Comprehensive telehealth intervention improves outcomes for people with type 2 diabetes
Comprehensive telehealth intervention could make a positive difference to people whose type 2 diabetes remains persistently poorly controlled despite clinic-based care, according to a new study.
Researchers carried out a randomised clinical trial of 200 adults with persistently poorly controlled type 2 diabetes (PPDM) to discover if comprehensive telehealth intervention would deliver better outcomes than a simpler telehealth approach involving telemonitoring and care coordination of blood glucose.
PPDM was defined as maintenance of haemoglobin A1c(HbA1c) level of 8.5% or higher for one year or longer despite engagement with clinic-based primary care and, or diabetes specialty care.
By the end of the trial, the haemoglobin A1c level of those who received the comprehensive telehealth intervention improved by 1.59% at 12 months, compared with 0.98% for the telemonitoring and care coordination group, reported Matthew J. Crowley, MD, MHS, of Duke University School of Medicine in Durham, North Carolina, and colleagues.
“These findings demonstrate that practically designed telehealth can be effective for patients whose type 2 diabetes remains persistently poorly controlled despite clinic-based care,” the group wrote in JAMA Internal Medicine.
Those receiving comprehensive telehealth also experienced significantly greater improvements in diabetes distress and diabetes self-care and self-efficacy.
However, there were no differences between the two groups with regard to body mass index or depression and neither group experienced more adverse events, such as diabetic ketoacidosis, hypoglycemia or hyperglycemia, than the other.
The cost of the comprehensive telehealth came in at $2,465 per patient each year while the simpler telehealth approach cost $946 per patient.
However, Crowley’s group has pointed out that although the comprehensive option was more expensive the incremental cost was less than most branded glucose-lowering medications and the comprehensive approach delivered added benefits.
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