Telecare for Patients With Type 1 Diabetes and Inadequate Glycemic Control
Open accessAbstract
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 HbA1c >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 HbA1c. To place our findings in context, we pooled HbA1c 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 HbA1c (8.2 vs. 7.8%, P = 0.03, after accounting for HbA1c at baseline) and a nonsignificant fourfold greater chance of achieving 6-month HbA1c ≤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 HbA1c mean change from baseline between the telecare and control groups. CONCLUSIONS—Telecare is associated with small effects on glycemic control in patients with type 1 diabetes on intensive insulin therapy but with inadequate glycemic control.
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In Type 1 diabetes, there were small but statistically significant pooled decreases in HbA1c of −0.4% difference (95% CI 0.0 to −0.8).
“In diabetes, there were small but statistically significant pooled decreases in HbA1c - In Type 1 diabetes (−0.4% difference, 95% C.I. 0.0 to −0.8) [40]”
From The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview (2013) · cites this paper as [40]
The “Systematic review and meta-analysis of the literature” section reports a pooled HbA1c difference of 0.4% (95% CI 0–0.8) for studies of adults with type 1 diabetes, matching the cited magnitude. But the claim omits the adults-only restriction and describes the result as statistically significant; the paper says the overall eight-study pooled result was not significantly different from usual care. No page number is available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFive reviews focused on type 1 diabetes and one analyzed type 1 diabetes within a mixed review.
“A total of 5 reviews focused on type 1 diabetes [23,24,41,48,49] and 1 analyzed type 1 diabetes within a mixed review [19].”
A meta-analysis scoring no stars in the weighting system also showed no improvement in glycemic control.
“A meta-analysis scoring no stars in the weighting system also showed no improvement in glycemic control [41].”
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- Authors
- Montori, V. M., Helgemoe, P. K., Guyatt, G. H., Dean, D. S., Leung, T. W., Smith, S. A., & Kudva, Y. C.
- Affiliations
- Division of Endocrinology, Diabetes, Metabolism, Nutrition, and Internal Medicine, Mayo Clinic, Rochester, Minnesota
- Mayo Clinic (US)
- McMaster University (CA)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2004-05-01
- Volume
- 27
- Issue
- 5
- Pages
- 1088-1094
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2085134595
- Cited by
- 169
- References
- 1
- Citations by year
- 2026: 1 · 2025: 2 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 3 · 2019: 9 · 2018: 7 · 2017: 6 · 2016: 10 · 2015: 9 · 2014: 7 · 2013: 16 · 2012: 13
- FWCI
- 7.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Mayo Foundation for Medical Education and Research
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- telecare, type 1 diabetes, glycemic control, intensive insulin therapy, HbA1c, clinician feedback, telemedicine
- MeSH terms
- Adult, Blood Glucose, Diabetes Mellitus, Type 1, Female, Humans, Male, Middle Aged, Blood Glucose Self-Monitoring, Telemedicine
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