Active Care Management Supported by Home Telemonitoring in Veterans With Type 2 Diabetes

Abstract

OBJECTIVEWe compared the short-term efficacy of home telemonitoring coupled with active medication management by a nurse practitioner with a monthly care coordination telephone call on glycemic control in veterans with type 2 diabetes and entry A1C ≥7.5%.RESEARCH DESIGN AND METHODSVeterans who received primary care at the VA Pittsburgh Healthcare System from June 2004 to December 2005, who were taking oral hypoglycemic agents and/or insulin for ≥1 year, and who had A1C ≥7.5% at enrollment were randomly assigned to either active care management with home telemonitoring (ACM+HT group, n = 73) or a monthly care coordination telephone call (CC group, n = 77). Both groups received monthly calls for diabetes education and self-management review. ACM+HT group participants transmitted blood glucose, blood pressure, and weight to a nurse practitioner using the Viterion 100 TeleHealth Monitor; the nurse practitioner adjusted medications for glucose, blood pressure, and lipid control based on established American Diabetes Association targets. Measures were obtained at baseline, 3-month, and 6-month visits.RESULTSBaseline characteristics were similar in both groups, with mean A1C of 9.4% (CC group) and 9.6% (ACM+HT group). Compared with the CC group, the ACM+HT group demonstrated significantly larger decreases in A1C at 3 months (1.7 vs. 0.7%) and 6 months (1.7 vs. 0.8%; P < 0.001 for each), with most improvement occurring by 3 months.CONCLUSIONSCompared with the CC group, the ACM+HT group demonstrated significantly greater reductions in A1C by 3 and 6 months. However, both interventions improved glycemic control in primary care patients with previously inadequate control.

Geographic and Racial/Ethnic Variations in Patterns of Multimorbidity Burden in Patients with Type 2 Diabetes

“…34 Interventions that use telemonitoring combined with another supportive strategy (such as active case management or care coordination) to improve glycemic control show higher potential for sustained post-intervention effect. [35][36][37][38] While there has been a growing number of such behavioral randomized trials or comprehensive multifaceted interventions, few have presented longitudinal outcomes data for improved health equity in disadvantaged populations with type 2 diabetes. Collectively, such studies will lead toward a better understanding of some of the root causes and variations of health equity, as well as potential interventions for improving equity in healthcare across different populations.…”

MANAGEMENT OF ENDOCRINE DISEASE: Effects of telecare intervention on glycemic control in type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials

“…The mean age of all participants ranged from 46 to 71 years. Ten studies (13,14,15,16,17,18,19,20,21,22) limited inclusion criteria to participants 1240 records identified through searches 899 records after duplicates removed 800 excluded based on abstracts.…”

“…Most studies reported improvement in HbA1c. Four studies (19,22,23,24) scored A for quality, nine (13,14,15,17,18,20,25,26,27) Fig. 2).…”

Do people with existing chronic conditions benefit from telephone coaching? A rapid review

“…weekly or monthly telephone calls to support the patients with chronic disease; n = 25) and only five studies described reactive coaching (see Table 4). 21,[29][30][31][32][33][34][35][36][37][38][39][40] Reactive coaching (responding to data uploaded by participants) tended to focus on patients categorised as being at level 2 who were engaged in active disease management such as symptom monitoring and SM. The majority of the telephone coaching interventions (n = 23) targeted patients categorised as being at level 2 or level 3 of the KPRP, i.e.…”

“…Only one 46 of seven studies using planned coaching reported improvements in adherence compared with 4/4 using reactive coaching. 21,33,35,[38][39][40] …”