Use of telemedicine in subjects with type 1 diabetes equipped with an insulin pump and real-time continuous glucose monitoring (original) (raw)
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Benefit of Telemedicine for Patients With Diabetes Mellitus
The mean HbA1c difference between Sensor Augmented Pump (SAP) therapy and Multiple Daily Injections (MDI) is 0.3 to 0.6% in favour of SAP, but adolescents, although treated with SAP therapy, show a progressive temporary deterioration of glucose control. Telemedicine in Type 1 Diabetes is thought to facilitate diabetes management and to improve compliance to CSII/SAP treatment especially during adolescence. The aim of the present study was to observe the long term impact on glycometabolic controlled by Telemedicine systems (Telemedicine Group) compared with traditional follow-up (Control Group) in Type 1 diabetes SAP treated adolescents. The observed HbA1c decrease in the group followed with telemedicine was associated with a better compliance to therapy in terms of frequency of sensor use, number of SMBG tests and number of insulin boluses.
Diabetes Care, 2005
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 selfmonitoring 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 Ϯ SD) 12.1 Ϯ 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 Ͻ 0.0001). There was a reduction in A1C in the intervention group after 9 months from 9.2 Ϯ 1.1 to 8.6 Ϯ 1.4% (difference 0.6% [95% CI 0.3-1.0]) and a reduction in A1C in the control group from 9.3 Ϯ 1.5 to 8.9 Ϯ 1.4% (difference 0.4% [0.03-0.7]). This difference in change in A1C between groups was not statistically significant (0.2% [Ϫ0.2 to 0.7, P ϭ 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.
Telemedicine and type 1 diabetes: Is technology per se sufficient to improve glycaemic control?
Diabetes & Metabolism, 2014
Aim. -In the TELEDIAB-1 study, the Diabeo system (a smartphone coupled to a website) improved HbA 1c by 0.9% vs controls in patients with chronic, poorly controlled type 1 diabetes. The system provided two main functions: automated advice on the insulin doses required; and remote monitoring by teleconsultation. The question is: how much did each function contribute to the improvement in HbA 1c ?
Telemedicine and diabetes: Achievements and prospects
Diabetes & Metabolism, 2011
Health authorities currently have high expectations for telemedicine (TM), as it addresses several major challenges: to improve access to healthcare (especially for patients in underserved or remote areas); to overcome the scarcity of specialists faced with epidemic disease; and to reduce the costs of healthcare while improving quality. The aims of TM in the field of diabetes differ according to the type of diabetes. In type 1 diabetes (T1DM) associated with complex insulin regimens, the goal of TM is to help patients achieve better control of their blood glucose levels through accurate adjustment of insulin doses. In type 2 diabetes (T2DM), while therapeutic adjustments may be necessary, improvement in blood glucose control is based primarily on behavioural changes (reduced calorie and carbohydrate intakes, increased physical activity). Many TM studies focusing on management of blood glucose levels have been published, but most failed to demonstrate any superiority of TM vs traditional care. While previously published meta-analyses have shown a slight advantage at best for TM, these meta-analyses included a mix of studies of varying durations and different populations (both T1DM and T2DM patients, adults and children), and tested systems of inconsistent quality. Studies published to date on TM suggest two currently promising approaches. First, handheld communicating devices, such as smartphones, loaded with software to apply physicians' prescriptions, have been shown to improve glycaemic control. These systems provide immediate assistance to the patient (such as insulin-dose calculation and food choice optimization at meals), and all data stored in the smartphone can be transmitted to authorized caregivers, enabling remote monitoring and even teleconsultation. These systems, initially developed for T1DM, appear to offer many possibilities for T2DM, too. Second, systems combining an interactive Internet system (or a mobile phone coupled to a remote server) with a system of communication between the healthcare provider and the patient by e-mail, texting or phone calls have also shown certain benefits for glycaemic control. These systems, primarily aimed at T2DM patients, generally provide motivational support as well. Although the individual benefits of these systems for glycaemic control are fewer than with smartphones, their widespread use should be of particular value for overcoming the relative shortage of doctors and reducing the health costs associated with a disease of such epidemic proportions.
Telemedicine as a tool for intensive management of diabetes: the DIABTel experience
Computer Methods and Programs in Biomedicine, 2002
This paper presents the current features of the DIABTel telemedicine system and the evaluation outcomes of its use in clinical routine. This telemedicine system is designed to complement the daily care and intensive management of diabetic patients through telemonitoring and telecare services. The system comprises a patient unit (PU) used by patients in their day-to-day activities and a Medical Workstation used by physicians and nurses at hospitals. Both applications offer tools to collect, manage, view and interpret data and to exchange data and messages. The system was evaluated for usability, telemedical protocols, metabolic control and quality of life. This evaluation consisted in a 6-month cross-over pilot study with ten Type I diabetic patients. The results of the evaluation allowed assessment of the telemedicine protocols in terms of the number of communications/patient (21.6 9 7.7); days between communications (5.4 92.66); messages sent by physicians (118 text messages); and data and messages transmitted by patients (3524 blood glucose readings, 1649 day-to-day insulin adjustments, 24 exercise reports, ten diet modifications and 63 text messages). Physicians performed more therapeutic changes during the DIABTel period than in the control period. There was a trend towards HbA1c improvement during DIABTel use with no incidence in the number of hypoglycaemias. This pilot study demonstrates the feasibility of the DIABTel system in clinical routine use and its potential benefits for diabetes care: improving the availability of information necessary for therapy adjustments; offering new physician-patient communication tools; increasing patient empowerment and education; and showing a positive trend towards improving the metabolic control of patients. Further studies are needed to validate these findings and to promote telemedicine as an opportunity to better diabetes care.
An automated telemedicine system improves patient-reported well-being
Diabetes technology & therapeutics, 2009
Control of serum glucose levels is essential for the reduction of complications of diabetes. Telemedicine is one strategy through which serum glucose control can be improved. A total of 35 adult, insulin-treated patients with diabetes (type 1 and type 2) were enrolled in the present study (63.0 +/- 10 years of age, 63% female) and randomized to telemedicine monitoring (including cordless, remote glucose monitor, and transmitter, n = 17), or conventional follow-up (n = 18). Metabolic parameters were evaluated, and a quality of life questionnaire was administered both pre- and post-treatment. Groups were similar at baseline in terms of demographic, quality of life, and metabolic parameters. Significant differences in post-treatment metabolic parameters were not observed, although serum glucose was marginally elevated in the control group compared to the telemedicine group (214 +/- 65 mg/dL vs. 171 +/- 77 mg/dL, P = 0.09). On the other hand, being clinically symptom-free (71% vs. 11%, ...
Telemedicine for the Self-Management of Type 2 Diabetes: A Literature Review
2021
The COVID-19 pandemic is an obstacle that prevents people living with type 2 diabetes from visiting primary health services. Telemedicine is a virtual health service that helps caregivers and clients to meet virtually. Telemedicine is capable of assisting sufferers in the form of self-management. This study aims to determine the effect of telemedicine on self-management of type 2 diabetes patients. This study uses a literature review design. Primary studies to be included in this review were searched from Pubmed electronic database. The inclusion criteria of studies were: published in the last five years in English-language journals, used randomized control trial design, had population aged > 18 years with type-2 diabetes, and used telemedicine. The exclusion criterion was comparing two or more telemedicine applications. A total of 11 studies was included in the review. Seven out of eleven studies showed a significant reduction in HbA1c in the intervention group than the control ...
Telemedicine Improved Diabetic Management
Military Medicine, 2000
Effective control of diabetes is known to delay or prevent the end-organ complications of this disease. Can telemedicine improve a patient's ability to self-manage diabetes? Twenty-eight patients entered a study comparing home telemedicine consultation with standard outpatient care. A nurse case manager contacted the telemedicine group once a week under the direction of a primary care physician, who contacted the telemedicine group once a month. Laboratory studies and total body weight were measured at the beginning and at the end of the 3-month study. The hemoglobin Ale (HbA 1c) and total body weight improved significantly in the intervention (telemedicine) group, as shown by a 16% reduction in mean HbA 1C level (from 9.5 to 8.2%)and a 4%mean weight reduction (from 214.3 to 206.7 pounds). Based on our experience, we present a functionally based telemedicine classification system to improve the application of electronic medicine in future studies.