title: Impact of the "Diabetes Interactive Diary" telemedicine system on metabolic control, risk of hypoglycemia, and quality of life: a randomized clinical trial in type 1 diabetes.
abstract: BACKGROUND
  Telemedicine systems based on mobile phones represent new promising educational tools. The "Diabetes Interactive Diary" (DID) is a carbohydrate/bolus calculator promoting the patient-physician communication via short message service. This study aimed to compare the efficacy of the DID versus usual care on metabolic control, hypoglycemia, and quality of life.
  
  
  METHODS
  Patients with type 1 diabetes on a basal:bolus regimen with insulin glargine and insulin glulisine, not previously educated on carbohydrate (CHO) counting, were randomized to DID (Group A; n=63) or traditional education (Group B; n=64). Generalized hierarchical linear regression models for repeated measures were applied to compare changes between groups. Incidence of hypoglycemia was compared using Poisson regression models.
  
  
  RESULTS
  Of 127 patients (age, 36.9±10.5 years; diabetes duration, 16.3±9.3 years), 15 (11.8%) dropped out. After 6 months, hemoglobin A1c (HbA1c) levels decreased by -0.49±0.11 in Group A and -0.48±0.11 in Group B (P=0.73). Group A showed a 86% lower risk of grade 2 hypoglycemia than Group B. Compared with usual care, DID improved the "perceived frequency of hyperglycemic episodes" scale of the Diabetes Treatment Satisfaction Questionnaire and the "social relations" and the "fear of hypoglycemia" dimensions of the Diabetes Specific Quality of Life Scale. Results obtained with DID markedly differ among patients and centers.
  
  
  CONCLUSIONS
  DID is no more effective than traditional CHO counting education in reducing HbA1c levels. DID reduces the risk of moderate/severe hypoglycemia and improves quality of life. A better understanding of patients' and healthcare professionals' attitudes associated with an effective care supported by technology is essential to avoid waste of resources.
authors.affiliation: Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro, Chieti, Italy. mrossi@negrisud.it
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Rossi
authors.forename: Antonio
authors.initials: A
authors.lastname: Nicolucci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lucisano
authors.forename: Fabio
authors.initials: F
authors.lastname: Pellegrini
authors.forename: Paolo
authors.initials: P
authors.lastname: Di Bartolo
authors.forename: Valerio
authors.initials: V
authors.lastname: Miselli
authors.forename: Roberto
authors.initials: R
authors.lastname: Anichini
authors.forename: Giacomo
authors.initials: G
authors.lastname: Vespasiani
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy / Q000009:adverse effects; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000178:diet therapy* / Q000188:drug therapy*; D015930:Diet Records; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000453:epidemiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D057194:Intention to Treat Analysis; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D017060:Patient Satisfaction; D011788:Quality of Life; D012306:Risk; D017216:Telemedicine / Q000379:methods*
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human