title: Evaluation of a Remote Monitoring System for Diabetes Control.
abstract: OBJECTIVE
  The use of technology to implement cost-effective health care management on a large scale may be an alternative for diabetes management but needs to be evaluated in controlled trials. This study assessed the utility and cost-effectiveness of an automated Diabetes Remote Monitoring and Management System (DRMS) in glycemic control versus usual care.
  
  
  METHODS
  In this randomized, controlled study, patients with uncontrolled diabetes on insulin were randomized to use of the DRMS or usual care. Participants in both groups were followed up for 6 months and had 3 clinic visits at 0, 3, and 6 months. The DRMS used text messages or phone calls to remind patients to test their blood glucose and to report results via an automated system, with no human interaction unless a patient had severely high or low blood glucose. The DRMS made adjustments to insulin dose(s) based on validated algorithms. Participants reported medication adherence through the Morisky Medication Adherence Scale-8, and diabetes-specific quality of life through the diabetes Daily Quality of Life questionnaire. A cost-effectiveness analysis was conducted based on the estimated overall costs of DRMS and usual care.
  
  
  RESULTS
  A total of 98 patients were enrolled (59 [60%] female; mean age, 59 years); 87 participants (89%) completed follow-up. HbA1c was similar between the DRMS and control groups at 3 months (7.60% vs 8.10%) and at 6 months (8.10% vs 7.90%). Changes from baseline to 6 months were not statistically significant for self-reported medication adherence and diabetes-specific quality of life, with the exception of the Daily Quality of Life-Social/Vocational Concerns subscale score (P = 0.04).
  
  
  CONCLUSIONS
  An automated system like the DRMS may improve glycemic control to the same degree as usual clinic care and may significantly improve the social/vocational aspects of quality of life. Cost-effectiveness analysis found DRMS to be cost-effective when compared to usual care and suggests DRMS has a good scale of economy for program scale up. Further research is needed to determine how to sustain the benefits seen with the automated system over longer periods.
authors: Tulane University Health Sciences Center, New Orleans, Louisiana; Southeast Louisiana Veterans Health Care Systems, New Orleans, Louisiana. Electronic address: bkatalen@tulane.edu.
authors: Bonnie
authors: B
authors: Katalenich
authors: Tulane University Health Sciences Center, New Orleans, Louisiana.
authors: Lizheng
authors: L
authors: Shi
authors: Tulane University Health Sciences Center, New Orleans, Louisiana.
authors: Shuqian
authors: S
authors: Liu
authors: Tulane University Health Sciences Center, New Orleans, Louisiana.
authors: Hui
authors: H
authors: Shao
authors: Tulane University Health Sciences Center, New Orleans, Louisiana; Southeast Louisiana Veterans Health Care Systems, New Orleans, Louisiana.
authors: Roberta
authors: R
authors: McDuffie
authors: Tulane University Health Sciences Center, New Orleans, Louisiana; Southeast Louisiana Veterans Health Care Systems, New Orleans, Louisiana.
authors: Gandahari
authors: G
authors: Carpio
authors: Tulane University Health Sciences Center, New Orleans, Louisiana; Southeast Louisiana Veterans Health Care Systems, New Orleans, Louisiana.
authors: Tina
authors: T
authors: Thethi
authors: Tulane University Health Sciences Center, New Orleans, Louisiana; Southeast Louisiana Veterans Health Care Systems, New Orleans, Louisiana.
authors: Vivian
authors: V
authors: Fonseca
mesh_terms: D000465:Algorithms; D015190:Blood Glucose Self-Monitoring; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011788:Quality of Life; D017010:Reminder Systems / Q000191:economics; D057566:Self Report; D011795:Surveys and Questionnaires; D013689:Telephone; D060145:Text Messaging
chemical_list: D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: adherence; diabetes mellitus; technology