Home and Community Care Digest
Methods: Patients aged 18-30, registered at either the Pediatric Transition Clinic or the Young Adult Diabetes Clinic in Oxford, UK, with uncomplicated type 1 diabetes, but poor glycemic control, were invited to participate in a randomized controlled trial. Each participant was given a blood glucose monitor and a mobile phone able to send and receive blood glucose data to a secure data processing facility. Participants were given an initial assessment to document baseline measures and then followedup at a final 9-month clinic visit. Blood glucose levels were measured at baseline, throughout the study (by the participants) and during the final visit. A total of 93 people participated in this study.
Participants were assigned to an "intensive feedback group" or to a comparison group. The "intensive feedback group" received counselling and advice from a diabetes specialist nurse in addition to real-time feedback on their mobile phones. The diabetes nurse reviewed the participant's blood glucose results at least once every two weeks (or more frequently) and provided detailed feedback and advice on how to control their condition either by telephone or by posting information to a personalized web page. In addition to counselling, "intense feedback group" participants also had immediate graphical feedback of blood glucose results presented on their mobile phones (i.e., colour coded histograms and time-series results for the past 24 hours). In contrast, the comparison group had access simple graphs of the participant's blood glucose readings for the previous 24 hour period on a web page or on the mobile phone.
Findings: Overall, both the intensive feedback and comparison groups had lower blood glucose levels at the after 9-months (intensive: 9.2 to 8.6 vs. minimal: 9.3 to 8.9). However, the intensive feedback group reported a greater number of blood glucose tests during the study (29,765 vs. 21,400) and a greater frequency of testing at least once a day (27 weeks vs. 19 weeks) than the comparison group.
There were 601 nurse-initiated phone calls to members of the "intensive feedback group", or one phone call every 2.5 weeks. Average phone call duration was around 7 minutes. The amount of time a nurse spent with a participant did not seem to affect changes in blood glucose levels.
Conclusions: This study demonstrated the feasibility of using a telemedicine system with real-time transmission of blood glucose test results and intensive feedback to support young adults with type 1 diabetes. Those participants who used the system reported improved results and more frequent monitoring of blood glucose, strongly suggesting that the system was valued and acceptable to users. While this study demonstrated that a real-time telemedicine system providing intensive nurse feedback can improve type 1 diabetes, no information is currently available regarding the cost-effectiveness of this type of intervention compared to technology independent protocols or standard practice.
Reference: Farmer AJ, Gibson OJ, Dudley C, Bryden K, Hayton PM, Tarassenko L, Neil A. "A randomized controlled trial of the effect of real-time telemedicine support on glycemic control in young adults with Type 1 Diabetes (ISRCTN 46889446)". Diabetes Care, 2005; 28 (11), 2697-2702.
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