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- Title
Telemonitoring and Team-Based Management of Glycemic Control on People with Type 2 Diabetes: a Cluster-Randomized Controlled Trial.
- Authors
Lee, Jun Yang; Chan, Carina Ka Yee; Chua, Siew Siang; Ng, Chirk Jenn; Paraidathathu, Thomas; Lee, Kenneth Kwing Chin; Lee, Shaun Wen Huey
- Abstract
<bold>Background: </bold>Connected devices that allow people with diabetes to monitor their blood glucose levels remotely with data visualization have been shown to improve self-care behavior in diabetes management. However, their effectiveness and usability for a low-middle-income, racially diverse population are unknown.<bold>Objective: </bold>This study aims to evaluate the effects of remote telemonitoring with team-based management on people with uncontrolled type 2 diabetes.<bold>Design: </bold>This was a pragmatic 52-week cluster-randomized controlled study among 11 primary care government practices in Malaysia.<bold>Participants: </bold>People with type 2 diabetes aged 18 and above, who had hemoglobin A1c ≥ 7.5% but less than 11.0% within the past 3 months and resided in the state of Selangor.<bold>Intervention: </bold>The intervention group received home gluco-telemonitors and transmitted glucose data to a care team who could adjust therapy accordingly. The team also facilitated self-management by supporting participants to improve medication adherence, and encourage healthier lifestyle and use of resources to reduce risk factors. Usual care group received routine healthcare service.<bold>Main Measure: </bold>The primary outcome was the change in HbA1c at 24 weeks and 52 weeks. Secondary outcomes included change in fasting plasma glucose, blood pressure, lipid levels, health-related quality of life, and diabetes self-efficacy.<bold>Results: </bold>A total of 240 participants were recruited in this study. The telemonitoring group reported larger improvements in glycemic control compared with control at the end of study (week 24, - 0.05%; 95% CI - 0.10 to 0.00%) and at follow-up (week 52, - 0.03%; - 0.07 to 0.02%, p = 0.226). Similarly, no differences in other secondary outcomes were observed, including the number of adverse events and health-related quality of life.<bold>Conclusion: </bold>This study indicates that there is limited benefit of replacing telemedicine with the current practice of self-monitoring of blood glucose. Further innovative methods to improve patient engagement in diabetes care are needed.<bold>Trial Registration: </bold>ClinicalTrials.gov identifier: NCT02466880.
- Subjects
SELANGOR; MALAYSIA; CLUSTER randomized controlled trials; TYPE 2 diabetes; GLYCEMIC control; BLOOD sugar monitoring; BLOOD sugar monitors; MANAGEMENT controls
- Publication
JGIM: Journal of General Internal Medicine, 2020, Vol 35, Issue 1, p87
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-019-05316-9