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DreamTel; diabetes risk evaluation and management tele-monitoring study protocol

Open access
Tobe, Sheldon W, Wentworth, Joan, Ironstand, Laurie, Hartman, Susan, Hoppe, Jackie, Whiting, Judi, Kennedy, Janice, McAllister, Colin +5 more·2009·BMC Endocrine Disorders
DOI 10.1186/1472-6823-9-13PMC PMC2689225
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Abstract

BACKGROUND: The rising prevalence of type 2 diabetes underlines the importance of secondary strategies for the prevention of target organ damage. While access to diabetes education centers and diabetes intensification management has been shown to improve blood glucose control, these services are not available to all that require them, particularly in rural and northern areas. The provision of these services through the Home Care team is an advance that can overcome these barriers. Transfer of blood glucose data electronically from the home to the health care provider may improve diabetes management. METHODS AND DESIGN: The study population will consist of patients with type 2 diabetes with uncontrolled A1c levels living on reserve in the Battlefords region of Saskatchewan, Canada. This pilot study will take place over three phases. In the first phase over three months the impact of the introduction of the Bluetooth enabled glucose monitor will be assessed. In the second phase over three months, the development of guidelines based treatment algorithms for diabetes intensification will be completed. In the third phase lasting 18 months, study subjects will have diabetes intensification according to the algorithms developed. DISCUSSION: The first phase will determine if the use of the Bluetooth enabled blood glucose devices which can transmit results electronically will lead to changes in A1c levels. It will also determine the feasibility of recruiting subjects to use this technology. The rest of the Diabetes Risk Evaluation and Management Tele-monitoring (DreamTel) study will determine if the delivery of a diabetes intensification management program by the Home Care team supported by the Bluetooth enabled glucose meters leads to improvements in diabetes management. TRIAL REGISTRATION: Protocol NCT00325624.

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Crossref · 10.1186/1472-6823-9-13

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65 of 65 references verified0 citation errors · 0 not checkable

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  • Providers default to therapeutic inertia, failing to titrate medications despite receiving actionable physiological data.

    “Consequently, providers default to therapeutic inertia, failing to titrate medications despite receiving actionable physiological data [7,8].”

    From Clinical Efficacy and Patient Adherence Hurdles of Remote Patient Monitoring (RPM) Frameworks in Managing Hypertension and Type 2 Diabetes: A Scoping Review (2026) · cites this paper as [7]

    The Discussion (page unavailable) describes clinical inertia in poorly controlled diabetes and reports that more than 50% of patients referred to specialists had no treatment intensification within four months of a high-A1c lab report. The Methods and design section defines intensification to include increasing a medication dose. This supports failure to adjust treatment despite an actionable result, but not the broader claim that providers generally default to inertia despite receiving physiological data. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Clinical teams routinely experience alert fatigue, increased administrative workloads, and persistent therapeutic inertia when attempting to titrate medications based on remotely transmitted data.

    “clinical teams routinely experience alert fatigue, increased administrative workloads, and persistent therapeutic inertia (delays in escalating treatment despite recorded clinical need) when attempting to titrate medications based on remotely transmitted data [7,8].”

    From Clinical Efficacy and Patient Adherence Hurdles of Remote Patient Monitoring (RPM) Frameworks in Managing Hypertension and Type 2 Diabetes: A Scoping Review (2026) · cites this paper as [7]

    The Discussion describes clinical inertia as a failure to intensify diabetes treatment despite evidence of poor control, and the Methods and design section describes adjusting medication using remotely available glucose readings. But the paper does not say that teams routinely experience alert fatigue or increased administrative workloads, or that remote-data titration itself causes persistent inertia. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • When an RPM platform shifts administrative or technical burdens onto clinical teams without automated triaging, it triggers alert fatigue.

    “when an RPM platform shifts administrative or technical burdens onto clinical teams without automated triaging, it triggers alert fatigue [7].”

    From Clinical Efficacy and Patient Adherence Hurdles of Remote Patient Monitoring (RPM) Frameworks in Managing Hypertension and Type 2 Diabetes: A Scoping Review (2026) · cites this paper as [7]

    The Methods and design section describes a planned system of graded alerts, and the Discussion describes remote monitoring. Neither addresses whether shifting administrative or technical work to clinical teams without automated triaging causes alert fatigue. Searches for alert fatigue, triaging, and staff workload found no passage making that connection. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

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Cites

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1 of the 66 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada Canadian Journal of Diabetes 2003 27 S58 S65 24070926
  2. 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada Canadian Journal of Diabetes 2008 31 24070961

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Authors
Tobe, S. W., Wentworth, J., Ironstand, L., Hartman, S., Hoppe, J., Whiting, J., Kennedy, J., McAllister, C., Kiss, A., Perkins, N., Vincent, L., Pylypchuk, G., & Lewanczuk, R. Z.
Affiliations
  • Sunnybrook Health Science Centre (CA)
  • First Nations University of Canada (CA)
  • Institute for Clinical Evaluative Sciences (CA)
  • St. Paul's Hospital (CA)
  • University of Alberta (CA)
Corresponding author
Tobe, Sheldon W
ORCID
Venue
BMC Endocrine Disorders
Publisher
Springer Science and Business Media LLC
Published
2009-05-09
Volume
9
Issue
1
Pages
13-13
ISSN
1472-6823 (ISSN-L)
DOI
10.1186/1472-6823-9-13
PMC
PMC2689225
OpenAlex
W2044803552
Cited by
2
References
66
Citations by year
2026: 1 · 2015: 1
FWCI
0.00
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Endocrine Disorders (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
type 2 diabetes, remote patient monitoring, home care, diabetes education, rural health care, treatment algorithm

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