Video consultations as add-on to standard care among patients with type 2 diabetes not responding to standard regimens: a randomized controlled trial.
OBJECTIVE
To examine whether video consultations preceded by measurements of blood glucose, weight and blood pressure as add-on to standard care could contribute to achieving and maintaining good diabetes control among patients with poorly regulated type 2 diabetes (T2D).


METHODS
Randomized controlled trial.


METHODS
165 patients with T2D were randomized 1:1 to telemedicine intervention as add-on to clinic-based care or control (clinic-based care). The intervention consisted of monthly video conferences with a nurse via a tablet computer and lasted for 32 weeks. Regularly self-monitored measurements of blood sugar, blood pressure and weight were uploaded and visible to patient and nurse. Both groups were followed up six months after the end of the intervention period.


METHODS
HbA1c after eight months.


RESULTS
Video conferences preceded by uploads of measurements as add-on to clinic-based care led to a significant reduction of HbA1c compared to that in standard care (0.69% vs 0.18%,P= 0.022). However, at six-month follow-up, the inter-group difference in HbA1c-reduction was no longer significant. Non-completers had higher HbA1c levels at baseline and a lower degree of education.


CONCLUSIONS
Video consultations preceded by uploading relevant measurements can lead to clinically and statistically significant improvements in glycemic control among patients who have not responded to standard regimens. However, continuing effort and attention are essential as the effect does not persist when intervention ends. Furthermore, future studies should focus on differentiation as the most vulnerable patients are at greater risk of non-adherence.
Department of EndocrinologyBispebjerg University Hospital, Copenhagen NV, Denmark.
Caroline Raun
CR
Hansen
Department of EndocrinologyBispebjerg University Hospital, Copenhagen NV, Denmark.
Hans
H
Perrild
Healthcare Centre NørrebroCopenhagen NV, Denmark.
Birgitte Gade
BG
Koefoed
Department of EndocrinologyBispebjerg University Hospital, Copenhagen NV, Denmark.
Mette
M
Zander
D000368:Aged; D015190:Blood Glucose Self-Monitoring / Q000451:nursing; D001794:Blood Pressure; D015992:Body Mass Index; D001835:Body Weight / Q000208:ethnology; D003131:Combined Modality Therapy / Q000451:nursing; D003430:Cross-Sectional Studies; D003718:Denmark; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000208:ethnology / Q000451:nursing* / Q000628:therapy; D003925:Diabetic Angiopathies / Q000208:ethnology / Q000451:nursing / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D006973:Hypertension / Q000150:complications / Q000208:ethnology / Q000451:nursing / Q000628:therapy; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000150:complications / Q000208:ethnology / Q000451:nursing / Q000628:therapy; D010349:Patient Compliance / Q000208:ethnology; D012648:Self Care; D055817:Telenursing; D049269:Videoconferencing
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human