Telecare for Patients with Type 1 Diabetes and Inadequate Glycemic Control

A randomized controlled trial and meta-analysis

Victor Manuel Montori, Pamela K. Helgemoe, Gordon H. Guyatt, Diana S. Dean, Teresa W. Leung, Steven A. Smith, Yogish C Kudva

Research output: Contribution to journalArticle

129 Citations (Scopus)

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 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.

Original languageEnglish (US)
Pages (from-to)1088-1094
Number of pages7
JournalDiabetes Care
Volume27
Issue number5
DOIs
StatePublished - May 2004

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Type 1 Diabetes Mellitus
Meta-Analysis
Randomized Controlled Trials
Insulin
Modems
Control Groups
Research Design
Therapeutics
Nurses

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Telecare for Patients with Type 1 Diabetes and Inadequate Glycemic Control : A randomized controlled trial and meta-analysis. / Montori, Victor Manuel; Helgemoe, Pamela K.; Guyatt, Gordon H.; Dean, Diana S.; Leung, Teresa W.; Smith, Steven A.; Kudva, Yogish C.

In: Diabetes Care, Vol. 27, No. 5, 05.2004, p. 1088-1094.

Research output: Contribution to journalArticle

Montori, Victor Manuel ; Helgemoe, Pamela K. ; Guyatt, Gordon H. ; Dean, Diana S. ; Leung, Teresa W. ; Smith, Steven A. ; Kudva, Yogish C. / Telecare for Patients with Type 1 Diabetes and Inadequate Glycemic Control : A randomized controlled trial and meta-analysis. In: Diabetes Care. 2004 ; Vol. 27, No. 5. pp. 1088-1094.
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