Telemedicine and type 1 diabetes: Is technology per se sufficient to improve glycaemic control?

• Published in: Diabetes & metabolism 2014-02, Vol.40 (1), p.61-66
• Main Authors: Franc, S, Borot, S, Ronsin, O, Quesada, J.-L, Dardari, D, Fagour, C, Renard, E, Leguerrier, A.-M, Vigeral, C, Moreau, F, Winiszewski, P, Vambergue, A, Mosnier-Pudar, H, Kessler, L, Reffet, S, Guerci, B, Millot, L, Halimi, S, Thivolet, C, Benhamou, P.-Y, Penfornis, A, Charpentier, G, Hanaire, H
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Blood Glucose - metabolism; Cell Phone; Decision support software; Diabetes Mellitus, Type 1 - drug therapy; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinology & Metabolism; Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Glycated Hemoglobin A - metabolism; Humans; Hypoglycemic Agents - administration & dosage; Insulin - administration & dosage; Insulin Infusion Systems; Internal Medicine; Internet; Life Sciences; Male; Medical sciences; Patient Compliance; Reminder Systems - instrumentation; Remote Consultation; Self Care; Software; Telemedicine; Telemonitoring; Type 1 diabetes
• ISSN: 1262-3636; 1878-1780
• DOI: 10.1016/j.diabet.2013.09.001

Abstract Aim In the TELEDIAB-1 study, the Diabeo system (a smartphone coupled to a website) improved HbA1c by 0.9% vs controls in patients with chronic, poorly controlled type 1 diabetes. The system provided two main functions: automated advice on the insulin doses required; and remote monitoring by teleconsultation. The question is: how much did each function contribute to the improvement in HbA1c ? Methods Each patient received a smartphone with an insulin dose advisor (IDA) and with (G3 group) or without (G2 group) the telemonitoring/teleconsultation function. Patients were classified as “high users” if the proportion of “informed” meals using the IDA exceeded 67% (median) and as “low users” if not. Also analyzed was the respective impact of the IDA function and teleconsultations on the final HbA1c levels. Results Among the high users, the proportion of informed meals remained stable from baseline to the end of the study 6 months later (from 78.1 ± 21.5% to 73.8 ± 25.1%; P = 0.107), but decreased in the low users (from 36.6 ± 29.4% to 26.7 ± 28.4%; P = 0.005). As expected, HbA1c improved in high users from 8.7% [range: 8.3–9.2%] to 8.2% [range: 7.8–8.7%] in patients with ( n = 26) vs without ( n = 30) the benefit of telemonitoring/teleconsultation (−0.49 ± 0.60% vs −0.52 ± 0.73%, respectively; P = 0.879). However, although HbA1c also improved in low users from 9.0% [8.5–10.1] to 8.5% [7.9–9.6], those receiving support via teleconsultation tended to show greater improvement than the others (−0.93 ± 0.97 vs −0.46 ± 1.05, respectively; P = 0.084). Conclusion The Diabeo system improved glycaemic control in both high and low users who avidly used the IDA function, while the greatest improvement was seen in the low users who had the motivational support of teleconsultations.