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Telemonitoring and Team-Based Management of Glycemic Control on People with Type 2 Diabetes: a Cluster-Randomized Controlled Trial

Lee JY 1 , Chan CKY 2 , Chua SS 3 , Ng CJ 4 , Paraidathathu T 3 , Lee KKC 1 Show all authors , Lee SWH 5

Affiliations 

  • 1 School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia
  • 2 School of Psychology and Public Health, La Trobe University, Edwards Road, Flora Hill, VIC, 3551, Australia
  • 3 School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University Lakeside Campus, No. 1 Jalan Taylor's, 47500, Subang Jaya, Selangor, Malaysia
  • 4 Department of Primary Care Medicine, Faculty of Medicine, University Malaya, 50603, Kuala Lumpur, Malaysia
  • 5 School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500, Bandar Sunway, Selangor, Malaysia. shaun.lee@monash.edu
J Gen Intern Med, 2020 Jan;35(1):87-94.
PMID: 31512187 DOI: 10.1007/s11606-019-05316-9

Abstract

BACKGROUND: 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.

OBJECTIVE: This study aims to evaluate the effects of remote telemonitoring with team-based management on people with uncontrolled type 2 diabetes.

DESIGN: This was a pragmatic 52-week cluster-randomized controlled study among 11 primary care government practices in Malaysia.

PARTICIPANTS: 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.

INTERVENTION: 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.

MAIN MEASURE: 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.

RESULTS: 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.

CONCLUSION: 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.

TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02466880.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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