Telecare in a structured therapeutic education programme addressed to patients with type 1 diabetes and poor metabolic control

Objective: To assess the effects of telecare on the results of intensive follow-up in T1D patients with poor metabolic control. Methods: After initial evaluation, 40 T1D were randomised to either a Telecare (TG) or Conventional Group (CG). Patients had an intensive 6-month follow-up and helped to make decisions concerning treatment self-management. The TG had 12 appointments: 9 telematic with the GlucoBeep system + 3 ambulatory. The CG had 12 outpatient appointments. At 0, 6 (end of study) and 12 months, metabolic control, self-management and quality of life were evaluated. Cost analysis was made at study end. Results: Thirty patients completed the study (16 TG, 14 CG). Intention to treat analysis included 19 TG and 16 CG. Improvement in HbA(1c) was similar in both groups TG: 8.4 +/- 1.2%; 7.5 +/- 1.4%; 7.6 +/- 0.9%, p = 0.008; CG: 8.9 +/- 1.3%; 7.7 +/- 0.9%; 7.6 +/- 0.7%, p = 0.001; with a decrease in hypoglycaemic events and improvement in self-management and quality of life. Patient costs were lower in the TG versus CG in appointment length (0.25 h versus 0.5 h). However, 30% of the diabetes team and patient appointments were longer than expected due to technical difficulties: (0.25 h versus I h). Conclusions: Intensive telematic follow-up achieves similar results to those of intensive face-to-face follow-up with lower patient costs. However, communication technology must be improved. (c) 2006 Elsevier Ireland Ltd. All rights reserved.