The Efficiency of Telemedicine to Optimize Metabolic Control in Patients with Type 1 Diabetes Mellitus : Telemed Study

Objective: This study evaluated the impact of an Internet-based telematic system on the economic and clinical management of patients with type 1 diabetes mellitus. Research Design and Methods: This 6-month prospective, randomized, comparative, open, multicenter study included patients with type 1 diabetes >18 years old treated with multiple insulin doses and with a glycated hemoglobin (HbA1c) level of >8%. We compared an intervention group (IG) (two face-to-face and five telematic appointments) with a control group (CG) (seven face-to-face appointments). The variables studied were (1) patient and healthcare team costs, (2) metabolic control, (3) knowledge of diabetes, (4) quality of life, and (5) self-care treatment adherence. Results: Of the 154 patients included, 118 (76.6%) completed the study (IG, 54; CG, 64). The time used by the CG to follow the program was 823 – 645 min versus 353 – 222 min in the IG (P < 0.0001). Compared with the CG, the IG required less healthcare time from the professionals (288 – 105 min vs. 232 – 89 min; P < 0.001). HbA1c improved in both groups (IG, 9.2 – 1.5% [77.0 – 17.0 mmol/mol] vs. 8.7 – 1.5% [71.6 – 17.0 mmol/mol] [P < 0.001]; CG, 9.2 – 0.9% [77.0 – 10.0 mmol/mol] vs. 8.6 – 0.9% [70.5 – 10.0 mmol/mol] [P < 0.001], as did knowledge and self-care treatment adherence. Conclusions: The use of interactive telematic appointments in subjects with type 1 diabetes and inadequate metabolic control is an efficient strategy, providing results comparable to those of face-to-face appointments in relation to improvement in glycemic control, knowledge acquisition, and self-care treatment adherence, with a significant reduction in the time used, especially by patients. Diabetes Unit, Hospital Clinic, University of Barcelona, Biomedical Research Center in Diabetes and Associated Metabolic Disorders, Barcelona, Spain. Endocrinology and Nutrition Unit, San Carlos Hospital Clinic, Biomedical Research Center in Diabetes and Associated Metabolic Disorders, Madrid, Spain. Endocrinology Unit, University Hospital Clinic, University of Valencia, Biomedical Research Center in Diabetes and Associated Metabolic Disorders, Valencia, Spain. Endocrinology Unit, Carlos Haya University Hospital, Biomedical Research Center in Diabetes and Associated Metabolic Disorders, Málaga, Spain. Endocrinology Unit, Cruces University Hospital, University of the Basque Country, Biomedical Research Center in Diabetes and Associated Metabolic Disorders, Barakaldo, Spain. August Pi i Sunyer Institute of Biomedical Studies, Hospital Clinic, University of Barcelona, Biomedical Research Center in Diabetes and Associated Metabolic Disorders, Barcelona, Spain. Health Institute Technology Transfer, Pere Virgili Institute of Health Studies, Barcelona, Tarragona, Spain. This study is registered at ClinicalTrials.gov with clinical trial registration number NCT 01337141. Part of this article was presented at the 49 EASD Congress, held in Barcelona, Spain, September 23–27, 2013. DIABETES TECHNOLOGY & THERAPEUTICS Volume 16, Number 7, 2014 a Mary Ann Liebert, Inc. DOI: 10.1089/dia.2013. 0313