Telecare in a structured therapeutic education programme addressed to patients with type 1 diabetes and poor metabolic control

The patient and the crossing between Primary and Hospital care. Systematic review of trials for the implementation of tools for integration in Spain

“…Los resultados de otras herramientas son menos atractivos dado la falta de consistencia entre los estudios. Este es el caso de las consultas no presenciales que fueron importantes en el estudio diseñado en la zona rural de Extremadura 33 donde permitieron reducir los tiempos hasta la atención, y sin embargo fueron decepcionantes en la DM 34 o tras el parto 35 , donde ni mejoraron el control de la enfermedad ni aumentaron el grado de An. Sist.…”

“…Un estudio cuasi-experimental mostró que los resultados en calidad de vida y parámetros de salud percibidos por el propio paciente no variaban entre pacientes atendidos de forma convencional (cara a cara) o mediante telemedicina (videoconferencia), con una reducción en los tiempos hasta alcanzar un diagnóstico o empezar un tratamiento en pacientes de áreas rurales 33 . En pacientes diabéticos tipo 1, un seguimiento intensivo mediante consulta telemática consiguió los mismos resultados sobre el control de la hemoglobina glicada o el número de hipoglucemias que un seguimiento intensivo mediante consulta cara a cara 34 . La sensación de que la consulta interfería en la vida diaria del paciente era menor en las consultas telemáticas (20%) que en las cara a cara (100%).…”

Internet Blood Glucose Monitoring Systems Provide Lasting Glycemic Benefit in Type 1 and 2 Diabetes

“…Rather, studies have reported nonsignificant trends toward a lower hypoglycemia rate or, in 2 cases, a significant decrease in the frequency of moderately severe 17 and severe hypoglycemia. 21 Crucially, this apparent increase in treatment safety with IBGMS was seen in insulin-using 16,17,32,35,36 as well as non-insulin-using patients, 20,21,23 and in studies of patients with poor baseline glycemic control, in which changes in HbA 1c level with treatment were particularly striking.…”

“…Moreover, among 4 studies reporting insulin dose data, none identified significant differences in insulin dose, comparing baseline and follow-up or between treatment arms. [14][15][16]36 Thus, it seems that improvement in HbA 1c level with IBGMS is largely independent of insulin dose adjustments. This conclusion is consistent with the finding that treatment modification was the least frequent type of feedback for patients to receive by means of IBGMS, with encouragement being the most frequent type of feedback.…”

“…42 The costs associated with the intervention arm, more than $8000 per patient per year, were driven mainly by the cost of a specialized home telemedicine unit and associated training and demonstrating costs. 42 However, as early as 2003, Jansa and colleagues 36 reported that, in the absence of technical problems, IBGMS use was associated with a decrease in health care provider costs of V40 (w$55 US) per case over 12 months, because of decreased lengths of appointments in the intervention group.…”