Ya Li
Department of endocrinology, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
Weiguo Ma
Department of endocrinology, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
Jiao Bai
Department of endocrinology, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
Chuanqing Xie
Department of endocrinology, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
Yuanyuan Huo
Department of endocrinology, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China
Objective: To evaluate the effectiveness of Internet and telephone-based telemedicine system managing on patients’ glycemic index, blood pressure, and lipid level control in underserved subjects with type 2 diabetes in Western China. Research designs and methods: In a 3 years, randomized, controlled, single-blind, parallel-group treat-to-target study, 412 subjects with type 2 diabetes were randomized to telemedicine (Tel; n =208) group and usual care (control; n =204) group. We evaluated the effects of the intervention on blood sugar, blood pressure, and lipid levels at 1, 2, 3 years point, and investigated the cause of the loss during follow-up by phone call. Results: Intra-group comparison: in the Tel group, the FBS, 2HPG, HbA1c, and SBP at 1, 2, 3 years and DBP, TC, TG, BMI at 2, 3 years were significantly decreased compared with baseline level (P<0.05). Moreover, the Tel group had an obvious better control of their HbA1c at 2 and 3 years and 2HPG at 3 years of follow-up respectively compared with the outcomes at 1 year (P<0.05).Inter-group comparison: the FBS, 2HPG, and HbA1c of Tel group decreased significantly from the baseline to the 1 year more than those of control group (P<0.05 or P<0.01 ). In this analysis, all clinical measures of Tel group had a significant downward compared with the outcomes of Control group at 2 years, the FBS, HbA1c and BMI (P<0.001), the 2HPG and SBP (P<0.01) and DBP, TC, and TG (P<0.05) were statistically significant respectively. Logistic regression analysis showed that the subject loss during follow-up was associated with worse diabetes management (OR=3.842), low income (OR=3.201), low education level (OR=0.923), and greater distance to the hospital (OR=0.921).Conclusions: The study results indicated that the telemedicine may be a useful tool for managing diabetes mellitus.
[1] Zimmet, P., et al., Diabetes mellitus statistics on prevalence and mortality: facts and fallacies. Nature Reviews Endocrinology, 2016. 12(10): 616.
[2] Whiting, D.R., et al., IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes research and clinical practice, 2011. 94(3): 311-321.
[3] Ning, G., W. Zhao, and W. Wang, Study evaluates prevalence of diabetes among adults in China Chicago. JAMA, 2013. 10: 161-163.
[4] Beck, J., et al., 2017 National standards for diabetes self-management education and support. The Diabetes Educator, 2018. 44(1): 35-50.
[5] Renders, C.M., et al., Interventions to improve the management of diabetes in primary care, outpatient, and community settings: a systematic review. Diabetes care, 2001. 24(10): 1821-1833.
[6] Blonde, L., et al., Patient‐directed titration for achieving glycaemic goals using a once‐daily basal insulin analogue: an assessment of two different fasting plasma glucose targets‐the TITRATETM study. Diabetes, Obesity and Metabolism, 2009. 11(6): 623-631.
[7] Association, A.D., Standards of medical care in diabetes—2016 abridged for primary care providers. Clinical diabetes: a publication of the American Diabetes Association, 2016. 34(1): 3.
[8] Hwang, C., et al., Development and validation of a Chinese version of the diabetes-39 to measure diabetes quality of life in Taiwan. Taiwan J Public Health, 2009. 28: 218-31.
[9] Mendenhall, E., et al., Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations. The Lancet, 2017. 389(10072): 951-963.
[10] Mullin, B., B.S. Cervantes, and J. Billimek, Material Need Insecurity and Its Concurrent Barriers to Diabetes Management Among Low-Income Latino Adults Receiving Medical Care. Diabetes care, 2019. 42(3): e31-e33.
[11] Parchman, M.L., et al., Competing demands or clinical inertia: the case of elevated glycosylated hemoglobin. The Annals of Family Medicine, 2007. 5(3): 196-201.
[12] Stange, K.C., Is ‘clinical inertia’blaming without understanding? Are competing demands excuses? The Annals of Family Medicine, 2007. 5(4): 371-374.
[13] Byers, D., et al., Facilitators and barriers to Type 2 diabetes self-management among rural African American adults. Journal of Health Disparities Research and Practice, 2016. 9(1): p. 9.
[14] Johansson, T., et al., Effectiveness of a peer support programme versus usual care in disease management of diabetes mellitus type 2 regarding improvement of metabolic control: a cluster-randomised controlled trial. Journal of diabetes research, 2016, 2016.
[15] Wright, A.K., et al., Life expectancy and cause-specific mortality in type 2 diabetes: a population-based cohort study quantifying relationships in ethnic subgroups. Diabetes Care, 2017. 40(3): 338-345.
[16] Glazier, R.H., et al., A systematic review of interventions to improve diabetes care in socially disadvantaged populations. Diabetes care, 2006. 29(7): 1675-1688.
[17] Powers, M.A., et al., Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. The Diabetes Educator, 2017. 43(1): 40-53.
[18] Izquierdo, R.E., et al., Case management with a diabetes team using home telemedicine: acceptance of treatment recommendations by primary care providers in IDEATel. Telemedicine and e-Health, 2015. 21(12): 980-986.
[19] Weinstock, R.S., et al., Glycemic control and health disparities in older ethnically diverse underserved adults with diabetes: five-year results from the Informatics for Diabetes Education and Telemedicine (IDEATel) study. Diabetes care, 2011. 34(2): 274-279.
[20] Association, A.D., 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2018. Diabetes care, 2018. 41(Supplement 1): S13-S27.
[21] Berkowitz, S.A., et al., Material need insecurities, control of diabetes mellitus, and use of health care resources: results of the Measuring Economic Insecurity in Diabetes study. JAMA internal medicine, 2015. 175(2): 257-265.
[22] Mohamed, H., et al., Culturally sensitive patient-centred educational programme for self-management of type 2 diabetes: a randomized controlled trial. Primary Care Diabetes, 2013. 7(3): 199-206.
[23] Delahanty, L.M., et al., Design and participant characteristics of a primary care adaptation of the Look AHEAD Lifestyle Intervention for weight loss in type 2 diabetes: The REAL HEALTH-diabetes study. Contemporary clinical trials, 2018. 71: 9-17.
Aims and Scope