26 Jul For Selected Patients, Telehealth Offers Better Control of Diabetes
MedicalResearch.com: What is the background for this study?
Response: The prevalence of diabetes is rising as the population ages and becomes more obese. Clinical services are increasingly stretched, so much so that it will be difficult for doctors and nurses to continue to look after patients using the same service delivery they have used in the past. Increasingly patients are being asked to self-manage long-term illnesses, but particularly with type 2 diabetes they find this stressful. One solution is to encourage self-management but with monitoring at a distance through telehealth.
We performed a randomised controlled trial in family practices in four regions of the United Kingdom among 321 people with type 2 diabetes and glycated haemoglobin (HbA1c) ( a measure of control over the previous three months) >58 mmol/mol. The supported telemonitoring intervention involved self-measurement and transmission to a secure website of twice weekly morning and evening glucose for review by family practice clinicians. The control group received usual care, with at least annual review and more frequent reviews for people with poor glycaemic or blood pressure control in the context of incentives in family practice based on a sliding scale of financial rewards for achieving glycaemic and blood pressure control targets. HbA1c assessed at nine months was the primary outcome. Intention-to-treat analyses were performed.
MedicalResearch.com: What are the main findings?
Response: 160 people were randomized to the intervention group and 161 to the usual care group The mean (SD) HbA1c at follow-up was 63.0 (15.5) mmol/mol in the intervention group and 67.8 (14.7) mmol/mol in the usual care group. Mean HbA1c was 5.60 mmol/mol (95% CI 2.38 to 8.81 mmol/mol, p=0·0007) lower among people in the intervention group when compared with usual care. Ambulatory blood pressure was lower in the intervention than control group: systolic BP by 3.06 mmHg; 95% CI 0.56 to 5.56 mm Hg; p=0.017 and diastolic BP by 2.17 mmHg; 95% CI 0.62 to 3.72 mmHg; p=0.006.
No differences were identified between groups in weight, treatment pattern, in adherence to medication or quality of life. There were few adverse events and these were equally distributed between the intervention and control groups. There was a greater number of telephone calls between practice nurses and patients in the intervention compared with control group (rate ratio 7.50 (95% CI 4.45 to 12.65) but no other differences between groups in use of health services were identified between groups.
MedicalResearch.com: What should readers take away from your report?
Response: That for selected patients telehealth offers a service which provides better outcomes than traditional care with minimal increase in workload. Prescribing did not increase and so it is likely that better adherence to life style and possibly to medications was responsible for the improved results
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We need to see if the benefits found in this randomised trial are maintained when a telehealth service is rolled out at scale and over a longer time scale
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Wild SH, Hanley J, Lewis SC, McKnight JA, McCloughan LB, Padfield PL, et al. (2016) Supported Telemonitoring and Glycemic Control in People with Type 2 Diabetes: The Telescot Diabetes Pragmatic Multicenter Randomized Controlled Trial. PLoS Med 13(7): e1002098. DOI: 10.1371/journal.pmed.1002098
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