A randomised, controlled trial of the effects of a mobile telehealth intervention on clinical and patient-reported outcomes in people with poorly controlled diabetes

Abstract

This is the accepted version of the paper.This version of the publication may differ from the final published version. The objective of this research is to determine the effects of mobile telehealth (MTH) on glycosylated haemoglobin (HbA1c) and other clinical and patient-reported outcomes in insulin-requiring people with diabetes. Permanent repository link MethodsA nine-month randomised, controlled trial compared standard care to standard care supplemented with MTH (self-monitoring, mobile-phone data transmissions, graphical and nurse-initiated feedback, and educational calls). Clinical (HbA1c, blood pressure, daily insulin dose, diabetes outpatient appointments (DOAs)) and questionnaire data (health-related quality of life, depression, anxiety) were collected. Mean group changes over time were compared using hierarchical linear models and MannWhitney tests. ResultsEighty-one participants with a baseline HbA1c of 8.98% ± 1.82 were randomised to the intervention (n = 45) and standard care (n = 36). The Group by Time effect revealed MTH did not significantly influence HbA1c (p = 0.228), but p values were borderline significant for blood pressure (p = 0.054) and mental-health related quality of life (p = 0.057). Examination of effect sizes and 95% confidence intervals for mean group differences at nine months supported the existence of a protective effect of MTH on mental health-related quality of life as well as depression. None of the other measured outcomes were found to be affected by the MTH intervention. ConclusionsFindings from this study must be interpreted with caution given the small sample size, but they do not support the widespread adoption of MTH to achieve clinically significant changes in HbA1c. MTH may, however, have positive effects on blood pressure and protective effects on some aspects of mental health.

Effect of Health Information Technologies on Glycemic Control Among Patients with Type 2 Diabetes

“…The included studies were conducted in several different countries and regions: 9 in the USA [ 47 – 55 ], 9 in Europe [ 5 , 32 , 56 – 62 ], 8 in South Korea [ 63 – 70 ], 3 in China [ 71 – 73 ], 2 in Iran [ 74 , 75 ], 1 in Canada [ 76 ], 1 in Bahrain [ 77 ], and 1 in Japan [ 78 ], The total participants were 3983, of which 2105 were randomized to intervention groups and 1878 to control groups. The majority of studies focused on type 2 diabetes (29 out of 34, 85%) [ 5 , 47 , 49 – 55 , 57 , 59 – 64 , 66 – 70 , 73 – 80 ]; 5 (15%) included both type 1 and type 2 diabetes [ 32 , 48 , 58 , 71 , 72 ]. The mean age for participants ranged from 30 to 60 years old.…”

Mobile phone applications and self‐management of diabetes: A systematic review with meta‐analysis, meta‐regression of 21 randomized trials and GRADE

“…Our results suggest no association with duration of follow-up, and this finding is supported by other studies. 8,9 However, whether the effect of diabetes apps can be sustained for a longer period of time (>1 year) remains largely unknown.…”

Effect of Health Information Technologies on Cardiovascular Risk Factors among Patients with Diabetes

“…The included studies were conducted in several different countries and regions: 6 in the USA [ 26 – 31 ], 9 in Europe [ 32 – 40 , 41 ], 6 in South Korea [ 42 – 47 ], 2 in China [ 48 , 49 ], 1 in Iran [ 50 ], 1 in Canada [ 51 ], 1 in India [ 52 ], and 1 in Japan [ 53 ]. The total participants were 3290, of which 1977 were randomized to intervention groups and 1313 to control groups.…”