title: Telemedicine and type 1 diabetes: is technology per se sufficient to improve glycaemic control?
abstract: OBJECTIVE
  In the TELEDIAB-1 study, the Diabeo system (a smartphone coupled to a website) improved HbA1c by 0.9% vs controls in patients with chronic, poorly controlled type 1 diabetes. The system provided two main functions: automated advice on the insulin doses required; and remote monitoring by teleconsultation. The question is: how much did each function contribute to the improvement in HbA1c?
  
  
  METHODS
  Each patient received a smartphone with an insulin dose advisor (IDA) and with (G3 group) or without (G2 group) the telemonitoring/teleconsultation function. Patients were classified as "high users" if the proportion of "informed" meals using the IDA exceeded 67% (median) and as "low users" if not. Also analyzed was the respective impact of the IDA function and teleconsultations on the final HbA1c levels.
  
  
  RESULTS
  Among the high users, the proportion of informed meals remained stable from baseline to the end of the study 6months later (from 78.1±21.5% to 73.8±25.1%; P=0.107), but decreased in the low users (from 36.6±29.4% to 26.7±28.4%; P=0.005). As expected, HbA1c improved in high users from 8.7% [range: 8.3-9.2%] to 8.2% [range: 7.8-8.7%] in patients with (n=26) vs without (n=30) the benefit of telemonitoring/teleconsultation (-0.49±0.60% vs -0.52±0.73%, respectively; P=0.879). However, although HbA1c also improved in low users from 9.0% [8.5-10.1] to 8.5% [7.9-9.6], those receiving support via teleconsultation tended to show greater improvement than the others (-0.93±0.97 vs -0.46±1.05, respectively; P=0.084).
  
  
  CONCLUSIONS
  The Diabeo system improved glycaemic control in both high and low users who avidly used the IDA function, while the greatest improvement was seen in the low users who had the motivational support of teleconsultations.
authors.affiliation: Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France; Centre d'Études et de Recherches pour l'Intensification du Traitement du Diabète (CERITD), Corbeil-Essonnes, France. Electronic address: sylvia.franc@ch-sud-francilien.fr.
authors.forename: S
authors.initials: S
authors.lastname: Franc
authors.affiliation: Department of Endocrinology-Metabolism and Diabetology-Nutrition, Jean-Minjoz Hospital, Besançon, France.
authors.forename: S
authors.initials: S
authors.lastname: Borot
authors.affiliation: Department of Diabetes, Sainte-Marguerite University Hospital, Marseille, France.
authors.forename: O
authors.initials: O
authors.lastname: Ronsin
authors.affiliation: Department of Biostatistics, CIC-Inserm, University Hospital, Grenoble, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Quesada
authors.affiliation: Centre d'Études et de Recherches pour l'Intensification du Traitement du Diabète (CERITD), Corbeil-Essonnes, France.
authors.forename: D
authors.initials: D
authors.lastname: Dardari
authors.affiliation: Department of Endocrinology, University Hospital Pessac, Pessac, France.
authors.forename: C
authors.initials: C
authors.lastname: Fagour
authors.affiliation: Department of Endocrinology, University Hospital, Montpellier, France.
authors.forename: E
authors.initials: E
authors.lastname: Renard
authors.affiliation: Department of Endocrinology, University Hospital, Rennes, France.
authors.forename: A-M
authors.initials: AM
authors.lastname: Leguerrier
authors.affiliation: Department of Diabetes, Hôtel-Dieu University Hospital, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Vigeral
authors.affiliation: Department of Endocrinology, University Hospital, Strasbourg, France.
authors.forename: F
authors.initials: F
authors.lastname: Moreau
authors.affiliation: Department of Endocrinology, Belfort Hospital, Belfort, France.
authors.forename: P
authors.initials: P
authors.lastname: Winiszewski
authors.affiliation: Clinique Marc Linquette, Department of Endocrinology and Diabetology, Lille, France.
authors.forename: A
authors.initials: A
authors.lastname: Vambergue
authors.affiliation: Department of Diabetes, Cochin Hospital, Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Mosnier-Pudar
authors.affiliation: Department of Endocrinology, University Hospital, Strasbourg, France.
authors.forename: L
authors.initials: L
authors.lastname: Kessler
authors.affiliation: Department of Endocrinology, Édouard-Herriot Hospital, Lyon, France.
authors.forename: S
authors.initials: S
authors.lastname: Reffet
authors.affiliation: Diabetology, Nutrition, Metabolic disorders, Brabois Hospital and Center of Clinical Investigation ILCV, University Hospital, Nancy, France.
authors.forename: B
authors.initials: B
authors.lastname: Guerci
authors.affiliation: Department of Endocrinology, Bellevue Hospital, Saint-Étienne, France.
authors.forename: L
authors.initials: L
authors.lastname: Millot
authors.affiliation: Department of Endocrinology, Diabetology, Nutrition University Hospital, Grenoble, France; University J Fourier 1, Grenoble, France.
authors.forename: S
authors.initials: S
authors.lastname: Halimi
authors.affiliation: Department of Endocrinology, Édouard-Herriot Hospital, Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Thivolet
authors.affiliation: Department of Endocrinology, Diabetology, Nutrition University Hospital, Grenoble, France.
authors.forename: P-Y
authors.initials: PY
authors.lastname: Benhamou
authors.affiliation: Department of Endocrinology-Metabolism and Diabetology-Nutrition, Jean-Minjoz Hospital, Besançon, France.
authors.forename: A
authors.initials: A
authors.lastname: Penfornis
authors.affiliation: Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France; Centre d'Études et de Recherches pour l'Intensification du Traitement du Diabète (CERITD), Corbeil-Essonnes, France.
authors.forename: G
authors.initials: G
authors.lastname: Charpentier
authors.affiliation: Department of Diabetes, Rangueil University Hospital, Toulouse, France.
authors.forename: H
authors.initials: H
authors.lastname: Hanaire
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D040421:Cell Phone; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D020407:Internet; D008297:Male; D010349:Patient Compliance; D017010:Reminder Systems / Q000295:instrumentation*; D019114:Remote Consultation; D012648:Self Care; D012984:Software; D017216:Telemedicine
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: Decision support software; Telemedicine; Telemonitoring; Type 1 diabetes