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Diabetes control improves with supervised self-monitoring
Patients with type 2 diabetes not treated with insulin who participated in a supervised web-based program to reinforce self-monitoring of blood glucose saw improvements in glycemic control compared with those whose self-monitoring was unsupervised, study data show.
“The key feature of our trial is robust evidence suggesting that blood glucose monitoring with relatively little additional support from health professionals can be of value in terms of improving glycemic control in people who have previously had poor glycemic control,” the researchers wrote.
Brian McKinstry, MBChB, MD, FRCPE, FRCGP, general practitioner and professor of primary care e-health at the University of Edinburgh in the United Kingdom, and colleagues evaluated data from the investigator-blinded, controlled Telescot trial on 321 adults (mean age, 61 years) with type 2 diabetes and HbA1c greater than 58 mmol/mol.
Brian McKinstry
Participants were randomly assigned to a supported telemonitoring intervention (n = 160) that included instructions for use of blood pressure, blood glucose and weight monitors that transmitted information to research nurses or to usual care with annual visits and reviews for participants with poor glycemic control or elevated BP (n = 161). The primary outcome was to determine levels of HbA1c after 9 months; the first participants were randomly assigned on June 6, 2011, and the last follow-up visit was May 21, 2014.
The intervention group had lower HbA1c compared with the control arm with an absolute mean difference of 5.6 mmol/mol between groups (P = .0007). Mean HbA1c was 63 mmol/mol in the intervention group and 67.8 mmol/mol in the control group at follow-up.
Data on ambulatory BP were available for 229 participants; BP was lower in the intervention group compared with the control group (systolic BP, P = .017; diastolic BP, P = .006). No significant difference was observed between the groups for weight at follow-up.
The intervention group participated in more telephone calls to practice nurses compared with the control group (P < .0001).
“The main take-home message is that telemonitoring of people with uncontrolled type 2 diabetes results in lower HbA1c and [BP] and that it does so with very little increased workload,” McKinstry told Endocrine Today. “Such reductions would be expected to reduce the complications of diabetes and, in particular, reduce the incidence of stroke and myocardial infarction.” – by Amber Cox
For more information:
Brian McKinstry, MBChB, MD, FRCPE, FRCGP, can be reached at brian.mckinstry@ed.ac.uk.
Disclosure: McKinstry reports no relevant financial disclosures.