title: Lessened decline in physical activity and impairment of older adults with diabetes with telemedicine and pedometer use: results from the IDEATel study.
abstract: OBJECTIVE
  to examine the effects of the Informatics for Diabetes Education and Telemedicine (IDEATel) telemedicine intervention and pedometer use on physical activity (PA) and impairment in older adults with diabetes.
  
  
  METHODS
  randomised clinical trial. Subjects ethnically diverse medically underserved Medicare beneficiaries with diabetes (n= 1,650).
  
  
  METHODS
  participants received home videovisits with a diabetes educator every 4-6 weeks or usual care. All received a pedometer. Annual measurements included hemoglobin A1c, Comprehensive Assessment and Referral Evaluation Activities of Daily Living, Diabetes Self-Care Activities, Charlson Comorbidity Index, Luben Social Support and pedometer use. Mixed model analyses were performed using random effects to adjust for clustering within primary care physicians.
  
  
  RESULTS
  in the telemedicine group compared with the usual care group, the rate of decline in PA (P= 0.0128) and physical impairment (PI) (P= 0.0370) was significantly less over time. Significant mean endpoint differences were observed for PA (P= 0.003). Pedometer use was significantly associated with PA (P= 0.0006) and PI (P< 0.0001). Baseline characteristics associated with greater PA included having fewer comorbid conditions (P= 0.0054), less depression (P< 0.0001), more social networking (P< 0.0001), lower BMI (P< 0.0001), male gender (P< 0.0001) and lower hemoglobin A1c level (P= 0.0045). Similar predictors were observed for PI, except duration of diabetes also predicted increased impairment (P< 0.0001). Significant indirect effects were observed through use of the pedometer on reduced decline in PA (P= 0.0024, 0.0013) and PI (P= 0.0024, P< 0.0001).
  
  
  CONCLUSIONS
  this telemedicine intervention reduced rates of decline in PA and impairment in older adults with diabetes. Pedometers may be a helpful inexpensive adjunct to diabetes initiatives delivered remotely with emerging technologies. ClinicalTrials.gov identifier NCT 00271739.
authors.affiliation: Department of Veterans Affairs Medical Center, SUNY Upstate Medical University, Syracuse NY, USA.
authors.forename: Ruth S
authors.initials: RS
authors.lastname: Weinstock
authors.forename: Gary
authors.initials: G
authors.lastname: Brooks
authors.forename: Walter
authors.initials: W
authors.lastname: Palmas
authors.forename: Philip C
authors.initials: PC
authors.lastname: Morin
authors.forename: Jeanne A
authors.initials: JA
authors.lastname: Teresi
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Eimicke
authors.forename: Stephanie
authors.initials: S
authors.lastname: Silver
authors.forename: Roberto
authors.initials: R
authors.lastname: Izquierdo
authors.forename: Robin
authors.initials: R
authors.lastname: Goland
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000097:blood / Q000503:physiopathology* / Q000523:psychology; D004864:Equipment and Supplies; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D009043:Motor Activity / Q000502:physiology*; D009765:Obesity / Q000517:prevention & control; D010353:Patient Education as Topic; D017216:Telemedicine; D016138:Walking / Q000502:physiology*
chemical_list: D006442:Glycated Hemoglobin