Results Telemedicine programs that include a nutritional component show similar effect in diabetes management as those programs that do not .
Furthermore , subgroup analysis reveals that nutritional intervention via SMS such as email and text messages is at least as equally effective in reducing HbA1c when compared to personal nutritional counseling with a practitioner over videoconference or telephone .
Conclusion The inclusion of nutritional counseling as part of a telemedicine program does not make a significant difference to diabetes outcomes .
Incorporating nutritional counseling into telemedicine programs via SMS is at least as effective as counseling via telephone or videoconference
Background A growing number of studies and review s have documented the impact of telemedicine on diabetes management .
However , no meta- analysis has assessed whether including nutritional counseling as part of a telemedicine program has a significant impact on diabetes outcomes or what kind of nutritional counseling is most effective .
Clinic-Based Versus Outsourced Implementation of a Diabetes Health Literacy Intervention
ABSTRACT BACKGROUND We compared two implementation approaches for a health literacy diabetes intervention design ed for community health centers . METHODS A quasi-experimental , clinic-r and omized evaluation was conducted at six community health centers from rural , suburban , and urban locations in Missouri between August 2008 and January 2010 . In all , 486 adult patients with type 2 diabetes mellitus participated . Clinics were set up to implement either : 1 ) a clinic-based approach that involved practice re- design to routinely provide brief diabetes education and counseling services , set action-plans , and perform follow-up without additional financial re sources [ CARVE-IN ] ; or 2 ) an out source d approach where clinics referred patients to a telephone-based diabetes educator for the same services [ CARVE-OUT ] . The fidelity of each intervention was determined by the number of contacts with patients , self-report of services received , and patient satisfaction . Intervention effectiveness was investigated by assessing patient knowledge , self-efficacy , health behaviors , and clinical outcomes . RESULTS Carve-out patients received on average 4.3 contacts ( SD = 2.2 ) from the telephone-based diabetes educator versus 1.7 contacts ( SD = 2.0 ) from the clinic nurse in the carve-in arm ( p < 0.001 ) . They were also more likely to recall setting action plans and rated the process more positively than carve-in patients ( p < 0.001 ) . Few differences in diabetes knowledge , self-efficacy , or health behaviors were found between the two approaches . However , clinical outcomes did vary in multivariable analyses ; carve-out patients had a lower HbA1c ( β = −0.31 , 95 % CI −0.56 to −0.06 , p = 0.02 ) , systolic blood pressure ( β = −3.65 , 95 % CI −6.39 to −0.90 , p = 0.01 ) , and low-density lipoprotein ( LDL ) cholesterol ( β = −7.96 , 95 % CI −10.08 to −5.83 , p < 0.001 ) at 6 months . CONCLUSION An out source d diabetes education and counseling approach for community health centers appears more feasible than clinic-based models . Patients receiving the  carve-out  strategy also demonstrated better clinical outcomes compared to those receiving the carve-in approach . Study limitations and unclear causal mechanisms explaining change in patient behavior suggest that further research is needed
Results Telemedicine programs that include a nutritional component show similar effect in diabetes management as those programs that do not .
Furthermore , subgroup analysis reveals that nutritional intervention via SMS such as email and text messages is at least as equally effective in reducing HbA1c when compared to personal nutritional counseling with a practitioner over videoconference or telephone .
Conclusion The inclusion of nutritional counseling as part of a telemedicine program does not make a significant difference to diabetes outcomes .
Incorporating nutritional counseling into telemedicine programs via SMS is at least as effective as counseling via telephone or videoconference
Background A growing number of studies and review s have documented the impact of telemedicine on diabetes management .
However , no meta- analysis has assessed whether including nutritional counseling as part of a telemedicine program has a significant impact on diabetes outcomes or what kind of nutritional counseling is most effective .