What We Can Really Expect from Telemedicine in Intensive Diabetes Treatment: Results from 3-Year Study on Type 1 Pregnant Diabetic Women

Abstract

Existing standards of the management of the diabetic patients are not efficient enough, and further improvement is needed. The major objective of this paper is to present and discuss the therapeutic effectiveness of an intensive care telematic system designed and applied for intensive treatment of pregnant type 1 diabetic women. The developed system operates automatically, every night transferring all the data recorded during the day in the patient's glucometer memory to a central clinical unit. In order to assess the efficiency of the designed and developed system, a 3-year randomized prospective clinical trial was conducted, using the study group and the control group, each consisting of 15 pregnant type 1 diabetic women. All patients were treated by the same diabetologist. In the presented analysis, two indices calculated weekly were used for the assessment of glycemic control: MBG represents mean blood glucose level, and the universal J-index is sensitive to the glycemic level and glycemic variations. The most important results from the study concern: (a) better glycemic control in the study group in comparison with the control group during the course of treatment, as assessed by the average differences of the MBG and J indices calculated weekly (n = 24) (deltaMBG = -3.2 +/- 4.3 mg/dL, p = 0.0016, deltaJ = -1.4 +/- 2.3, p = 0.0065); (b) much more similar results in glycemic control among members of the study group compared to each other, than among members of the control group compared to each other, as indicated by significantly lower variations of the applied glycemic control indices (SDMBG: 11.9 vs. 18.7 mg/dL, p = 0.0498; SDJ: 6.5 vs. 10.9, p = 0.0318); (c) the observed tendency of a better glycemic control for patients with a lower level of intelligence (IQ < 100) supported by the telematic system in comparison with all other assessed groups of patients. The last result was not statistically significant (p > 0.05). This telematic intensive care system improved the effectiveness of diabetes treatment during pregnancy. It also allows the diabetologist's strategy to be much more precise than if it were conducted without telematic support. This telematic system is inexpensive and simple in use.

The Impact of Mobile Health Interventions on Chronic Disease Outcomes in Developing Countries: A Systematic Review

“…In two of three studies diabetic clinical outcomes improved with mhealth interventions. Wojcicki et al 35 found that patients who transferred daily glucose readings to physicians using a telematic system and received telephone medication regimen feedback had better diabetic glycemic control, as defined by mean blood glucose and glucose variability indices, than control subjects. Although there was no significant difference in number of hyperglycemic or hypoglycemic episodes in the control or intervention group, the absolute number of either event was lower in the intervention group.…”

CGM, Pregnancy, and Remote Monitoring

“…66 Some studies examined remote monitoring of glucose meter data by a provider who then adjusted treatment in pregnant women with GDM or T1D. [69][70][71][72] We presented data at the American Diabetes Association (ADA) Scientific Sessions of interim analyses of a study using CGM alone or with ShareÔ remote monitoring technology in pregnant women with T1D. Share allows followers (family and friends) to view sensor glucose trends and receive alerts.…”

Telecare for Patients With Type 1 Diabetes and Inadequate Glycemic Control

“…Systematic review and meta-analysis of the literature Two reviewers working independently considered six trials published in seven manuscripts (22)(23)(24)(25)(26)(27)(28) eligible for review, with perfect interobserver agreement (Table 2). One additional eligible study was presented as a poster at the 63rd Scientific Sessions of the American Diabetes Association in June 2003 (29).…”