Utilization of a Cloud-Based Diabetes Management Program for Insulin Initiation and Titration Enables Collaborative Decision Making Between Healthcare Providers and Patients.

Source: Hsu, W. C., et al. 2016 - Pubmed ID: 26645932

Setting: USA, Diabetes center

Study design:



Follow up: 12 ± 2 weeks

Patient group:

Sample size:

Total: 40 (35)

IG: 20 (19)

CG: 20 (16)


Inclusion criteria:

  • Diabetes type 2
  • HbA1c levels of 9-14%
Type of technology:

Home monitoring

  • Blood glucose


  • Diabetes management program (on tablet)
  • Secure messaging
  • Shared screen control
  • Video and voice communication.

Intervention: Patient instructed in mobile technology and the individual plan on initial visit with Health care provider.  Virtual interactions (messaging and video/voice communication on regular basis as needed. In the beginning the HCPs monitored the glucose values remotely on a daily basis and modeled expert decision making through the communication features on the tablet but gradually intervened less frequently throughout the course of the study to encourage patient self-management.

3 months

Add on: NA


Control group: Standard care at clinic

Clinical effect/ Patient safety:

Clinical effect:

  • Mean HbA1c ↓
  • Reaching HbA1c target (≤7%) →
  • Weight →
  • Satisfaction (DTSQ) ↑ (improved)

Patient safety: Four subjects in the intervention group and two in the control group reported hypoglycemia during the study.

Patient experiences/ Staff experiences:

Patient experiences:  High patient satisfaction (based on exit citation from interview)

Staff experiences:

  • IG: Mean visit time: 22.5 min per subject
  • CG: Mean visit time: 68.8 min per subject
Costs and organization:



  • Tablet
  • Glucometer


Staff resources

  • Patient training in mobile tech (approx. 40 min)
  • Monitoring of clinical data
  • Communication with patients


Health care utilization:

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“↑”: Statistically significant increase

“↓”: Statistically significant decrease

“→”: Statistically insignificant (no difference)