title: Implementation of telehealth support for patients with type 2 diabetes using insulin treatment: an exploratory study.
abstract: BACKGROUND
  Initiating and adjusting insulin treatment for people with type 2 diabetes (T2D) requires frequent clinician contacts both face-to-face and by telephone. We explored the use of a telehealth system to offer additional support to these patients.
  
  
  METHODS
  Twenty-three patients with uncontrolled T2D were recruited from nine general practices to assess the feasibility and acceptability of telehealth monitoring and support for insulin initiation and adjustment. The intervention included a standard algorithm for self-titration of insulin dose, a Bluetooth enabled glucose meter linked to a mobile phone, an integrated diary to record insulin dose, feedback of charted blood glucose data and telehealth nurse review with telephone follow-up. Additional contact with patients was initiated when no readings were transmitted for >3 days or when persistent hyper- or hypoglycaemia was identified. Reponses of patients and clinicians to the system were assessed informally.
  
  
  RESULTS
  The mean (SD) patient age was 58 years (12) with 78% male. The mean (SD) diabetes duration was 6.4 years (4.5), HbA1c at baseline was 9.5% (2.2), and the decrease in HbA1c at three months was 0.52% (0.91) with an insulin dose increase of 9 units (26). A mean (SD) of 160 (93) blood glucose readings was transmitted per patient in these three months. Practice nurses and general practitioners (GPs) viewed the technology as having the potential to improve patient care. Most patients were able to use the equipment with training and welcomed review of their blood glucose readings by a telehealth nurse.
  
  
  CONCLUSIONS
  Although the concept of telehealth monitoring is unfamiliar to most patients and practice nurses, the technology improved the support available for T2D patients commencing insulin treatment.
authors.affiliation: National Institute of Health Research (NIHR) School of Primary Care Research, Department of Primary Health Care, University of Oxford, Oxford, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Turner
authors.forename: Mark
authors.initials: M
authors.lastname: Larsen
authors.forename: Lionel
authors.initials: L
authors.lastname: Tarassenko
authors.forename: Andrew
authors.initials: A
authors.lastname: Neil
authors.forename: Andrew
authors.initials: A
authors.lastname: Farmer
mesh_terms: D000368:Aged; D015190:Blood Glucose Self-Monitoring; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012648:Self Care; D011795:Surveys and Questionnaires; D017216:Telemedicine
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin