Improving Management of Type 2 Diabetes Using Home-Based Telemonitoring: Cohort Study

Abstract

Background Diabetes is present in 10.5% of the US population and accounts for 14.3% of all office-based physician visits made by adults. Despite this established office-based approach, the disease and its adverse outcomes including glycemic control and clinical events tend to worsen over time. Available home technology now provides accurate, reliable data that can be transmitted directly to the electronic medical record. Objective This study aims to evaluate the impact of a virtual, home-based diabetes management program on clinical measures of diabetes control compared to usual care. Methods We evaluated glycemic control and other diabetes-related measures after 1 year in 763 patients with type 2 diabetes enrolled into a home-based digital medicine diabetes program and compared them to 794 patients matched for age, sex, race, BMI, hemoglobin A1c (HbA1c), creatinine, estimated glomerular filtration rate, and insulin use in a usual care group after 1 year. Digital medicine patients completed questionnaires online, received medication management and lifestyle recommendations from a clinical pharmacist or advanced practice provider and a health coach, and were asked to submit blood glucose readings using a commercially available Bluetooth-enabled glucose meter that transmitted data directly to the electronic medical record. Results After 1 year, usual care patients demonstrated no significant changes in HbA1c (mean 7.3, SE 1.7 to mean 7.3, SE 1.6; P=.41) or changes in the proportion of patients with HbA1c≥9.0 (n=117, 15% to n=113, 14%; P=.51). Digital medicine patients demonstrated improvements in HbA1c (mean 7.3, SE 1.5 to mean 6.9, SE 1.2; P<.001) and significant changes in the proportion of patients with HbA1c≥9.0 (n=107, 14% to n=49, 6%; P<.001), diabetes distress (n=198, 26% to n=122, 16%; P<.001), and hypoglycemic episodes (n=313, 41.1% to n=91, 11.9%; P<.001). Conclusions A digital diabetes program is associated with significant improvement in glycemic control and other diabetes measures. The use of a virtual health intervention using connected devices was widely accepted across a broad range of ethnic diversity, ages, and levels of health literacy.

Tele-Assessment of Functional Capacity through the Six-Minute Walk Test in Patients with Diabetes Mellitus Type 2: Validity and Reliability of Repeated Measurements

“…A large number of studies have reported the necessity and utility of telehealth through various applications for patients with DM2, including telelearning, telemonitoring, DM self-management, and telecounseling [ 21 , 24 , 41 , 42 ]. Telemedicine studies, such as the research by Milani [ 23 ], have shown that telehealth applications can increase glycemic control, reduce glycated hemoglobin values, and improve the quality of life [ 43 , 44 , 45 ]. Regarding the implementation of telerehabilitation for diabetic patients, only one study by Duruturk (2019) has investigated the effect of a remote intervention in glucose control, physical activity, muscle strength, and patient’s psychosocial status [ 46 ].…”

“…Home-based telemonitoring has proven to be a safe and effective alternative to center-based programs and can result in higher exercise compliance [ 20 ] and compliance with dietary recommendations in patients with DM2 [ 21 ]. Thus, telehealth could represent a valuable method to improve blood sugar control, prevent rehospitalization, enhance the quality of life, and improve adherence rates to therapeutic interventions in patients with DM2 [ 21 , 22 , 23 ]. Telehealth services also reduce costs and increase the potential to attend more sessions compared to center-based facilities [ 24 ].…”

Best practices and current implementation of emerging smartphone-based (bio)sensors - Part 2: Development, validation, and social impact

“…Since the 1960s, portable electrochemical glucose meters have improved the quality of life of many people who have diabetes [173]. It has been demonstrated that regular remote reporting of results using SbSs can improve patients' outcomes [174].…”

Feasibility and Impact of Remote Glucose Monitoring Among Patients With Newly Diagnosed Type 1 Diabetes: Single-Center Pilot Study

“…This pilot study demonstrates the feasibility of remote glucose monitoring among pediatric patients with newly diagnosed T1D using Bluetooth-capable glucose meters and Wi-Fi-enabled mobile devices. Remote glucose monitoring has been utilized previously for adults with type 2 diabetes [9,10], and for children with T1D utilizing insulin pumps [11] or CGM devices [12].…”