Spotlight on telehealth for diabetes management

Two recent studies analyzed telehealth interventions to improve glycemic control among patients with type 2 diabetes and high HbA1c levels.

The first study, published online by Diabetes Care on July 25, included 280 patients (61.6% men) and their partners in the U.S. They were divided into 3 arms, which all received self-management education calls, but 1 arm included 10 additional phone calls to the patient about behavior change, and 1 arm received 10 phone calls, involving both the patient and the partner and discussing collaboration, relationships, and communication. After a year, all of the interventions were associated with HbA1c reductions (−0.57%, −0.52%, and −0.47%, respectively). However, when patients were stratified by baseline HbA1c, none of the interventions worked for the lowest tertile (7.5% to 8.2%) and only the couples calls were associated with significant reductions in the middle tertile (8.3% to 9.2%), while all were effective in the highest group (≥9.3%). The researchers also found that both the couples calls and individual calls were associated with improved diabetes self-efficacy. They noted that this is the first study of a couples intervention by telephone and it “shows promise for enhancing the potential positive impact of partners of type 2 diabetes patients in poor glycemic control.”

The other study, published in PLOS Medicine on July 26, involved telemonitoring of self-measured glucose levels in 321 British patients with type 2 diabetes and HbA1c levels above 7.5%. Half the patients were randomized to transmitting twice-weekly morning and evening glucose measurements to a family practice clinician through a secure website, while the rest received usual care. After 9 months, the mean HbA1c was 7.9% in the intervention group compared to 8.4% in the control group, an adjusted mean difference of 0.51% (P=0.0007). Mean blood pressure was also slightly lower in the intervention group. The researchers observed more telephone calls between nurses and patients in the intervention group (rate ratio, 7.50), but no marked differences in prescribing patterns. The latter finding was a surprise, the authors noted, and suggested that the benefits of the intervention might have resulted from changes in diet, lifestyle, or medication adherence. A strength of the study was its setting in typical outpatient practice, but a limitation was that only 12% of eligible patients agreed to participate, the study authors said. The authors concluded by recommending further research to determine if these improvements are sustained over time and to identify which specific patient groups might benefit.