{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T21:06:23Z","timestamp":1790283983422,"version":"4.1.0"},"reference-count":40,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Nursing"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Older adults with diabetes are vulnerable, facing multimorbidity and challenges in reaching glycemic targets. When insulin therapy is required, limited knowledge of geriatric therapeutic goals often leads to regimens that increase the risk of hypoglycemia. Simplified approaches such as once-daily basal insulin are recommended, yet titration protocols and unclear regimens remain barriers in home care nursing. Digital decision support systems (DDSSs) such as GlucoTab address this gap by offering evidence-based titration guidance integrated into nursing workflows. DDSSs also strengthen nurse autonomy, which leads to improved care processes and better outcomes in home care settings.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study assessed the effects of a nurse-guided intervention including a DDSS for diabetes management in older adults with type 2 diabetes receiving home care nursing.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n The prospective quasi-experimental feasibility and implementation study was conducted using GlucoTab for diabetes management as part of a multicomponent intervention at 2 home care nursing sites. Nine adults with type 2 diabetes receiving insulin therapy were enrolled (n=5 women; mean age 77, SD 10 years; mean BMI 27.7, SD 4.7 kg\/m\n 2<\/jats:sup>\n ; mean baseline hemoglobin A\n 1c<\/jats:sub>\n 59.5, SD 12.8 mmol\/mol). After receiving training, nurses implemented the DDSS, which integrates evidence-based diabetes management recommendations for home care and nursing workflows. Diabetes-related hospital admissions and glycemic outcomes were assessed before, during, and after implementation of the DDSS intervention.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Before implementation, 5 diabetes-related emergency admissions led to 4 hospitalizations, compared with none during implementation and 4 after implementation, mostly due to hyperglycemia. The median hospital stay was 9 (IQR 8-15) days (before and after implementation). Diabetes management shifted from predominantly premixed insulin therapy at baseline to basal insulin with or without bolus insulin during implementation. Diabetes-related home care visits decreased from 1.81 to 1.01 per day (before vs during implementation), and general practitioner contacts for insulin adjustments declined (19 before implementation vs 16 after implementation). Mean morning blood glucose decreased from 212 (SD 72) mg\/dL to 162 (SD 42) mg\/dL, and the proportion of measurements within the target range (70\u2010180 mg\/dL) increased from 39.0% to 70.8% before vs during implementation. No incidence of hypoglycemia requiring third-party help was observed during implementation. Adherence of nurses to DDSS recommendations exceeded 94%.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This study suggests that integrating a DDSS in a multicomponent intervention into home care nursing yielded longitudinal changes in diabetes outcomes. Emergency visits and hospitalizations were lower during implementation, no severe hypoglycemia was observed, glycemic control improved throughout the observation period, and therapy was simplified in routine care. Nursing visits decreased, suggesting potential improvements in care processes and resource use. High adherence and acceptance by nurses indicate feasibility and usability in home care practice. These findings align with evidence from hospitalized patients and telehealth studies, suggesting the potential for clinical, safety, and efficiency benefits.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/89687","type":"journal-article","created":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T20:52:11Z","timestamp":1790283131000},"page":"e89687-e89687","source":"Crossref","is-referenced-by-count":0,"title":["Effects of a Digital Decision Support System on Diabetes Management in a Real-World Home Care Setting: Prospective Quasi-Experimental Feasibility and Implementation Study"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8778-1994","authenticated-orcid":false,"given":"Katharina Maria","family":"Lichtenegger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3568-0939","authenticated-orcid":false,"given":"Lara","family":"Scholle-Winkler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4082-0807","authenticated-orcid":false,"given":"Julia","family":"Kopanz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7543-3404","authenticated-orcid":false,"given":"Angela","family":"Libiseller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4671-6218","authenticated-orcid":false,"given":"Klaus","family":"Donsa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9947-1413","authenticated-orcid":false,"given":"Felix","family":"Aberer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3554-0405","authenticated-orcid":false,"given":"Thomas Rudolf","family":"Pieber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7854-4233","authenticated-orcid":false,"given":"Julia Katharina","family":"Mader","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"R1","unstructured":"Diabetes. World Health Organization. URL: https:\/\/www.who.int\/health-topics\/diabetes#tab=tab_1 [Accessed 06-07-2026]"},{"key":"R2","unstructured":"IDF Diabetes Atlas. 11th ed. International Diabetes Federation; 2025. ISBN: 9782930229966"},{"issue":"Suppl 1","key":"R3","doi-asserted-by":"publisher","first-page":"S277","DOI":"10.2337\/dc26-S013","article-title":"13. Older adults: Standards of Care in Diabetes-2026","volume":"49","author":"American Diabetes Association Professional Practice Committee for Diabetes","journal-title":"Diabetes Care"},{"issue":"2","key":"R4","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2017-000053","article-title":"Improving monitoring of diabetic complications in home care patients","volume":"6","author":"Alam","journal-title":"BMJ Open Qual"},{"issue":"Supplement_1","key":"R5","doi-asserted-by":"publisher","first-page":"S339","DOI":"10.2337\/dc26-S016","article-title":"16. Diabetes care in the hospital: Standards of Care in Diabetes-2026","volume":"49","author":"American Diabetes Association Professional Practice Committee for Diabetes","journal-title":"Diabetes Care"},{"issue":"12","key":"R6","doi-asserted-by":"publisher","first-page":"2211","DOI":"10.2337\/dc15-0160","article-title":"Comparison of basal-bolus and premixed insulin regimens in hospitalized patients with type 2 diabetes","volume":"38","author":"Bellido","journal-title":"Diabetes Care"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-020-01961-6","article-title":"Hypoglycaemia in older home-dwelling people with diabetes- a scoping review","volume":"21","author":"Hermann","journal-title":"BMC Geriatr"},{"issue":"1","key":"R8","doi-asserted-by":"publisher","DOI":"10.1186\/s12902-021-00713-w","article-title":"Documented diabetes care among older people receiving home care services: a cross-sectional study","volume":"21","author":"Heimro","journal-title":"BMC Endocr Disord"},{"issue":"1","key":"R9","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-023-02089-3","article-title":"Examining nursing processes in primary care settings using the Chronic Care Model: an umbrella review","volume":"24","author":"Dufour","journal-title":"BMC Prim Care"},{"issue":"1","key":"R10","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1370\/afm.1196","article-title":"Impact of electronic health record clinical decision support on diabetes care: a randomized trial","volume":"9","author":"O\u2019Connor","journal-title":"Ann Fam Med"},{"issue":"3","key":"R11","doi-asserted-by":"publisher","first-page":"637","DOI":"10.12669\/pjms.313.6732","article-title":"Postgraduate education needs of nurses\u2019 who are caregivers for patients with diabetes","volume":"31","author":"U\u011fur","journal-title":"Pak J Med Sci"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-14-214","article-title":"Substitution of physicians by nurses in primary care: a systematic review and meta-analysis","volume":"14","author":"Mart\u00ednez-Gonz\u00e1lez","journal-title":"BMC Health Serv Res"},{"issue":"7","key":"R13","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001271.pub3","article-title":"Nurses as substitutes for doctors in primary care","volume":"7","author":"Laurant","journal-title":"Cochrane Database Syst Rev"},{"issue":"4","key":"R14","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2021-002705","article-title":"Update on the management of diabetes in long-term care facilities","volume":"10","author":"Idrees","journal-title":"BMJ Open Diabetes Res Care"},{"issue":"10","key":"R15","doi-asserted-by":"publisher","first-page":"2085","DOI":"10.1007\/s00125-024-06240-2","article-title":"Ageing well with diabetes: the role of technology","volume":"67","author":"Maltese","journal-title":"Diabetologia"},{"issue":"3","key":"R16","doi-asserted-by":"publisher","DOI":"10.2196\/16769","article-title":"Improving self-care in patients with coexisting type 2 diabetes and hypertension by technological surrogate nursing: randomized controlled trial","volume":"22","author":"Or","journal-title":"J Med Internet Res"},{"issue":"1-2","key":"R17","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1503\/cmaj.081272","article-title":"Individualized electronic decision support and reminders to improve diabetes care in the community: COMPETE II randomized trial","volume":"181","author":"Holbrook","journal-title":"CMAJ"},{"issue":"11","key":"R18","doi-asserted-by":"publisher","first-page":"2526","DOI":"10.2337\/dc21-0829","article-title":"Clinical decision support for glycemic management reduces hospital length of stay","volume":"45","author":"Pichardo-Lowden","journal-title":"Diabetes Care"},{"issue":"1","key":"R19","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2020-001557","article-title":"Clinical decision support to improve management of diabetes and dysglycemia in the hospital: a path to optimizing practice and outcomes","volume":"9","author":"Pichardo-Lowden","journal-title":"BMJ Open Diabetes Res Care"},{"issue":"3","key":"R20","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1111\/dom.13559","article-title":"GlucoTab-guided insulin therapy using insulin glargine U300 enables glycaemic control with low risk of hypoglycaemia in hospitalized patients with type 2 diabetes","volume":"21","author":"Aberer","journal-title":"Diabetes Obes Metab"},{"issue":"2","key":"R21","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1111\/dom.12186","article-title":"Efficacy, usability and sequence of operations of a workflow-integrated algorithm for basal-bolus insulin therapy in hospitalized type 2 diabetes patients","volume":"16","author":"Mader","journal-title":"Diabetes Obes Metab"},{"issue":"10","key":"R22","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1089\/dia.2015.0027","article-title":"Standardized glycemic management with a computerized workflow and decision support system for hospitalized patients with type 2 diabetes on different wards","volume":"17","author":"Neubauer","journal-title":"Diabetes Technol Ther"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.2196\/56474","article-title":"The cooperation between nurses and a new digital colleague \u201cAI-driven lifestyle monitoring\u201d in long-term care for older adults: viewpoint","volume":"7","author":"Groeneveld","journal-title":"JMIR Nurs"},{"key":"R24","doi-asserted-by":"publisher","DOI":"10.2196\/59276","article-title":"Development of a knowledge base for an integrated older adult care model (SMART system) based on an intervention mapping framework: mixed methods study","volume":"8","author":"Guo","journal-title":"JMIR Nurs"},{"issue":"9","key":"R25","doi-asserted-by":"publisher","first-page":"1364","DOI":"10.1038\/s41591-020-1034-x","article-title":"Reporting guidelines for clinical trial reports for interventions involving artificial intelligence: the CONSORT-AI extension","volume":"26","author":"Liu","journal-title":"Nat Med"},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.1016\/j.conctc.2020.100620","article-title":"Study protocol for assessing the user acceptance, safety and efficacy of a tablet-based workflow and decision support system with incorporated basal insulin algorithm for glycaemic management in participants with type 2 diabetes receiving home health care: a single-centre, open-label, uncontrolled proof-of-concept study","volume":"19","author":"Libiseller","journal-title":"Contemp Clin Trials Commun"},{"issue":"1","key":"R27","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-024-02318-3","article-title":"A qualitative study of the experiences of insulin use by older people with type 2 diabetes mellitus","volume":"25","author":"Langerman","journal-title":"BMC Prim Care"},{"key":"R28","doi-asserted-by":"publisher","DOI":"10.2147\/DMSO.S297913","article-title":"Efficacy and safety of a decision support intervention for basal insulin self-titration assisted by the nurse in outpatients with T2DM: a randomized controlled trial","volume":"14","author":"Hu","journal-title":"Diabetes Metab Syndr Obes"},{"key":"R29","doi-asserted-by":"publisher","DOI":"10.2196\/67339","article-title":"Effectiveness of patients\u2019 education and telenursing follow-ups on self-care practices of patients with diabetes mellitus: cross-sectional and quasi-experimental study","volume":"8","author":"Alsahli","journal-title":"JMIR Nurs"},{"key":"R30","doi-asserted-by":"publisher","DOI":"10.2196\/68214","article-title":"A nurse-led telemonitoring approach in diabetes during the COVID-19 pandemic: prospective cohort study","volume":"10","author":"Noonan","journal-title":"JMIR Diabetes"},{"issue":"2","key":"R31","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/s0169-2607(02)00036-6","article-title":"Involving users in the design and usability evaluation of a clinical decision support system","volume":"69","author":"Carroll","journal-title":"Comput Methods Programs Biomed"},{"key":"R32","doi-asserted-by":"crossref","unstructured":"Kalun Or C Chan AH . Inspection methods for usability evaluation. In: Stephanidis C Salvendy G , editors. User Experience Methods and Tools in Human-Computer Interaction. 1st ed. CRC Press; 2024:170-192. [doi: 10.1201\/9781003495161-7]","DOI":"10.1201\/9781003495161-7"},{"key":"R33","doi-asserted-by":"publisher","DOI":"10.2196\/63733","article-title":"Designing clinical decision support systems (CDSS)-a user-centered lens of the design characteristics, challenges, and implications: systematic review","volume":"27","author":"Bayor","journal-title":"J Med Internet Res"},{"key":"R34","unstructured":"National Insulin Titration Guideline for Nurses Working With People With Diabetes Who Require Subcutaneous Insulin Injections, Version 2; National Clinical Programmes for Diabetes and the Irish Diabetes Nurse Specialists Association; 2023. URL: https:\/\/web.archive.org\/web\/20231008140658\/https:\/\/www.hse.ie\/eng\/about\/who\/cspd\/ncps\/diabetes\/resources\/national-insulin-titration-guideline-for-nurses.pdf [Accessed 18-09-2026]"},{"issue":"2","key":"R35","doi-asserted-by":"publisher","DOI":"10.2196\/23244","article-title":"Clinical improvements by telemedicine interventions managing type 1 and type 2 diabetes: systematic meta-review","volume":"23","author":"Eberle","journal-title":"J Med Internet Res"},{"issue":"10","key":"R36","doi-asserted-by":"publisher","DOI":"10.2196\/17298","article-title":"Determining if telehealth can reduce health system costs: scoping review","volume":"22","author":"Snoswell","journal-title":"J Med Internet Res"},{"issue":"5","key":"R37","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.1177\/19322968221145964","article-title":"Time for using machine learning for dose guidance in titration of people with type 2 diabetes? A systematic review of basal insulin dose guidance","volume":"18","author":"Thomsen","journal-title":"J Diabetes Sci Technol"},{"key":"R38","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2024.105783","article-title":"Developing an AI-based clinical decision support system for basal insulin titration in type 2 diabetes in primary care: a mixed-methods evaluation using heuristic analysis, user feedback, and eye tracking","volume":"195","author":"Thomsen","journal-title":"Int J Med Inform"},{"issue":"8","key":"R39","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare13080950","article-title":"Artificial intelligence as a tool for self-care in patients with type 1 and type 2 diabetes-an integrative literature review","volume":"13","author":"Persson","journal-title":"Healthcare (Basel)"},{"key":"R40","doi-asserted-by":"publisher","DOI":"10.3389\/fcdhc.2022.986672","article-title":"Digital algorithm-guided insulin therapy in home healthcare for elderly persons with type 2 diabetes: a proof-of-concept study","volume":"3","author":"Kopanz","journal-title":"Front Clin Diabetes Healthc"}],"container-title":["JMIR Nursing"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T20:52:18Z","timestamp":1790283138000},"score":1,"resource":{"primary":{"URL":"https:\/\/nursing.jmir.org\/2026\/1\/e89687"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,24]]},"references-count":40,"URL":"https:\/\/doi.org\/10.2196\/89687","relation":{},"ISSN":["2562-7600"],"issn-type":[{"value":"2562-7600","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,24]]},"article-number":"v9iSuppl 1e89687"}}