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 .
Insulin adjustment by a diabetes nurse educator improves glucose control in insulin-requiring diabetic patients: a randomized trial.
BACKGROUND Diabetic patients taking insulin  often have suboptimal glucose control , and st and ard methods of health care delivery are ineffective in improving such control . This study was undertaken to determine if insulin adjustment according to advice provided by telephone by a diabetes nurse educator could lead to better glucose control , as indicated by level of glycated hemoglobin ( HbA1c ) . METHODS The authors conducted a prospect i ve r and omized trial involving 46 insulin-requiring diabetic patients who had poor glucose control ( HbA1c of 0.085 or more ) . Eligible patients were those already taking insulin and receiving endocrinologist-directed care through a diabetes centre and whose most recent HbA1c level was 0.085 or higher . The patients were r and omly assigned to receive st and ard care or to have regular telephone contact with a diabetes nurse educator for advice about adjustment of insulin therapy . RESULTS At baseline there was no statistically significant difference between the 2 groups in terms of HbA1c level ( mean [ and st and ard deviation ] for st and ard-care group 0.094 [ 0.008 ] and for intervention group 0.096 [ 0.010 ] ) , age , sex , type or duration of diabetes , duration of insulin therapy or complications . After 6 months , the mean HbA1c level in the st and ard-care group was 0.089 ( 0.010 ) , which was not significantly different from the mean level at baseline . However , the mean HbA1c level in the intervention group had fallen to 0.078 ( 0.008 ) , which was significantly lower than both the level at baseline for that group ( p < 0.001 ) and the level for the st and ard-care group at 6 months ( p < 0.01 ) . INTERPRETATION Insulin adjustment according to advice from a diabetes nurse educator is an effective method of improving glucose control in insulin-requiring diabetic patients
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 .