Telemonitoring and Team-Based Management of Glycemic Control on People with Type 2 Diabetes: a Cluster-Randomized Controlled Trial

Abstract

BACKGROUND: Connected devices that allow people with diabetes to monitor their blood glucose levels remotely with data visualization have been shown to improve selfcare behavior in diabetes management. However, their effectiveness and usability for a low-middle-income, racially diverse population are unknown. OBJECTIVE: This study aims to evaluate the effects of remote telemonitoring with team-based management on people with uncontrolled type 2 diabetes. DESIGN: This was a pragmatic 52-week cluster-randomized controlled study among 11 primary care government practices in Malaysia. PARTICIPANTS: People with type 2 diabetes aged 18 and above, who had hemoglobin A1c ≥ 7.5% but less than 11.0% within the past 3 months and resided in the state of Selangor. INTERVENTION: The intervention group received home gluco-telemonitors and transmitted glucose data to a care team who could adjust therapy accordingly. The team also facilitated self-management by supporting participants to improve medication adherence, and encourage healthier lifestyle and use of resources to reduce risk factors. Usual care group received routine healthcare service. MAIN MEASURE: The primary outcome was the change in HbA1c at 24 weeks and 52 weeks. Secondary outcomes included change in fasting plasma glucose, blood pressure, lipid levels, health-related quality of life, and diabetes self-efficacy. RESULTS: A total of 240 participants were recruited in this study. The telemonitoring group reported larger improvements in glycemic control compared with control at the end of study (week 24, − 0.05%; 95% CI − 0.10 to 0.00%) and at follow-up (week 52, − 0.03%; − 0.07 to 0.02%, p = 0.226). Similarly, no differences in other secondary outcomes were observed, including the number of adverse events and health-related quality of life. CONCLUSION: This study indicates that there is limited benefit of replacing telemedicine with the current practice of self-monitoring of blood glucose. Further innovative methods to improve patient engagement in diabetes care are needed. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02466880

Using telemedicine to support care for people with type 2 diabetes mellitus: a qualitative analysis of patients’ perspectives

“…This outcome is not surprising, as younger individuals are more familiar with technology and its use. This was noted in the IDEAS study where the average SMBG uploads were only one reading per week instead of the recommended six readings a week 31. Participants cited various reasons for being not being able to use a web-based glucometer.…”

“…The present qualitative study was part of a larger multicentre cluster randomised controlled study (Intervention for Diabetes with Education, Advancement and Support (IDEAS)) conducted between April 2015 and June 2017, which examined the impact of a telemedicine programme for people with type 2 diabetes (box 1). 30 31 This nested study design allowed the investigators to explore the perceived obstacles and incentives patients experienced when using telemedicine in the management of their type 2 diabetes.…”

“…Participants included those who: (1) had been diagnosed with type 2 diabetes for at least 6 months; (2) aged between 18 and 75 years; (3) had regular access to the Internet; (4) had HbA1c levels between 7.5% and 11.0% and (5) were randomised into the intervention arm of the IDEAS study 30 31. Participants were excluded if they had no experience in using telemedicine devices or had dropped out of the IDEAS study 31. All potentially eligible participants were contacted by telephone and invited to participate in the study.…”

Health system interventions for adults with type 2 diabetes in low- and middle-income countries: A systematic review and meta-analysis

“…Of the 11 studies reporting quality of life, 6 studies reported no significant differences between the intervention and comparator arms [29,32,45,46,52,59], and 5 studies showed improved quality of life in the intervention arm [33,40,51,58,62]. Seven different scales were used to assess quality of life, and only the EuroQol EQ-5D was used in more than 1 study [29,45,46,52,58]. Only 1 study reported quality of life as a primary outcome [51].…”

Capsule Commentary on Lee et al., Telemonitoring and Team-Based Management of Glycemic Control on People with Type 2 Diabetes: a Cluster Randomized Controlled Trial

“…L ee and colleagues tested the impact on glycemic control of a remote telemonitoring intervention with team-based management for diabetes. 1 They found no effect of this intervention. While a negative finding is disappointing, given prior evidence of the power of telemedicine, this finding can also be informative, as it emphasizes that it is not enough to add technology to the equation but rather it has to be designed and implemented to have a measurable effect.…”