Telecare of diabetic patients with intensified insulin therapy. A randomized clinical trial.
BACKGROUND
Patients with insulin dependent diabetes require frequent advice if their metabolic control is suboptimal. A telemedical system for transmission of self monitoring blood glucose values from the patients' home to the diabetes center with a combined modem-interface is described. Data are processed by PC and advice is given by telephone. The study focuses on metabolic outcome, fiscal and administrative aspects.


METHODS
A prospective, randomized trial with 46 patients with intensified insulin therapy was conducted, 30 patients used telecare and 16 conventional care.


RESULTS
HbA1c, as a parameter of metabolic control, dropped from 8.3% to 7.3% in the telecare group and from 8.0% to 6.8% in the conventional group after 8 months of observation. There was no significant difference between the two groups. Time expenditure for telemanagement, compared to conventional advice, was moderately higher, but there was a substantial amount of time on the patients side that could be saved mainly by reduction of to travel time and work stoppage. Setting up an optimal telemanagement scenario a cost analysis was done. This yields a cost saving of about 650 EURO per year.


CONCLUSIONS
Telemanagement of insulin-requiring diabetic patients is a cost and time saving procedure for the patients and results in metabolic control comparable to conventional outpatient management.
Biermann
E
E
Institute for Diabetes Research, Kölnerplatz 1, 80804 München, Germany.
Dietrich
W
W
Standl
E
E
D000328:Adult; D000553:Ambulatory Care; D015190:Blood Glucose Self-Monitoring / Q000295:instrumentation*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D020407:Internet; D008297:Male; D008838:Microcomputers; D008875:Middle Aged; D011446:Prospective Studies; D013686:Telemetry / Q000295:instrumentation*; D014584:User-Computer Interface
D006442:Glycated Hemoglobin; D007328:Insulin