Using Telemedicine and Wireless Technology to Improve Diabetic Outcomes in Poorly Controlled Patients

摘要

Diabetes mellitus is a condition that lends itself to the use of telemedicine and technology because its management relies heavily on the collection, sharing, and interpretation of blood glucose data by the patient and healthcare provider. We studied whether or not we could improve the blood sugars of poorly controlled diabetics (A1 C> 8.0%) by giving them one of three technologies to communicate their blood sugar results from home to their provider. Poorly controlled type 1 and 2 diabetic patients were prospectively randomized to 'routine care' (n=67) or 'technology' (n=104). Patients in the latter group were further randomized to one of three technologies - modem (n=37) , WebTV (n=22), internet accessible computer (n=45) - which connected their glucose meter to their provider via a secure password-protected web site maintained by Healths entry. Patients in the WebTV and computer groups could review their own data on the web site, whereas those using the modem could not. 'Routine care' patients were seen by their provider as needed but no less than every 3 months and treated according to clinical practice guidelines. The patients in the 'technology' group were similarly seen but were also instructed to download their blood glucose values weekly by the assigned technology. The HealthSentry software accepts downloads from any brand of glucose meter which it then analyzes and displays in tabular and graphic formats. Treatment recommendations were then made based on the data. Data for the first 92 patients have been analyzed (45 'routine care' and 47 'technology'). Since there were no difference among the 3 'technology' groups, their results have been grouped together. Furthermore, patients were equally matched in each group with respect to demographics and pre-study glycemic control.