A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus.
BACKGROUND
Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions who experience barriers to access to care or a high burden of illness.


METHODS
The authors conducted a randomized, controlled trial comparing telemedicine case management to usual care, with blinding of those obtaining outcome data, in 1,665 Medicare recipients with diabetes, aged 55 years or greater, and living in federally designated medically underserved areas of New York State. The primary endpoints were HgbA1c, blood pressure, and low-density lipoprotein (LDL) cholesterol levels.


RESULTS
In the intervention group (n = 844), mean HgbA1c improved over one year from 7.35% to 6.97% and from 8.35% to 7.42% in the subgroup with baseline HgbA1c > or =7% (n = 353). In the usual care group (n = 821) mean HgbA1c improved over one year from 7.42% to 7.17%. Adjusted net reductions (one-year minus baseline mean values in each group, compared between groups) favoring the intervention were as follows: HgbA1c, 0.18% (p = 0.006), systolic and diastolic blood pressure, 3.4 (p = 0.001) and 1.9 mm Hg (p < 0.001), and LDL cholesterol, 9.5 mg/dL (p < 0.001). In the subgroup with baseline HgbA1c > or =7%, net adjusted reduction in HgbA1c favoring the intervention group was 0.32% (p = 0.002). Mean LDL cholesterol level in the intervention group at one year was 95.7 mg/dL. The intervention effects were similar in magnitude in the subgroups living in New York City and upstate New York.


CONCLUSIONS
Telemedicine case management improved glycemic control, blood pressure levels, and total and LDL cholesterol levels at one year of follow-up.
Shea
Steven
S
Department of Medicine, 630 W. 168th Street, New York, NY 10032, USA. ss35@columbia.edu
Weinstock
Ruth S
RS
Starren
Justin
J
Teresi
Jeanne
J
Palmas
Walter
W
Field
Lesley
L
Morin
Philip
P
Goland
Robin
R
Izquierdo
Roberto E
RE
Wolff
L Thomas
LT
Ashraf
Mohammed
M
Hilliman
Charlyn
C
Silver
Stephanie
S
Meyer
Suzanne
S
Holmes
Douglas
D
Petkova
Eva
E
Capps
Linnea
L
Lantigua
Rafael A
RA
D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D001794:Blood Pressure; D019090:Case Management; D008078:Cholesterol, LDL / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood / Q000208:ethnology / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D006278:Medicare; D008875:Middle Aged; D009518:New York; D012959:Socioeconomic Factors; D017216:Telemedicine
D001786:Blood Glucose; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin