Evaluation of a Remote Monitoring System for Diabetes Control

Abstract

Purpose The use of technology to implement cost-effective health care management on a large scale may be an alternative for diabetes management but needs to be evaluated in controlled trials. This study assessed the utility and cost-effectiveness of an automated Diabetes Remote Monitoring and Management System (DRMS) in glycemic control versus usual care. Methods In this randomized, controlled study, patients with uncontrolled diabetes on insulin were randomized to use of the DRMS or usual care. Participants in both groups were followed up for 6 months and had 3 clinic visits at 0, 3, and 6 months. The DRMS used text messages or phone calls to remind patients to test their blood glucose and to report results via an automated system, with no human interaction unless a patient had severely high or low blood glucose. The DRMS made adjustments to insulin dose(s) based on validated algorithms. Participants reported medication adherence through the Morisky Medication Adherence Scale-8, and diabetes-specific quality of life through the diabetes Daily Quality of Life questionnaire. A cost-effectiveness analysis was conducted based on the estimated overall costs of DRMS and usual care. Findings A total of 98 patients were enrolled (59 [60%] female; mean age, 59 years); 87 participants (89%) completed follow-up. HbA1c was similar between the DRMS and control groups at 3 months (7.60% vs 8.10%) and at 6 months (8.10% vs 7.90%). Changes from baseline to 6 months were not statistically significant for self-reported medication adherence and diabetes-specific quality of life, with the exception of the Daily Quality of Life–Social/Vocational Concerns subscale score (P = 0.04). Implications An automated system like the DRMS may improve glycemic control to the same degree as usual clinic care and may significantly improve the social/vocational aspects of quality of life. Cost-effectiveness analysis found DRMS to be cost-effective when compared to usual care and suggests DRMS has a good scale of economy for program scale up. Further research is needed to determine how to sustain the benefits seen with the automated system over longer periods.

Do health information technology self-management interventions improve glycemic control in medically underserved adults with diabetes? A systematic review and meta-analysis

“…Figure 2 illustrates the quality of the included studies. Most studies received a low risk score for their random sequence generation 54,[56][57][58][59][60][61]63,66 ; however, only 1 study reported method of allocation concealment. 57 While blinding of participants, personnel, and the outcome assessment was reported in only 3 of the 13 studies, 57,61,65 we deemed all studies to be at low risk for performance and detection bias, since the outcome, glycemic control, and its measurement are not likely to be influenced by lack of blinding.…”

“…[57][58][59]66 Regarding "other bias," the majority of studies were rated as high risk of bias, as the control groups received usual care only. 54,[58][59][60][61][62]65,66 Those employing an attention control group achieved this by providing usual care plus in-person individual DSME using printed materials, 55,57,63 multiple-choice quizzes, 56 or a mix of in-person group and individual DSME. 64 Of the 13 studies, only 1 received an overall score of low risk of bias.…”

“…Many studies recruited African Americans as either the majority or the entire sample. 54,55,58,59,61 Most samples were exclusively adults with T2DM. 54,57,59,60,[62][63][64]66 Most studies were conducted in primary care settings serving low-income populations, such as federally qualified health centers, 55,57,64,65 public clinics, or community health centers.…”

“…DSME interventions utilized a variety of HIT: cellular and/or automated telephone, 58,61,62,66 Internet-based applications, 57,60,63,64 telemedicine/telehealth, 54,55,65 and computer software programs without Internet. 56,59 Table 2 details the variety of functions by intervention and technology type.…”

Emerging Diabetes Research: Prevention, Risk and Management

“…This month we feature a research report from Katalenich et al, 12 "Evaluation of a Remote Monitoring System for Diabetes Control." The authors evaluated a system that employs text messaging or phone calls to remind patients to test blood glucose levels and that reports results using an automated system.…”