Telecare for Patients With Type 1 Diabetes and Inadequate Glycemic Control
A randomized controlled trial and meta-analysis
- Victor M. Montori, MD, MSC1,
- Pamela K. Helgemoe, RN1,
- Gordon H. Guyatt, MD, MSC23,
- Diana S. Dean, MD1,
- Teresa W. Leung, BHSC4,
- Steven A. Smith, MD1 and
- Yogish C. Kudva, MD1
- 1Division of Endocrinology, Diabetes, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic, Rochester, Minnesota
- 2Department of Clinical Epidemiology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- 3Department of Biostatistics and Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- 4Bachelor of Health Sciences Program, McMaster University, Hamilton, Ontario, Canada
- Address correspondence and reprint requests to Yogish C. Kudva, MD, Mayo W18, 200 1st St. SW, Rochester, MN 55905. E-mail: kudva.yogish{at}mayo.edu
Abstract
OBJECTIVE—To determine the efficacy of telecare (modem transmission of glucometer data and clinician feedback) to support intensive insulin therapy in patients with type 1 diabetes and inadequate glycemic control.
RESEARCH DESIGN AND METHODS—Thirty-one patients with type 1 diabetes on intensive insulin therapy and with HbA1c >7.8% were randomized to telecare (glucometer transmission with feedback) or control (glucometer transmission without feedback) for 6 months. The primary end point was 6-month HbA1c. To place our findings in context, we pooled HbA1c change from baseline reported in randomized trials of telecare identified in a systematic review of the literature.
RESULTS—Compared with the control group, telecare patients had a significantly lower 6-month HbA1c (8.2 vs. 7.8%, P = 0.03, after accounting for HbA1c at baseline) and a nonsignificant fourfold greater chance of achieving 6-month HbA1c ≤7% (29 vs. 7%; risk difference 21.9%, 95% CI −4.7 to 50.5). Nurses spent 50 more min/patient giving feedback on the phone with telecare patients than with control patients. Meta-analysis of seven randomized trials of adult patients with type 1 diabetes found a 0.4% difference (95% CI 0–0.8) in HbA1c mean change from baseline between the telecare and control groups.
CONCLUSIONS—Telecare is associated with small effects on glycemic control in patients with type 1 diabetes on intensive insulin therapy but with inadequate glycemic control.
- DCCT, Diabetes Control and Complications Trial
- IQR, interquartile range
- SDIS, Stockholm Diabetes Intervention Study
- SDSCA, Summary of Diabetes Self-Care Activities
Footnotes
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V.M.M. and Y.C.K. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
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- Accepted February 2, 2004.
- Received October 9, 2003.
- DIABETES CARE
