title: Active care management supported by home telemonitoring in veterans with type 2 diabetes: the DiaTel randomized controlled trial.
abstract: OBJECTIVE We compared the short-term efficacy of home telemonitoring coupled with active medication management by a nurse practitioner with a monthly care coordination telephone call on glycemic control in veterans with type 2 diabetes and entry A1C > or =7.5%. RESEARCH DESIGN AND METHODS Veterans who received primary care at the VA Pittsburgh Healthcare System from June 2004 to December 2005, who were taking oral hypoglycemic agents and/or insulin for > or =1 year, and who had A1C > or =7.5% at enrollment were randomly assigned to either active care management with home telemonitoring (ACM+HT group, n = 73) or a monthly care coordination telephone call (CC group, n = 77). Both groups received monthly calls for diabetes education and self-management review. ACM+HT group participants transmitted blood glucose, blood pressure, and weight to a nurse practitioner using the Viterion 100 TeleHealth Monitor; the nurse practitioner adjusted medications for glucose, blood pressure, and lipid control based on established American Diabetes Association targets. Measures were obtained at baseline, 3-month, and 6-month visits. RESULTS Baseline characteristics were similar in both groups, with mean A1C of 9.4% (CC group) and 9.6% (ACM+HT group). Compared with the CC group, the ACM+HT group demonstrated significantly larger decreases in A1C at 3 months (1.7 vs. 0.7%) and 6 months (1.7 vs. 0.8%; P < 0.001 for each), with most improvement occurring by 3 months. CONCLUSIONS Compared with the CC group, the ACM+HT group demonstrated significantly greater reductions in A1C by 3 and 6 months. However, both interventions improved glycemic control in primary care patients with previously inadequate control.
authors.affiliation: Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors.forename: Roslyn A
authors.initials: RA
authors.lastname: Stone
authors.forename: R Harsha
authors.initials: RH
authors.lastname: Rao
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Sevick
authors.forename: Chunrong
authors.initials: C
authors.lastname: Cheng
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Hough
authors.forename: David S
authors.initials: DS
authors.lastname: Macpherson
authors.forename: Carol M
authors.initials: CM
authors.lastname: Franko
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Anglin
authors.forename: D Scott
authors.initials: DS
authors.lastname: Obrosky
authors.forename: Frederick R
authors.initials: FR
authors.lastname: Derubertis
mesh_terms: D000284:Administration, Oral; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services / Q000458:organization & administration; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000494:pharmacology; D008055:Lipids / Q000097:blood; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods*; D017063:Outcome Assessment, Health Care; D012648:Self Care; D017216:Telemedicine / Q000379:methods*; D013689:Telephone; D014728:Veterans
chemical_list: D007004:Hypoglycemic Agents; D008055:Lipids