A randomized controlled trial of the effect of real-time telemedicine support on glycemic control in young adults with type 1 diabetes (ISRCTN 46889446)

OBJECTIVE - To determine whether a system of telemedicine support can improve glycemic control in type 1 diabetes. RESEARCH DESIGN AND METHODS - A 9-month randomized trial compared glucose self-monitoring real-time result transmission and feedback of results for the previous 24 h in the control group With real-time graphical phone-based feedback for the previous 2 weeks together with nurse-initiated support using a web-based graphical analysis of glucose self-monitoring results in the intervention group. All patients aged 18-30 years with HbA(1c) (AlC) levels of 8 - 11% were eligible for inclusion. RESULTS - A total of 93 patients (55 men) with mean diabetes duration (means +/- SD) 12.1 +/- 6.7 years were recruited from a young adult clinic. In total, the intervention and control groups transmitted 29,765 and 21,400 results, respectively. The corresponding median blood glucose levels were 8.9 mmol/l (interquartile range 5.4 - 13.5) and 10.3 mmol/l (6.5 - 14.4) (P < 0.0001). There was a reduction in AlC in the intervention group after 9 months from 9.2 +/- 1.1 to 8.6 +/- 1.4% (difference 0.6% [95% Cl 0.3 - 1.0]) and a reduction in AlC in the control group from 9.3 +/- 1.5 to 8.9 +/- 1.4% (difference 0.4% [0.03 - 0.7]). This difference in change in AlC between groups was not statistically significant (0.2% [-0.2 to 0.7, P = 0.3). CONCLUSIONS - Real-time telemedicine transmission and feedback of information about blood glucose results with nurse support is feasible and acceptable to patients, but to significantly improve glycemic control, access to real-time decision support for medication dosing and changes in diet and exercise may be required.