61mg/dl vs. 241±77 mg/dl, p＜0.0l), as well as in the control group (221±64 mg/dl vs. 252±57mg/dl, p=0.008). Additionally, fasting plasma glucose levels showed significant difference (p=0.038) between the experimental group (179±61 mg/dl) and control group (221±64 mg/dl) at the end of the study. In the experimental group, mean HbA1c level reduced significantly (p＜0.001)from the initial 11.3±1.9% to 8.4±1.8%, while in the control group, there was no significant change in mean HbA1c level (p=0.807), which was initially 10.9±2.0% and 10.8±2.2% at the end of the study. HbA1c levels showed significant reduction (p＜0.00l) when the experimental group (8.4±1.8%) was compared with the control group (10.8±2.2%) at the end of the study. Our study demonstrated that the quick response telemedical healthcare system seems to be feasible and highly effective. It integrates not only the monitoring of blood glucose control but also allows a quick response model, assisting in the delivery of diabetes self-management education (DSME), an evolving process which helps to meet the needs and expectations of individuals with diabetes. These results suggest that our system could improve the quality of, and hence possibly help to reduce the complications of diabetes.

關鍵字

糖尿病 ； 公開金鑰基礎建設 ； 快速回應 ； 網路健康服務 ； 糖化血色素 ； 空腹血糖

並列摘要

The internet has begun to play a greater role in many health-care processes. To improve the quality of diabetes control while safeguarding and keeping the patients information confidential, a certificate-based and quick response telemedical health-care system can be used to devise a program which allows patients with diabetes to transmit their self-monitored blood glucose data directly from their personal glucometer device to their diabetes care provider over the internet. The system can integrate the remotely transmitted glycemic data to a secure database for retrieval by physician to analyze at a later time. If unusual or alarming trends are detected by an intelligent agent (IA) system, both the physician and patient are notified of the occurrence. Patients are also allowed to access clinical data through web-based interface. We hope that this initiative can improve the quality of diabetic care. The aim of this study was to evaluate the effectiveness of a quick response telemedical health-care model to biomonitor type 2 diabetic patients attending the diabetic OPD of Mackay Memorial Hospital and Taipei Medical University Hospital. A total of 134 unrelated type 2 diabetic patients were included in a 6-month prospective study. They were categorized into either the experimental or the control group. The experimental group was monitored using our telemedical health-care system for 6 months. The control group received the usual outpatient management over the same period. We compared the differences in HbA1c and fasting plasma glucose levels before and at the end of the study, both in each group as well as between the experimental group and the control group. Initially, there is no significant difference in either fasting glucose levels or HbA1c between the experimental group and control group. At the end of the study (6 months later), there were significant changes in fasting plasma glucose when compared with the initial data, both in the experimental group (179±61mg/dl vs. 241±77 mg/dl, p＜0.0l), as well as in the control group (221±64 mg/dl vs. 252±57mg/dl, p=0.008). Additionally, fasting plasma glucose levels showed significant difference (p=0.038) between the experimental group (179±61 mg/dl) and control group (221±64 mg/dl) at the end of the study. In the experimental group, mean HbA1c level reduced significantly (p＜0.001)from the initial 11.3±1.9% to 8.4±1.8%, while in the control group, there was no significant change in mean HbA1c level (p=0.807), which was initially 10.9±2.0% and 10.8±2.2% at the end of the study. HbA1c levels showed significant reduction (p＜0.00l) when the experimental group (8.4±1.8%) was compared with the control group (10.8±2.2%) at the end of the study. Our study demonstrated that the quick response telemedical healthcare system seems to be feasible and highly effective. It integrates not only the monitoring of blood glucose control but also allows a quick response model, assisting in the delivery of diabetes self-management education (DSME), an evolving process which helps to meet the needs and expectations of individuals with diabetes. These results suggest that our system could improve the quality of, and hence possibly help to reduce the complications of diabetes.

並列關鍵字

Diabetes mellitus ； Public key infrastructure ； Quick response ； Telemedical health-care ； HbA1c, Hemoglobin A1c ； Fasting plasma glucose