E-health feedback loop helps diabetics boost outcomes

The use of telehealth remote monitoring as part of a eHealth larger feedback loop for diabetics led to vastly improved A1c levels compared with patients who did not use the technology, according to research published this week in the Journal of Medical Internet Research.

For the study, which took place between January and October 2013, researchers examined 90 individuals, half of whom used telehealth remote monitoring with paired glucose testing via self-monitoring; the other 45 individuals received usual care. The participants were between 30 and 70 years old, did not use insulin and had A1c levels between 7.5 percent and 10.9 percent in the previous six months. Researchers from Sutter Health, the University of California, Davis, the University of California Health System and the University of Maryland conducted the study.

Participants in the telehealth group used a tablet computer to transmit data from paired glucose tests--glucose test results obtained before and after meals or physical activities--to providers who analyzed the data and shared that analysis with patients every week via the patient's electronic health record. Additionally, certified diabetes educators (CDEs) called patients in both groups to discuss trends and continuously develop care plans.

While individuals in both groups lowered their A1c levels, those in the telehealth group saw an estimated average decrease of 1.11 percentage points compared to an average decrease of 0.70 percentage points for those in the usual care group. Those in the treatment group also saw better glucose monitoring and foot care results.

"Although the complete feedback loop is an essential component of both SMBG [self-monitoring of blood glucose] and remote monitoring, there is limited and inconsistent incorporation of SMBG feedback in diabetes management," the authors said. "Incorporating telehealth remote monitoring with CDE support employs the complete feedback loop to improve outcomes."

Telemedicine also has been shown to be an effective means to diagnose diabetic retinopathy in patients, particularly those who do not have easy access to eye care, according to research published last fall in JAMA Ophthalmology, as well as in the Archives of Internal Medicine in October 2012.

To learn more:
- read the study