title: Diabetes Interactive Diary: a new telemedicine system enabling flexible diet and insulin therapy while improving quality of life: an open-label, international, multicenter, randomized study.
abstract: OBJECTIVE
  Widespread use of carbohydrate counting is limited by its complex education. In this study we compared a Diabetes Interactive Diary (DID) with standard carbohydrate counting in terms of metabolic and weight control, time required for education, quality of life, and treatment satisfaction.
  
  
  METHODS
  Adults with type 1 diabetes were randomly assigned to DID (group A, n = 67) or standard education (group B, n = 63) and followed for 6 months. A subgroup also completed the SF-36 Health Survey (SF-36) and World Health Organization-Diabetes Treatment Satisfaction Questionnaire (WHO-DTSQ) at each visit.
  
  
  RESULTS
  Of 130 patients (aged 35.7 +/- 9.4 years; diabetes duration 16.5 +/- 10.5 years), 11 dropped out. Time for education was 6 h (range 2-15 h) in group A and 12 h (2.5-25 h) in group B (P = 0.07). A1C reduction was similar in both groups (group A from 8.2 +/- 0.8 to 7.8 +/- 0.8% and group B from 8.4 +/- 0.7 to 7.9 +/- 1.1%; P = 0.68). Nonsignificant differences in favor of group A were documented for fasting blood glucose and body weight. No severe hypoglycemic episode occurred. WHO-DTSQ scores increased significantly more in group A (from 26.7 +/- 4.4 to 30.3 +/- 4.5) than in group B (from 27.5 +/- 4.8 to 28.6 +/- 5.1) (P = 0.04). Role Physical, General Health, Vitality, and Role Emotional SF-36 scores improved significantly more in group A than in group B.
  
  
  CONCLUSIONS
  DID is at least as effective as traditional carbohydrate counting education, allowing dietary freedom for a larger proportion of type 1 diabetic patients. DID is safe, requires less time for education, and is associated with lower weight gain. DID significantly improved treatment satisfaction and several quality-of-life dimensions.
authors.affiliation: Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Santa Maria Imbaro (CH), Italy. mrossi@negrisud.it
authors.forename: Maria C E
authors.initials: MC
authors.lastname: Rossi
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolucci
authors.forename: Paolo
authors.initials: P
authors.lastname: Di Bartolo
authors.forename: Daniela
authors.initials: D
authors.lastname: Bruttomesso
authors.forename: Angela
authors.initials: A
authors.lastname: Girelli
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Ampudia
authors.forename: David
authors.initials: D
authors.lastname: Kerr
authors.forename: Antonio
authors.initials: A
authors.lastname: Ceriello
authors.forename: Carmen De La Questa
authors.initials: Cde L
authors.lastname: Mayor
authors.forename: Fabio
authors.initials: F
authors.lastname: Pellegrini
authors.forename: David
authors.initials: D
authors.lastname: Horwitz
authors.forename: Giacomo
authors.initials: G
authors.lastname: Vespasiani
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000178:diet therapy* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin