Clinical- and Cost-effectiveness of Telemedicine in Type 2 Diabetes Mellitus

Zhai, Yunkai; Zhu, Weijun; Cai, Yanling; Sun, Dongxu; Zhao, Jie

doi:10.1097/md.0000000000000312

Cited by 209 publications

(191 citation statements)

References 62 publications

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“…A meta-analysis of 35 randomized controlled trials (RCTs) employing a heterogeneous selection of TH interventions revealed a significant, albeit slight, decrease in HbA1c in the intervention group compared to the control group. 15 In a recent Cochrane Database systematic review that only considered RCTs of interactive TH interventions that involved direct patient-provider interaction and was delivered in addition to, or substituting for, usual care compared with usual care alone found that in studies recruiting participants with diabetes (16 studies, N = 2768) those allocated to TH had lower HbA1c values (mean difference -0.31, 95% CI -0.37 to -0.24; p <0.00001) at a median of 9 months of follow-up. 16 Our findings also demonstrated that a single endocrinology consultation (independent of the modality) improved glycemic control and decreased the percentage of patients who had poorly controlled diabetes.…”

Section: Discussionmentioning

confidence: 99%

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Endocrinology Telehealth Consultation Improved Glycemic Control Similar to Face-to-Face Visits in Veterans

Liu

Saxon

McNair

et al. 2016

J Diabetes Sci Technol

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Background: Rates of diabetes for veterans who receive health care through the Veterans Health Administration are higher than rates in the general population. Furthermore, many veterans live in rural locations, far from Veterans Affairs (VA) hospitals, thus limiting their ability to readily seek face-to-face endocrinology care for diabetes. Telehealth (TH) technologies present an opportunity to improve access to specialty diabetes care for such patients; however, there is a lack of evidence regarding the ability of TH to improve glycemic control in comparison to traditional face-to-face consultations. Methods: This was a retrospective cohort study of all new endocrinology diabetes consultations at the Denver VA Medical Center over a 1-year period. Results: A total of 189 patients were included in the analysis. In all, 85 patients had received face-to-face (FTF) endocrinology consultation for diabetes and 104 patients had received TH consultation. Subjects were mostly males (94.7%) and the mean age was 62.8 ± 10.1 years old. HbA1c improved from 9.76% (9.40% to 10.11%) to 8.55% (8.20% to 8.91%) ( P < .0001) for the TH group and from 9.56% (9.16% to 9.95%) to 8.62% (8.22% to 9.01%) ( P < .0001) for the FTF group after 1 visit. This change in HbA1c was not significantly different in the TH and FTF groups ( P = .24). TH visits were associated with a hypothetical savings in median distance traveled of 231.2 miles per trip (which equates to $94.79 saved per trip). Conclusions: Endocrinology TH consultations improved short-term glycemic control as effectively as traditional FTF visits in a veteran population with diabetes.

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Section: Discussionmentioning

confidence: 99%

“…5 With regards to TH care for type 2 diabetes, a recent meta-analysis found that only 2 of 35 studies included assessment of cost-effectiveness. 15 Clearly more robust economic analyses of TH care are needed.…”

Section: Discussionmentioning

confidence: 99%

Endocrinology Telehealth Consultation Improved Glycemic Control Similar to Face-to-Face Visits in Veterans

Liu

Saxon

McNair

et al. 2016

J Diabetes Sci Technol

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“…Table 32 in Appendix 6 provides a summary of the AMSTAR results. Only three reviews were methodologically strong, 342,353,362 with the remaining 21 obtaining a score of ≤ 6, thus being rated as being of poor quality.…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

“…Taking into consideration the limited data surrounding the financial implications of telemedicine, some reviews were unable to draw any meaningful conclusions. 45,140,362 …”

mentioning

confidence: 99%

The role of digital communication in patient–clinician communication for NHS providers of specialist clinical services for young people [the Long-term conditions Young people Networked Communication (LYNC) study]: a mixed-methods study

Griffiths

Armoiry

Atherton

et al. 2018

Health Serv Deliv Res

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Health Services and Delivery ResearchISSN 2050-4349 (Print) ISSN 2050-4357 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: journals.library@nihr.ac.ukThe full HS&DR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Services and Delivery Research journalReports are published in Health Services and Delivery Research (HS&DR) if (1) they have resulted from work for the HS&DR programme or programmes which preceded the HS&DR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. HS&DR programmeThe Health Services and Delivery Research (HS&DR) programme, part of the National Institute for Health Research (NIHR), was established to fund a broad range of research. It combines the strengths and contributions of two previous NIHR research programmes: the Health Services Research (HSR) programme and the Service Delivery and Organisation (SDO) programme, which were merged in January 2012.The HS&DR programme aims to produce rigorous and relevant evidence on the quality, access and organisation of health services including costs and outcomes, as well as research on implementation. The programme will enhance the strategic focus on research that matters to the NHS and is keen to support ambitious evaluative research to improve health services.For more information about the HS&DR programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hsdr This reportThe research reported in this issue of the journal was funded by the HS&DR programme or one of its preceding programmes as project number 12/209/51. The contractual start date was in May 2014. The final report began editorial review in August 2016 and was accepted for publication in April 2017. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HS&DR editors and production house have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the final report document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Department of Health and Social Care. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, NETSCC, the HS&DR programme or the Departm...

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“…They reported that TM, compared to control therapy, resulted in a clinically and statistically significant difference in A1C of -0.37% (P < .001). 5 In 2015 Flodgren and colleagues performed a review of randomized controlled trials of TM outcomes diseases and of 93 studies that they identified, 21 we for diabetes. Among the diabetes TM studies, they found lower A1C levels in subjects allocated to TM than in controls with a difference of -0.31% (P < .00001) at a median of 9 months follow-up with a high certainty of evidence.…”

Section: Outcomes Of Tm Interventionsmentioning

confidence: 99%

Telemedicine for Diabetes

Klonoff

2015

J Diabetes Sci Technol

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EditorialTelemedicine (TM) is increasingly becoming part of the practice of medicine rather than a special practice that is separate from the normal practice of medicine. Health care planners are now seeking to identify technologies and settings where this practice can be best applied to improve outcomes, save time, and/or save money. DefinitionsTM is defined by the American Telemedicine Association as the use of medical information exchanged from 1 site to another via electronic communications to improve a patient's clinical health status.1 TM incorporates multiple types of communication services such as 2-way video, email, texting, smartphones, tablets, wireless monitors, decision support tools, and other forms of telecommunication technologies.The definition of mHealth is the use of mobile digital communication devices for health services and information. 2Wearable or portable sensors, smartphones, tablets, and other mobile wireless devices can deliver mHealth. Most mHealth systems incorporate a method of data storage utilizing remote distributed servers, which are also known as the cloud. How Telemedicine Is Applied to Diabetes CareDiabetes is well suited for being treated with TM. This disease has better outcomes when monitoring occurs and TM allows monitored data to be stored and analyzed. Many types of inputs affecting diabetes can be digitalized including blood glucose (BG) levels, time spent exercising, steps walked, calories ingested, medication doses administered, blood pressure, and weight. Patterns can be identified by software that can lead to specific treatment recommendations. Many decisions for diabetes management can be supported by or made in real time with algorithms. Finally the medical literature supports the value of using TM in diabetes management. The steps for how blood glucose data and other physiologic data can be measured, transmitted, aggregated, analyzed, stored, and then either presented as actionable information to a patient or else delivered to a treatment algorithm, where a specific action is advised, are presented in Figure 1. The result of generating actionable information is either to provide information that a patient can use to assist them in making a decision or else to provide a specific algorithm-determined recommendation that specifies a particular treatment. The decision results in data-driven action and hopefully better outcomes. Sensor-Based TMTM systems can be divided into 2 main categories: (1) systems that incorporate automatically uploaded digital sensor data and then provide descriptions, analysis, and treatment recommendations based on the data; 3 and (2) systems that do not utilize sensors and facilitate communication between a patient and a health care professional (HCP) through intentionally uploaded messages or videos and provide responses back to the patient from the HCP. 4 When the first type of TM system (digital sensor-based) uses a wearable device or a mobile carried device, then this form of TM is also known as mHealth. Mobile digital sensor TM syste...

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Clinical- and Cost-effectiveness of Telemedicine in Type 2 Diabetes Mellitus

Abstract: Supplemental Digital Content is available in the text

Cited by 209 publications

References 62 publications

Endocrinology Telehealth Consultation Improved Glycemic Control Similar to Face-to-Face Visits in Veterans

Endocrinology Telehealth Consultation Improved Glycemic Control Similar to Face-to-Face Visits in Veterans

The role of digital communication in patient–clinician communication for NHS providers of specialist clinical services for young people [the Long-term conditions Young people Networked Communication (LYNC) study]: a mixed-methods study

Telemedicine for Diabetes

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