title: Meta-analysis of telemonitoring to improve HbA1c levels: promise for stroke survivors.
abstract: Monitoring glycemic control is useful not only in the primary prevention of stroke in diabetics, but also in the rehabilitation from and secondary prevention of stroke. In an often functionally and neurocognitively impaired population, however, poor compliance with treatment regimens is a major problem. Wireless, telemonitoring glucometers - often integrated into the patient's healthcare system - offer a solution to the compliance issue. We sought to evaluate the effectiveness of telemonitoring technologies in improving long-term glycemic control. A search on www.clinicaltrials.gov, using keywords such as "telemonitoring" and "self-care device" was performed, and five trials were identified that compared hemoglobin A1c (HbA1c) levels of a group receiving standard care (controls) to a group receiving a telemonitoring intervention. Four of the five studies showed a greater reduction in HbA1c in the intervention group compared to controls at 6 months, although only one was statistically significant. There was considerable heterogeneity between studies (I(2)=69.5%, p=0.02), and the random effects model estimated the aggregate effect size for mean difference in reduction of HbA1c levels to be 0.08% (95% confidence interval -0.12% to 0.28%), which was not statistically significant (p=0.42). The varying results may be due to specific factors in the trials that contributed to their large heterogeneity, and further trials are needed to support the role of telemonitoring in improving diabetes management in this population. Nonetheless, in the future telemonitoring may substantially help patients at risk of ischemic stroke and those who require close glucose monitoring.
authors: Department of Neurosurgery, New York University, New York, NY, USA; Cerebrovascular Laboratory, Columbia University, New York, NY, USA.
authors: Bryan A
authors: BA
authors: Lieber
authors: Department of Neurosurgery, Columbia University, 630 West 168th Street Suite 5-454, New York, NY 10032, USA; Columbia University, College of Physicians and Surgeons, New York, NY, USA; Cerebrovascular Laboratory, Columbia University, New York, NY, USA.
authors: Blake
authors: B
authors: Taylor
authors: Department of Neurosurgery, Columbia University, 630 West 168th Street Suite 5-454, New York, NY 10032, USA; Cerebrovascular Laboratory, Columbia University, New York, NY, USA. Electronic address: ga@neuro-digital.com.
authors: Geoff
authors: G
authors: Appelboom
authors: Cerebrovascular Laboratory, Columbia University, New York, NY, USA.
authors: Kiran
authors: K
authors: Prasad
authors: Department of Neurosurgery, Columbia University, 630 West 168th Street Suite 5-454, New York, NY 10032, USA; Columbia University, College of Physicians and Surgeons, New York, NY, USA; Cerebrovascular Laboratory, Columbia University, New York, NY, USA.
authors: Sam
authors: S
authors: Bruce
authors: Department of Neurosurgery, Columbia University, 630 West 168th Street Suite 5-454, New York, NY 10032, USA; Cerebrovascular Laboratory, Columbia University, New York, NY, USA.
authors: Annie
authors: A
authors: Yang
authors: Department of Neurosurgery, Columbia University, 630 West 168th Street Suite 5-454, New York, NY 10032, USA; Cerebrovascular Laboratory, Columbia University, New York, NY, USA.
authors: Eliza
authors: E
authors: Bruce
authors: Department of Neurosurgery, Columbia University, 630 West 168th Street Suite 5-454, New York, NY 10032, USA; Cerebrovascular Laboratory, Columbia University, New York, NY, USA.
authors: Brandon
authors: B
authors: Christophe
authors: Department of Neurosurgery, Columbia University, 630 West 168th Street Suite 5-454, New York, NY 10032, USA; Columbia University, College of Physicians and Surgeons, New York, NY, USA; Neurointensive Care Unit, Columbia University Medical Center, New York, NY, USA; Cerebrovascular Laboratory, Columbia University, New York, NY, USA.
authors: E Sander
authors: ES
authors: Connolly
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D002986:Clinical Trials as Topic / Q000379:methods; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012648:Self Care / Q000379:methods; D020521:Stroke / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D017741:Survivors; D017216:Telemedicine / Q000379:methods* / Q000592:standards
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Adherence; Diabetes; HbA1c; Mobile health; Telemonitoring