Telemonitoring and Team-Based Management of Glycemic Control on People with Type 2 Diabetes: a Cluster-Randomized Controlled Trial
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.
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.
KEY WORDStype 2 diabetes glucose self-monitoring telemonitoring cluster-randomized
The authors would like to thank health clinics and patients who participated in this study.
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 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.
- 3.Organization WH. Global Report on Diabetes. In: Organization WH, ed. Geneva: World Health Organization; 2016.Google Scholar
- 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
- 16.Ezat SE, Na A, Mn A, Bs S. Economic burden of diabetic care in government Health Facilities in Selangor. Vol 152009.Google Scholar