Telemonitoring and Team-Based Management of Glycemic Control on People with Type 2 Diabetes: a Cluster-Randomized Controlled Trial

  • Jun Yang Lee
  • Carina Ka Yee Chan
  • Siew Siang Chua
  • Chirk Jenn Ng
  • Thomas Paraidathathu
  • Kenneth Kwing Chin Lee
  • Shaun Wen Huey LeeEmail author
Original Reserch



Connected devices that allow people with diabetes to monitor their blood glucose levels remotely with data visualization have been shown to improve self-care behavior in diabetes management. However, their effectiveness and usability for a low-middle-income, racially diverse population are unknown.


This study aims to evaluate the effects of remote telemonitoring with team-based management on people with uncontrolled type 2 diabetes.


This was a pragmatic 52-week cluster-randomized controlled study among 11 primary care government practices in Malaysia.


People with type 2 diabetes aged 18 and above, who had hemoglobin A1c ≥ 7.5% but less than 11.0% within the past 3 months and resided in the state of Selangor.


The intervention group received home gluco-telemonitors and transmitted glucose data to a care team who could adjust therapy accordingly. The team also facilitated self-management by supporting participants to improve medication adherence, and encourage healthier lifestyle and use of resources to reduce risk factors. Usual care group received routine healthcare service.

Main Measure

The primary outcome was the change in HbA1c at 24 weeks and 52 weeks. Secondary outcomes included change in fasting plasma glucose, blood pressure, lipid levels, health-related quality of life, and diabetes self-efficacy.


A total of 240 participants were recruited in this study. The telemonitoring group reported larger improvements in glycemic control compared with control at the end of study (week 24, − 0.05%; 95% CI − 0.10 to 0.00%) and at follow-up (week 52, − 0.03%; − 0.07 to 0.02%, p = 0.226). Similarly, no differences in other secondary outcomes were observed, including the number of adverse events and health-related quality of life.


This study indicates that there is limited benefit of replacing telemedicine with the current practice of self-monitoring of blood glucose. Further innovative methods to improve patient engagement in diabetes care are needed.

Trial Registration identifier: NCT02466880


type 2 diabetes glucose self-monitoring telemonitoring cluster-randomized 



The authors would like to thank health clinics and patients who participated in this study.

Author Contributions

All authors named contributed substantially to the document. JYL collected data, interpreted the results, and wrote the draft manuscript. SWHL obtained the funding, designed the study, and provided support in editing the manuscript. CKYC, SSC, CJN, TP, and KKCL contributed to the study design and reviewed the manuscript. All authors approved the final version.

Funding Information

Funding of this study was through the e-Science fund from the Ministry of Science, Technology and Innovation, Malaysia (03-02-10-SF0238 (MOSTI)).

Compliance with Ethical Standards

Ethics approval was obtained from the Medical Research and Ethics Committee, Malaysia (NMRR-14-1368-22943), and Monash University Research Ethics Committee (CF15/1073-2015000502). All participants provided written informed consent at the beginning of clinic visit.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_5316_MOESM1_ESM.docx (41 kb)
ESM 1 (DOCX 41 kb)


  1. 1.
    Whiting DR, Guariguata L, Weil C, Shaw J. IDF Diabetes Atlas: Global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011;94(3):311–321.CrossRefGoogle Scholar
  2. 2.
    NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 2016;387(10027):1513–1530.CrossRefGoogle Scholar
  3. 3.
    Organization WH. Global Report on Diabetes. In: Organization WH, ed. Geneva: World Health Organization; 2016.Google Scholar
  4. 4.
    Seuring T, Archangelidi O, Suhrcke M. The economic costs of type 2 diabetes: a global systematic review. Pharmacoeconomics. 2015;33(8):811–831.CrossRefGoogle Scholar
  5. 5.
    Tricco AC, Ivers NM, Grimshaw JM, et al. Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysis. Lancet. 2012;379(9833):2252–2261.CrossRefGoogle Scholar
  6. 6.
    Lee JY, Lee SW, Nasir NH, How S, Tan CS, Wong CP. Diabetes telemonitoring reduces the risk of hypoglycaemia during Ramadan: a pilot randomized controlled study. Diabet Med. 2015;32(12):1658–1661.CrossRefGoogle Scholar
  7. 7.
    Wild SH, Hanley J, Lewis SC, et al. Supported Telemonitoring and Glycemic Control in People with Type 2 Diabetes: The Telescot Diabetes Pragmatic Multicenter Randomized Controlled Trial. PLoS Med. 2016;13(7):e1002098.CrossRefGoogle Scholar
  8. 8.
    Sood A, Watts SA, Johnson JK, Hirth S, Aron DC. Telemedicine consultation for patients with diabetes mellitus: a cluster randomised controlled trial. J Telemed Telecare. 2017:1357633X17704346.Google Scholar
  9. 9.
    Paré G, Jaana M, Sicotte C. Systematic Review of Home Telemonitoring for Chronic Diseases: The Evidence Base. J Am Med Inform Assoc. 2007;14(3):269–277.CrossRefGoogle Scholar
  10. 10.
    Pare G, Moqadem K, Pineau G, St-Hilaire C. Clinical effects of home telemonitoring in the context of diabetes, asthma, heart failure and hypertension: a systematic review. J Med Internet Res. 2010;12(2):e21.CrossRefGoogle Scholar
  11. 11.
    Lee SWH, Chan CKY, Chua SS, Chaiyakunapruk N. Comparative effectiveness of telemedicine strategies on type 2 diabetes management: A systematic review and network meta-analysis. Sci Rep. 2017;7(1):12680.CrossRefGoogle Scholar
  12. 12.
    Lee JY, Chan CKY, Chua SS, et al. Intervention for Diabetes with Education, Advancement and Support (IDEAS) study: protocol for a cluster randomised controlled trial. BMC Health Serv Res. 2016;16:524.CrossRefGoogle Scholar
  13. 13.
    Brazier J, Roberts J, Tsuchiya A, Busschbach J. A comparison of the EQ-5D and SF-6D across seven patient groups. Health Econ. 2004;13(9):873–884.CrossRefGoogle Scholar
  14. 14.
    Al-Qazaz HK, Hassali MA, Shafie AA, Sulaiman SAS, Sundram S. The 14-item Michigan Diabetes Knowledge Test: translation and validation study of the Malaysian version. Pract Diabetes Int. 2010;27(6):238-241a.CrossRefGoogle Scholar
  15. 15.
    Welch GW, Jacobson AM, Polonsky WH. The Problem Areas in Diabetes Scale: An evaluation of its clinical utility. Diabetes Care. 1997;20(5):760–766.CrossRefGoogle Scholar
  16. 16.
    Ezat SE, Na A, Mn A, Bs S. Economic burden of diabetic care in government Health Facilities in Selangor. Vol 152009.Google Scholar
  17. 17.
    Young LA, Buse JB, Weaver MA, et al. Glucose Self-monitoring in Non-Insulin-Treated Patients With Type 2 Diabetes in Primary Care Settings: A Randomized Trial. JAMA Intern Med. 2017;177(7):920–929.CrossRefGoogle Scholar
  18. 18.
    Katalenich B, Shi L, Liu S, et al. Evaluation of a Remote Monitoring System for Diabetes Control. Clin Ther. 2015;37(6):1216–1225.CrossRefGoogle Scholar
  19. 19.
    Quinn CC, Shardell MD, Terrin ML, Barr EA, Ballew SH, Gruber-Baldini AL. Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control. Diabetes Care. 2011;34(9):1934–1942.CrossRefGoogle Scholar
  20. 20.
    Nicolucci A, Cercone S, Chiriatti A, Muscas F, Gensini G. A Randomized Trial on Home Telemonitoring for the Management of Metabolic and Cardiovascular Risk in Patients with Type 2 Diabetes. Diabetes Technol Ther 2015;17(8):563–570.CrossRefGoogle Scholar
  21. 21.
    Lee JY, Wong CP, Tan CSS, Nasir NH, Lee SWH. Telemonitoring in fasting individuals with Type 2 Diabetes Mellitus during Ramadan: A prospective, randomised controlled study. Sci Rep. 2017;7(1):10119.CrossRefGoogle Scholar
  22. 22.
    Lee SW, Ooi L, Lai YK. Telemedicine for the Management of Glycemic Control and Clinical Outcomes of type 1 diabetes mellitus: a systematic review and meta-analysis of randomized controlled studies. Front Pharmacol. 2017;8:330.CrossRefGoogle Scholar
  23. 23.
    Lee JY, Lee SWH. Is telemedicine cost effectiveness for diabetes management: A systematic review. Diabetes Technol Ther. 2018;20(7):492–500.CrossRefGoogle Scholar
  24. 24.
    Bagayoko CO, Traoré D, Thevoz L, et al. Medical and economic benefits of telehealth in low- and middle-income countries: results of a study in four district hospitals in Mali. BMC Health Serv Res. 2014;14(Suppl 1):S9-S9.CrossRefGoogle Scholar
  25. 25.
    McConnell KA, Krisher LK, Lenssen M, Bunik M, Bunge Montes S, Domek GJ. Telehealth to Expand Community Health Nurse Education in Rural Guatemala: A Pilot Feasibility and Acceptability Evaluation. Front Public Health. 2017;5(60).CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Jun Yang Lee
    • 1
  • Carina Ka Yee Chan
    • 2
    • 3
  • Siew Siang Chua
    • 4
  • Chirk Jenn Ng
    • 5
  • Thomas Paraidathathu
    • 4
  • Kenneth Kwing Chin Lee
    • 1
  • Shaun Wen Huey Lee
    • 1
    • 4
    • 6
    Email author
  1. 1.School of Pharmacy Monash University MalaysiaBandar SunwayMalaysia
  2. 2.School of Psychology and Public HealthLa Trobe UniversityFlora HillAustralia
  3. 3.Jeffrey Cheah School of Medicine and Health SciencesMonash University MalaysiaBandar SunwayMalaysia
  4. 4.School of Pharmacy, Faculty of Health and Medical SciencesTaylor’s University Lakeside CampusSubang JayaMalaysia
  5. 5.Department of Primary Care Medicine, Faculty of MedicineUniversity MalayaKuala LumpurMalaysia
  6. 6.Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) PlatformMonash University MalaysiaBandar SunwayMalaysia

Personalised recommendations