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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

Abstract

Background

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.

Objective

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

Design

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

Participants

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.

Intervention

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.

Results

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.

Conclusion

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

ClinicalTrials.gov identifier: NCT02466880

KEY WORDS

type 2 diabetes glucose self-monitoring telemonitoring cluster-randomized 

Notes

Acknowledgments

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)

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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

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