We conducted a six-month prospective interventional crossover study examining a computerized diabetes monitoring system (DMS) that conveyed dietary information. The objectives were to compare glycaemic control between intervention and control periods, and to assess patients' acceptance of the DMS. Nineteen patients were randomized into two groups, each using the DMS for three months and serving as the control group for another three months. The patients recorded information about their meal portions and blood glucose readings in a hand-held electronic diary. After transmitting the data to the DMS through a telephone modem, the patients received immediate feedback about the carbohydrate, protein and fat content of the meal, as well as the calorie content. A significant improvement in glycaemic control was achieved during intervention compared with control periods (mean HbA1C reduction of 0.825%). The DMS was also highly acceptable: 95% patients found it easy to operate while 63% found it useful. The DMS was thus a feasible model of telemedicine in diabetes care and a larger study is warranted to examine its cost-effectiveness.

the other hand, commonly suggested advantages were: faster diagnosis, increased accuracy of diagnosis and a decrease in the need for patient travel. One-third of doctors could see no advantage in the use of telemedicine in relation to themselves or colleagues. However, three main advantages emerged: these were the educational value of telemedicine, diagnostic and management reassurance for GPs and a reduction in time spent travelling by consultants. Similarly, one-third of doctors believed that the use of telemedicine posed no problems for patients, themselves or colleagues. However, a potential lack of confidentiality was of major concern to both groups. Other concerns included inaccuracy during a teleconsultation due to a combination of technical limitations and the GP having to perform a proxy examination for the specialist, the supposed 'impersonal' nature of a teleconsultation and a lack of reassurance for the patient. In relation to themselves and their colleagues, inaccuracy was perceived as a potential problem, as were time constraints and the costs associated with the setting up and maintenance of a telemedicine system. Consultants were particularly worried about technical limitations and the impersonal nature of telemedicine whereas GPs were concerned that its use could lead to a further increase in patient expectations and hence pressure on services.