Telecare for Patients with Type 1 Diabetes and Inadequate Glycemic Control: A randomized controlled trial and meta-analysis

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 HbA_1c >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 HbA _1c. To place our findings in context, we pooled HbA_1c 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 HbA_1c (8.2 vs. 7.8%, P = 0.03, after accounting for HbA_1c at baseline) and a nonsignificant fourfold greater chance of achieving 6-month HbA_1c ≤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 HbA_1c mean change from baseline between the telecare and control groups. CONCLUSIONS - Telecare is associated with small effects on glycernic control in patients with type 1 diabetes on intensive insulin therapy but with inadequate glycemic control.