JAMIA: Home telemonitoring shows improvement in HbA1c
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Roslyn A. Stone, PhD, from the Center for Health Equity Research and Promotion at the VA Pittsburgh Healthcare System, and colleagues sought to address the intensity or duration of telemonitoring required to sustain such improvements in glycemic control in patients with diabetes. They specifically wished to assess whether initial improvements could be sustained with interventions of the same or lower intensity among participants who re-enrolled in a six-month extension of the Diabetes Telemonitoring (DiaTel) study.
The study compared active care management (ACM) with home telemonitoring (n=73) to monthly care coordination (CC) telephone calls (n=77) from January 2005 to November 2007 among veterans with diabetes and suboptimal glycemic control.
DiaTel participants receiving ACM were re-assigned randomly to monthly CC calls with continued telemonitoring but no active medication management (ACM-to-CCHT, n=23) or monthly CC telephone calls (ACM-to-CC, n=21). DiaTel participants receiving CC were re-assigned randomly to continued CC (CC-to-CC, n=28) or usual care (UC, n=29). HbA1c was assessed at three and six months following re-randomization.
Marked HbA1c improvements observed in DiaTel ACM participants were sustained six months after re-randomization in both ACM-to-CCHT and ACM-to-CC groups, the authors found. "Lesser HbA1c improvements observed in DiaTel CC participants were sustained in both CC-to-CC and CC-to-UC groups. No benefit was apparent for continued transmission of glucose data among DiaTel ACM participants or continued monthly telephone calls among DiaTel CC participants six months after re-randomization."
“The ACM-to-CCHT and ACM-to-CC comparisons failed to show benefits from continuing the use of home telemonitoring in the DiaTel Extension,” the authors wrote. “These and other subgroup comparisons in the DiaTel Extension suggest that the same or lower intensity contact could be as effective as higher intensity contact in maintaining achieved improvements in glycemic control, at least over a six-month period. However, because participants in the ACM-to-CC group continued to receive monthly CC phone calls, the DiaTel Extension does not address the value of a short-term, high-intensity telemonitoring intervention followed by a return to conventional primary care.”
Ongoing monitoring of HbA1c will provide an opportunity to identify patients who may, despite an initial course of intensive management and improvement, need additional intensive management at some time in the future, the authors concluded.