Study: Remote Glucose Monitoring May Improve Control
Findings from a new University of Edinburgh-led study suggest that an intervention that entails nurses checking diabetics' glucose levels, weight, and blood pressure online can improve glucose control in these patients.
In a study including 321 patients, the researchers investigated whether health-professional review of telemetrically transmitted self-monitored glucose results improved glycemic control in people with poorly controlled type 2 diabetes. The authors performed a randomized, parallel, investigator-blind controlled trial with centralized randomization in family practices in 4 regions of the United States. The supported telemonitoring intervention involved self-measurement and transmission to a secure website of twice-weekly morning and evening glucose for review by family practice clinicians who were not blinded to allocation group.
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The control group received usual care, with at least annual review and more frequent reviews for people with poor glycemic or blood pressure control. HbA1c assessed at 9 months was the primary outcome, according to the authors, who added that intention-to-treat analyses were performed. Overall, 160 people were randomly assigned to the intervention group and 161 to the usual care group between June 6, 2011, and July 19, 2013. HbA1c data at follow-up were available for 146 people in the intervention group and 139 people in the control group. The mean (SD) HbA1c at follow-up was 63.0 (15.5) mmol/mol in the intervention group and 67.8 (14.7) mmol/mol in the usual care group.
The researchers found no significant differences between groups in weight, treatment pattern, adherence to medication, or quality of life in secondary analyses. The authors also reported few adverse events, which were "equally distributed between the intervention and control groups." In secondary analysis, there was a greater number of telephone calls between practice nurses and patients in the intervention compared with control group, "but no other significant differences between groups in use of health services were identified between groups."
The investigators note that key limitations in the study included potential lack of representativeness of trial participants, inability to blind participants and health professionals, and uncertainty about the mechanism, the duration of the effect, and the optimal length of the intervention.
Still, the findings suggest that "care for diabetes can be organized in a more effective way, which improves the care of patients," said Brian McKinstry, MD, a professor at the University of Edinburgh's Usher Institute of Population Health Sciences and Informatics, and coauthor of the study.
"While telehealth may not suit all patients," Dr McKinstry said, "it could be provided as an option for those who want to take more control of their condition."
Wild SH, Hanley J, Lewis SC, et al. Supported telemonitoring and glycemic control in people with type 2 diabetes: The Telescot Diabetes Pragmatic Multicenter Randomized Controlled Trial [published online July 26, 2016]. PLoS Med. doi:http://dx.doi.org/10.1371/journal.pmed.1002098.