title: Impact and duration effect of telemonitoring on ΗbA1c, BMI and cost in insulin-treated Diabetes Mellitus patients with inadequate glycemic control: A randomized controlled study.
abstract: OBJECTIVE
  To monitor and control the blood glucose levels in inefficiently insulin-treated patients with type 1 and 2 diabetes mellitus (DM) using a telemonitoring system and determine whether the improvement of HbA1c has a lasting effect following its discontinuation.
  
  
  METHODS
  Seventy inefficiently controlled insulin-treated DM patients using telemonitoring (telemonitoring group-TG) [HbA1c 9.9±2.3% (85±24.9mmol/mol)] and 35 age-, body mass index (BMI)- and Hba1c-matched insulin-treated patients receiving outpatient care (control group-CG) [HbA1c 9.7±2.1% (82±23.4mmol/mol)] were enrolled. Data of TG were transmitted from the glucose-meters to our computers via modem. Communication was achieved via e-mails and mobile phone text-messages through integrated software. HbA1c and BMI were evaluated at enrollment, 3 and 6 months, and 6 months after telemonitoring discontinuation. Frequency of hypo- and hyperglycemias and cost were also analyzed.
  
  
  RESULTS
  Significant reduction in HbA1c was observed in TG both at 3 [7.1±1.0% (54±10.5mmol/mol) p&#60;0.001] and 6 months [6.9±0.9% (52±9.5mmol/mol) p&#60;0.001], compared to the CG group at the same timepoints. Significant reduction was also observed in the TG subgroups with ΗbA1c&#8805;10% and 10&#62;HbA1c&#8805;7.5% at 3 and 6 months, compared to CG. No statistically significant differences in BMI were observed between TG and CG. Six months after telemonitoring discontinuation, HbA1c in TG was slightly increased [7.3±1.0% (56±10.4mol/mol)]. Attenuation was also observed in both TG subgroups. Compared to CG, the number of monthly hypo- and hyperglycemias was reduced in TG. The intervention had a financial benefit for patients living more than 100 km from the health care provider.
  
  
  CONCLUSIONS
  Telemonitoring can result in reduction of HbA1c and frequency of hypo- and hyperglycemias. This beneficial effect is slightly attenuated 6 months after terminating telemonitoring.
authors.affiliation: Department of Endocrinology and Diabetes Center, "G. Gennimatas", General Hospital of Athens, Athens, Greece.
authors.forename: Stelios
authors.initials: S
authors.lastname: Fountoulakis
authors.affiliation: Department of Endocrinology and Diabetes Center, "G. Gennimatas", General Hospital of Athens, Athens, Greece.
authors.forename: Labrini
authors.initials: L
authors.lastname: Papanastasiou
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, National and KapodistrianUniversity of Athens Medical School; Athens, Greece.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Gryparis
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, National and KapodistrianUniversity of Athens Medical School; Athens, Greece.
authors.forename: Athina
authors.initials: A
authors.lastname: Markou
authors.affiliation: Department of Endocrinology and Diabetes Center, "G. Gennimatas", General Hospital of Athens, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Piaditis
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D015992:Body Mass Index; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D034742:Electronic Mail / Q000191:economics; D030141:Feedback, Psychological; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006115:Greece; D017048:Health Care Costs; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced / Q000191:economics / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000191:economics; D011237:Predictive Value of Tests; D011446:Prospective Studies; D017216:Telemedicine / Q000191:economics* / Q000379:methods; D013686:Telemetry / Q000191:economics* / Q000379:methods; D060145:Text Messaging / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human