Long-Term Effect of the Internet-Based Glucose Monitoring System on HbA1c Reduction and Glucose Stability

Abstract

OBJECTIVE -To investigate the long-term effectiveness of the Internet-based glucose monitoring system (IBGMS) on glucose control in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS -We conducted a prospective, randomized, controlled trial in 80 patients with type 2 diabetes for 30 months. The intervention group was treated with the IBGMS, while the control group made conventional office visits only. HbA 1c (A1C) was performed at 3-month intervals. For measuring of the stability of glucose control, the SD value of A1C levels for each subject was used as the A1C fluctuation index (HFI).RESULTS -The mean A1C and HFI were significantly lower in the intervention group (n ϭ 40) than in the control group (n ϭ 40). (A1C [mean Ϯ SD] 6.9 Ϯ 0.9 vs. 7.5 Ϯ 1.0%, P ϭ 0.009; HFI 0.47 Ϯ 0.23 vs. 0.78 Ϯ 0.51, P ϭ 0.001; intervention versus control groups, respectively). Patients in the intervention group with a basal A1C Ն7% (n ϭ 27) had markedly lower A1C levels than corresponding patients in the control group during the first 3 months and maintained more stable levels throughout the study (P ϭ 0.022). Control patients with a basal A1C Ͻ7% (n ϭ 15) showed the characteristic bimodal distribution of A1C levels, whereas the A1C levels in the intervention group remained stable throughout the study with low HFI.CONCLUSIONS -Long-term use of the IBGMS has proven to be superior to conventional diabetes care systems based on office visits for controlling blood glucose and achieving glucose stability. Diabetes Care 29:2625-2631, 2006M any controlled clinical trials have shown that prolonged maintenance of the appropriate HbA 1c (A1C) level reduces the risk of developing diabetes complications in individuals with type 1 and type 2 diabetes (1-3). However, data from the National Health and Nutrition Examination Surveys in the U.S. showed that overall glycemic control did not improve between the assessment periods of 1988 -1994 and 1999 -2000 (4,5). Similar findings have been reported in other countries (6,7).Therefore, to achieve and maintain the target level of A1C, new approaches for a medical delivery system are necessary. For this purpose, different strategies using electronic technologies or educational programs have been proposed to improve the quality and efficiency of care for people with diabetes (8 -15). In our previous study (16), we introduced a new bidirectional communication tool for diabetes management referred to as the Internet-based glucose monitoring system (IBGMS) and demonstrated its short-term effects over 3 months. The IBGMS comprises an electronically organized circuit for diabetes management that includes both online and offline systems. This management system provides a close doctor-patient relationship, offers more educational opportunities, and enhances patient feedback.In this study, we demonstrated the long-term effectiveness of the IBGMS on glucose stability and A1C reduction.RESEARCH DESIGN AND METHODS -Initially, 120 individuals with type 2 diabetes were screened by a review of their medical reco...

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

“…For PPG, four studies (16,18,27,28) presented outcome data and the meta-analysis showed a significant reduction in telecare group compared with standard care group from baseline (K52.86 mg/dl; 95% CI, K77.13 to K28.58; P!0.05). There were nine studies (13,16,18,21,23,27,28,29,30) with FPG data that could be pooled to metaanalysis, which indicated a small but significant difference in FPG decline from baseline, favoring telecare intervention (K9.00 mg/dl; 95% CI, K17.36 to K0.64; PZ0.03).…”

Comment on: Davidson MB (2007) The dilemma of self-monitoring of blood glucose. Diabetologia 50:497–499

“…Clearly, SMBG may not be useful to patients who lack the necessary skills and motivation. However, several studies that have tested randomised interventions in patients already using SMBG [5,6] found that training to improve their ability to make appropriate behavioural decisions in response to blood glucose readings resulted in better glycaemic control.…”

Overview of Telemedicine Applications in the Follow-Up of the Diabetic Patient

“…Available studies of telematics systems applied to diabetes are generally short in follow-up and small in sample sizes. To date, the study that has evaluated over a longest time the usefulness of a glucose monitoring system based on Internet, had a follow-up of 30 months (Cho et al, 2006). It concluded with a significantly greater reduction in HbA1c and a reduction in the rate of fluctuation of HbA1c in the intervention group compared to control.…”