Telemedicine and type 1 diabetes: Is technology per se sufficient to improve glycaemic control?

详细信息    查看全文

• 作者：S. Franc ; S. Borot ; O. Ronsin ; J.-L. Quesada ; D. Dardari ; C. Fagour ; E. Renard ; A.-M. Leguerrier ; C. Vigeral ; F. Moreau ; P. Winiszewski ; A. Vambergue ; H. Mosnier-Pudar ; L. Kessler ; S. Reffet ; B. Guerci ; L. Millot ; S. Halimi ; C. Thivolet ; P.-Y. Benhamou ; A. Penfornis ; et al.
• 关键词：Telemedicine ; Telemonitoring ; Decision support software ; Type 1 diabetes
• 刊名：Diabetes Metabolism
• 出版年：February, 2014
• 年：2014
• 卷：40
• 期：1
• 页码：61-66
• 全文大小：489 K

文摘

Aim

In the TELEDIAB-1 study, the Diabeo system (a smartphone coupled to a website) improved HbA_1c by 0.9% vs controls in patients with chronic, poorly controlled type 1 diabetes. The system provided two main functions: automated advice on the insulin doses required; and remote monitoring by teleconsultation. The question is: how much did each function contribute to the improvement in HbA_1c?

Methods

Each patient received a smartphone with an insulin dose advisor (IDA) and with (G3 group) or without (G2 group) the telemonitoring/teleconsultation function. Patients were classified as 鈥渉igh users鈥?if the proportion of 鈥渋nformed鈥?meals using the IDA exceeded 67% (median) and as 鈥渓ow users鈥?if not. Also analyzed was the respective impact of the IDA function and teleconsultations on the final HbA_1c levels.

Results

Among the high users, the proportion of informed meals remained stable from baseline to the end of the study 6 months later (from 78.1 卤 21.5% to 73.8 卤 25.1%; P = 0.107), but decreased in the low users (from 36.6 卤 29.4% to 26.7 卤 28.4%; P = 0.005). As expected, HbA_1c improved in high users from 8.7% [range: 8.3-9.2%] to 8.2% [range: 7.8-8.7%] in patients with (n = 26) vs without (n = 30) the benefit of telemonitoring/teleconsultation (鈭?.49 卤 0.60% vs 鈭?.52 卤 0.73%, respectively; P = 0.879). However, although HbA_1c also improved in low users from 9.0% [8.5-10.1] to 8.5% [7.9-9.6], those receiving support via teleconsultation tended to show greater improvement than the others (鈭?.93 卤 0.97 vs 鈭?.46 卤 1.05, respectively; P = 0.084).

Conclusion

The Diabeo system improved glycaemic control in both high and low users who avidly used the IDA function, while the greatest improvement was seen in the low users who had the motivational support of teleconsultations.