Abstract

OBJECTIVE—To determine whether a system of telemedicine support can improve glycemic control in type 1 diabetes.

RESEARCH DESIGN AND METHODS—A 9-month randomized trial compared glucose self-monitoring real-time result transmission and feedback of results for the previous 24 h in the control group with real-time graphical phone-based feedback for the previous 2 weeks together with nurse-initiated support using a web-based graphical analysis of glucose self-monitoring results in the intervention group. All patients aged 18–30 years with HbA_1c (A1C) levels of 8–11% were eligible for inclusion.

RESULTS—A total of 93 patients (55 men) with mean diabetes duration (means ± SD) 12.1 ± 6.7 years were recruited from a young adult clinic. In total, the intervention and control groups transmitted 29,765 and 21,400 results, respectively. The corresponding median blood glucose levels were 8.9 mmol/l (interquartile range 5.4–13.5) and 10.3 mmol/l (6.5–14.4) (P < 0.0001). There was a reduction in A1C in the intervention group after 9 months from 9.2 ± 1.1 to 8.6 ± 1.4% (difference 0.6% [95% CI 0.3–1.0]) and a reduction in A1C in the control group from 9.3 ± 1.5 to 8.9 ± 1.4% (difference 0.4% [0.03–0.7]). This difference in change in A1C between groups was not statistically significant (0.2% [−0.2 to 0.7, P = 0.3).

CONCLUSIONS—Real-time telemedicine transmission and feedback of information about blood glucose results with nurse support is feasible and acceptable to patients, but to significantly improve glycemic control, access to real-time decision support for medication dosing and changes in diet and exercise may be required.