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Telemedicine intervention improves metabolic control in advanced type 2 diabetes
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In adults with poorly controlled type 2 diabetes, a telemedicine intervention combining weekly motivational phone calls and protein-rich meal replacement led to greater reductions in HbA1c and body weight and fewer antidiabetes medications compared with those assigned to usual care, according to findings published in Diabetes Care.
“The increasing prevalence of type 2 diabetes and the concomitant increase in antidiabetes medication costs are a considerable burden for national health care systems,” Kerstin Kempf, PhD, of the West-German Center of Diabetes and Health at Düsseldorf Catholic Hospital Group, Germany, and colleagues wrote. “Consequently, there is a strong need for alternative lifestyle-based therapeutic approaches. ... [The telemedical lifestyle intervention program] combines five components, including telemonitoring, telemedical coaching, medical-mental motivation, [protein-rich meal replacement] and self-monitoring of blood glucose, in a supraregional 12-week intervention program, which can be implemented alongside the standard care provided by general practitioners or diabetologists.”
In a single blind, active-comparator, intervention study, Kempf and colleagues analyzed data from 202 adults with type 2 diabetes, HbA1c at least 7.5% and BMI at least 27 kg/m², who were prescribed at least two antidiabetes medications, recruited in Germany. Researchers randomly assigned participants to either routine care (quarterly visits with their attending physician; n = 100) or to a telemedical lifestyle intervention program (TeLiPro; n = 102), receiving weekly telemedical coaching, including medical/mental motivation, a protein-rich meal replacement diet, and SMBG for 12 weeks. All participants also received a self-management guide, scale and step counter; participants were advised to measure their steps and weight daily. Primary endpoint was the estimated treatment difference in HbA1c reduction after 12 weeks. All available values per patient (n = 202) were analyzed. Analyses were also performed at 26 and 52 weeks of follow-up.
Participants assigned to the TeLiPro group saw HbA1c fall by a mean of 1.1% vs. a decrease of 0.2% for controls; estimated treatment difference was –0.8% after adjustment (95% CI, –1.1 to –0.5). Results persisted through follow-up at 26 weeks (estimated treatment difference, –0.6%; 95% CI, –1 to –0.3) and 52 weeks (estimated treatment difference, –0.6%; 95% CI, –0.9 to –0.2). Participants in the intervention group also saw greater reductions in weight (mean, –6.2 kg vs. –1 kg), BMI (mean, –2.1 kg/m² vs. –0.3 kg/m²) and systolic blood pressure (mean, –5.7 mm Hg vs. –1.6 mm Hg). No adverse events were reported.
“Even with advanced diabetes, it is not too late for lifestyle changes,” Kempf told Endocrine Today. “Carbohydrate restriction seems to improve the HbA1c even before a significant weight reduction occurs. As an alternative to the intensification of medical diabetic therapy, TeLiPro might be used as add-on to national diabetes management programs in order to support patients in the implementation of lifestyle change.”
Kempf added that researchers must next investigate whether a one-time TeLiPro training is sufficient to sustain long-term effects, or whether repeating on a multi-year basis is necessary to maintain motivation.
“Moreover, it is essential to determine whether the diabetic late complications can be reduced by consistently implementing the TeLiPro-mediated lifestyle change as basic therapy for type 2 diabetes,” Kempf said. – by Regina Schaffer
Disclosure: Boehringer Ingelheim funded this study. All study authors either received research support, serve on the advisory board or are employees of Boehringer Ingelheim.
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