Using the Internet-based upload blood glucose monitoring and therapy management system in patients with type 1 diabetes

Abstract

The aim of this study is to assess the impact of the internet-based upload blood glucose monitoring and therapy management system (Carelink(®)) in patients with type 1 diabetes. Diabetic patients treated with pump infusion for ≥3 months were prospectively randomized to use the CareLink(®) with (4 months) and without (4 months) diabetes-team initiated contact (n = 36, intervention group) or to continue standard care for 4 months and then transfer to the CareLink(®) without diabetes-team initiated contact (n = 34, control group). In the first 4 months, treatment was adjusted monthly by the same team in both groups. Main outcome measures were HbA1c level and scores on the Diabetes Treatment Satisfaction and Diabetes Quality of Life Questionnaires. Patients who submitted <3 times during each 4-month segment were considered noncompliant. Mean patient age was 14.02 ± 5.33 years; mean diabetes duration, 6.4 ± 4.7 years; median duration of pump treatment, 2.5 years. After 4 months, mean HbA1c level decreased from 8.75 ± 0.84 to 8.45 ± 0.90% in the intervention group (p = 0.013) and from 8.65 ± 0.57 to 8.37 ± 0.73% in the control group (p = 0.054). Within the intervention group, the difference in the change in HbA1c levels between compliant and noncompliant patients was significant (8.17 ± 0.81 vs. 8.99 ± 0.85%, p = 0.017). Only in the compliant subgroup was the decrease from baseline significant (p = 0.006). Similar findings were noted in the control group at 8 months (p < 0.05 and p = 0.018, respectively). There were no significant changes in questionnaire scores at 4 or 8 months in either group. Use of the CareLink(®) system is associated with significantly improved glycemic control in compliant patients, with no apparent effect on patient satisfaction or quality of life.

Telemedicine for the Management of Glycemic Control and Clinical Outcomes of Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

“…In the 11 trials that reported quality of life (Gómez et al, 2002; Lawson et al, 2005; Jansà et al, 2006; Benhamou et al, 2007; Rossi et al, 2010, 2013; Charpentier et al, 2011; Kirwan et al, 2013; Esmatjes et al, 2014; Shalitin et al, 2014; Suh et al, 2014), no differences were reported between telemedicine and usual care when using generic health-related quality of life (SF12, EuroQoL) or diabetes specific quality of life (Diabetes Quality of Life for Youth, Diabetes Quality of Life).…”

“…The telemedicine system used in most trials were relatively simple and involved data transmission of blood glucose data with feedback ( n = 19; Ahring et al, 1992; Marrero et al, 1995; Fallucca et al, 1996; Biermann et al, 1999; Gómez et al, 2002; Chase et al, 2003; Montori et al, 2004; Vähätalo et al, 2004; Farmer et al, 2005; Lawson et al, 2005; Rami et al, 2006; Benhamou et al, 2007; Cadario et al, 2007; Rigla et al, 2008; Landau et al, 2012; DeSalvo et al, 2013; Kirwan et al, 2013; Berndt et al, 2014; Shalitin et al, 2014; Schiaffini et al, 2016) or blood glucose data only ( n = 2; Wojcicki et al, 2001; Chase et al, 2003). Data was mostly transmitted daily in five trials, weekly or less often in 15 trials and in one studies the timing was unspecified.…”

CGM, Pregnancy, and Remote Monitoring

“…Remote monitoring includes the ability to see glucose meter data, CGM data as trends or daily patterns, and insulin pump downloads. Regarding CGM remote monitoring, some companies have software specifically for their products, such as CareLink and CareLink Pro for Medtronic products [54][55][56][57][58][59] and Studio, Share, and Clarity for Dexcom products. 60,61 Other programs can download multiple devices and view data in one system, such as Glooko, [61][62][63] Tidepool Blip, 61,64 and Diasend.…”

“…61,65 Software and online programs have been used in remote or retrospective monitoring of glucose data in nonpregnant populations. [55][56][57][58][59][66][67][68] One CGM system was evaluated with concurrent remote monitoring at children's diabetes camps. On control nights of CGM use, subjects (n = 57) could hear hypoglycemia alarms, but on intervention nights, only medical personnel received alarms through remote monitoring.…”

Adjusting insulin doses in patients with type 1 diabetes who use insulin pump and continuous glucose monitoring: Variations among countries and physicians

“…2 According to the Type 1 Diabetes Exchange registry, 50% of patients with type 1 diabetes in the United States use insulin pump therapy. 8 Nevertheless, analysis of this multitude of information may be overwhelming for many patients, caregivers and healthcare providers, as it requires extensive training and considerable time. 4 Studies have shown that insulin pump therapy may be associated with improved overall metabolic control compared with multiple daily injections, improved glycated haemoglobin (HbA1c) levels 5,6 and reduced rates of severe hypoglycaemia.…”