Telemedicine had no convincing effect on quality of life , mortality or hypoglycemia .
INTERPRETATION : Compared with usual care , the addition of telemedicine , especially systems that allowed medication adjustments with or without text messaging or a Web portal , improved HbA1C but not other clinical ly relevant outcomes among patients with diabetes
BACKGROUND : Telemedicine , the use of telecommunications to deliver health services , expertise and information , is a promising but unproven tool for improving the quality of  diabetes care  .
We summarized the effectiveness of different methods of telemedicine for the management of diabetes compared with usual care .
Health coaching by telephony to support self-care in chronic diseases: clinical outcomes from The TERVA randomized controlled trial
Background The aim was to evaluate the effect of a 12-month individualized health coaching intervention by telephony on clinical outcomes . Methods An open-label cluster-r and omized parallel groups trial . Pre- and post-intervention anthropometric and blood pressure measurements by trained nurses , laboratory measures from electronic medical records ( EMR ) . A total of 2594 patients filling inclusion criteria ( age 45 years or older , with type 2 diabetes , coronary artery disease or congestive heart failure , and unmet treatment goals ) were identified from EMRs , and 1535 patients ( 59 % ) gave consent and were r and omized into intervention or control arm . Final analysis included 1221 ( 80 % ) participants with data on primary end-points both at entry and at end . Primary outcomes were systolic and diastolic blood pressure , serum total and LDL cholesterol concentration , waist circumference for all patients , glycated hemoglobin ( HbA1c ) for diabetics and NYHA class in patients with congestive heart failure . The target effect was defined as a 10-percentage point increase in the proportion of patients reaching the treatment goal in the intervention arm . Results The proportion of patients with diastolic blood pressure initially above the target level decreasing to 85 mmHg or lower was 48 % in the intervention arm and 37 % in the control arm ( difference 10.8 % , 95 % confidence interval 1.5–19.7 % ) . No significant differences emerged between the arms in the other primary end-points . However , the target levels of systolic blood pressure and waist circumference were reached non-significantly more frequently in the intervention arm . Conclusions Individualized health coaching by telephony , as implemented in the trial was unable to achieve majority of the disease management clinical measures . To provide substantial benefits , interventions may need to be more intensive , target specific sub-groups , and /or to be fully integrated into local health care . Trial registration Clinical Trials.gov Identifier :
Telemedicine had no convincing effect on quality of life , mortality or hypoglycemia .
INTERPRETATION : Compared with usual care , the addition of telemedicine , especially systems that allowed medication adjustments with or without text messaging or a Web portal , improved HbA1C but not other clinical ly relevant outcomes among patients with diabetes
BACKGROUND : Telemedicine , the use of telecommunications to deliver health services , expertise and information , is a promising but unproven tool for improving the quality of  diabetes care  .
We summarized the effectiveness of different methods of telemedicine for the management of diabetes compared with usual care .