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 .
Pro-active call center treatment support (PACCTS) to improve glucose control in type 2 diabetes: a randomized controlled trial.
OBJECTIVE To determine whether Pro-Active Call Center Treatment Support ( PACCTS ) , using trained nonmedical telephonists supported by specially design ed software and a diabetes nurse , can effectively improve glycemic control in type 2 diabetes . RESEARCH DESIGN AND METHODS A r and omized controlled implementation trial of 1-year duration was conducted in Salford , U.K. The trial comprised 591 r and omly selected individuals with type 2 diabetes . By r and om allocation , 197 individuals were assigned to the usual care ( control ) group and 394 to the PACCTS ( intervention ) group . Lifestyle advice and drug treatment in both groups followed local guidelines . PACCTS patients were telephoned according to a protocol with the frequency of calls proportional to the last HbA(1c ) level . The primary outcome was absolute reduction in HbA(1c ) , and the secondary outcome was the proportion of patients reducing HbA(1c ) by at least 1 % . RESULTS A total of 332 patients ( 84 % ) in the PACCTS group and 176 patients ( 89 % ) in the control group completed the study .  Final HbA(1c ) values were available in 374 patients ( 95 % ) in the PACCTS group and 180 patients ( 92 % ) in the usual care group . Compared with usual care , HbA(1c ) improved by 0.31 % ( 95 % CI 0.11 - 0.52 , P = 0.003 ) overall in the PACCTS patients . For patients with baseline HbA(1c ) > 7 % , the improvement increased to 0.49 % ( 0.21 - 0.77 , P < 0.001 ) , whereas in patients with baseline HbA(1c ) < 7 % there was no change . The difference in the proportions of patients achieving a > /=1 % reduction in HbA(1c ) significantly favored the PACCTS intervention : 10 % ( 4 - 16 , P < 0.001 ) overall and 15 % ( 7 - 24 , P < 0.001 ) for patients with baseline HbA(1c ) > 7 % . CONCLUSIONS In an urban Caucasian trial population with blood glucose HbA(1c ) > 7 % , PACCTS facilitated significant improvement in glycemic control . Further research should extend the validity of findings to rural communities and other ethnic groups , as well as to smoking and lipid and blood pressure control
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 .