title: The efficiency of telemedicine to optimize metabolic control in patients with type 1 diabetes mellitus: Telemed study.
abstract: OBJECTIVE
  This study evaluated the impact of an Internet-based telematic system on the economic and clinical management of patients with type 1 diabetes mellitus.
  
  
  METHODS
  This 6-month prospective, randomized, comparative, open, multicenter study included patients with type 1 diabetes >18 years old treated with multiple insulin doses and with a glycated hemoglobin (HbA1c) level of >8%. We compared an intervention group (IG) (two face-to-face and five telematic appointments) with a control group (CG) (seven face-to-face appointments). The variables studied were (1) patient and healthcare team costs, (2) metabolic control, (3) knowledge of diabetes, (4) quality of life, and (5) self-care treatment adherence.
  
  
  RESULTS
  Of the 154 patients included, 118 (76.6%) completed the study (IG, 54; CG, 64). The time used by the CG to follow the program was 823±645 min versus 353±222 min in the IG (P<0.0001). Compared with the CG, the IG required less healthcare time from the professionals (288±105 min vs. 232±89 min; P<0.001). HbA1c improved in both groups (IG, 9.2±1.5% [77.0±17.0 mmol/mol] vs. 8.7±1.5% [71.6±17.0 mmol/mol] [P<0.001]; CG, 9.2±0.9% [77.0±10.0 mmol/mol] vs. 8.6±0.9% [70.5±10.0 mmol/mol] [P<0.001], as did knowledge and self-care treatment adherence.
  
  
  CONCLUSIONS
  The use of interactive telematic appointments in subjects with type 1 diabetes and inadequate metabolic control is an efficient strategy, providing results comparable to those of face-to-face appointments in relation to improvement in glycemic control, knowledge acquisition, and self-care treatment adherence, with a significant reduction in the time used, especially by patients.
authors: 1 Diabetes Unit, Hospital Clinic, University of Barcelona , Biomedical Research Center in Diabetes and Associated Metabolic Disorders, Barcelona, Spain .
authors: Enric
authors: E
authors: Esmatjes
authors: Margarida
authors: M
authors: Jansà
authors: Daria
authors: D
authors: Roca
authors: Natalia
authors: N
authors: Pérez-Ferre
authors: Laura
authors: L
authors: del Valle
authors: Sergio
authors: S
authors: Martínez-Hervás
authors: Marisol
authors: M
authors: Ruiz de Adana
authors: Francisca
authors: F
authors: Linares
authors: Ricardo
authors: R
authors: Batanero
authors: Federico
authors: F
authors: Vázquez
authors: Ramon
authors: R
authors: Gomis
authors: Oriol
authors: O
authors: de Solà-Morales
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D020407:Internet; D008297:Male; D055118:Medication Adherence; D010353:Patient Education as Topic; D015397:Program Evaluation; D011446:Prospective Studies; D011788:Quality of Life; D012648:Self Care; D013030:Spain / Q000453:epidemiology; D017216:Telemedicine
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human