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TeleHealth improves diabetes self-management in an underserved community: diabetes TeleCare.

Davis RM, Hitch AD, Salaam MM, Herman WH, Zimmer-Galler IE, Mayer-Davis EJ - Diabetes Care (2010)

Bottom Line: Mixed linear regression model results for repeated measures showed a significant reduction in glycated hemoglobin (GHb) in the Diabetes TeleCare group from baseline to 6 and 12 months (9.4 +/- 0.3, 8.3 +/- 0.3, and 8.2 +/- 0.4, respectively) compared with usual care (8.8 +/- 0.3, 8.6 +/- 0.3, and 8.6 +/- 0.3, respectively).LDL cholesterol was reduced at 12 months in the Diabetes TeleCare group compared with usual care.Telehealth effectively created access to successfully conduct a 1-year remote DSME by a nurse CDE and dietitian that improved metabolic control and reduced cardiovascular risk in an ethnically diverse and rural population.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, USA. richard_davis@med.unc.edu

ABSTRACT

Objective: To conduct a 1-year randomized clinical trial to evaluate a remote comprehensive diabetes self-management education (DSME) intervention, Diabetes TeleCare, administered by a dietitian and nurse/certified diabetes educator (CDE) in the setting of a federally qualified health center (FQHC) in rural South Carolina.

Research design and methods: Participants were recruited from three member health centers of an FQHC and were randomized to either Diabetes TeleCare, a 12-month, 13-session curriculum delivered using telehealth strategies, or usual care.

Results: Mixed linear regression model results for repeated measures showed a significant reduction in glycated hemoglobin (GHb) in the Diabetes TeleCare group from baseline to 6 and 12 months (9.4 +/- 0.3, 8.3 +/- 0.3, and 8.2 +/- 0.4, respectively) compared with usual care (8.8 +/- 0.3, 8.6 +/- 0.3, and 8.6 +/- 0.3, respectively). LDL cholesterol was reduced at 12 months in the Diabetes TeleCare group compared with usual care. Although not part of the original study design, GHb was reduced from baseline to 12 and 24 months in the Diabetes TeleCare group (9.2 +/- 0.4, 7.4 +/- 0.5, and 7.6 +/- 0.5, respectively) compared with usual care (8.7 +/- 0.4, 8.1 +/- 0.4, and 8.1 +/- 0.5, respectively) in a post hoc analysis of a subset of the randomized sample who completed a 24-month follow-up visit.

Conclusions: Telehealth effectively created access to successfully conduct a 1-year remote DSME by a nurse CDE and dietitian that improved metabolic control and reduced cardiovascular risk in an ethnically diverse and rural population.

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Related in: MedlinePlus

Comparison of GHb in intervention and control groups.
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Figure 1: Comparison of GHb in intervention and control groups.

Mentions: Table 3 provides least square means by intervention status over time from the linear mixed models for the primary and secondary outcomes and corresponding P values. The improvement in glycated hemoglobin was significantly greater in the intervention group compared with usual care from baseline to 6 and 12 months (Fig. 1). Improvement in LDL cholesterol was significantly greater in the intervention group compared with usual care from baseline to 12 months only. There was no difference in improvement in systolic blood pressure, diastolic blood pressure, BMI, waist circumference, or albumin-to-creatinine ratio. At the 12-month measurement visit, a significantly greater proportion of participants in the intervention group reported receiving an eye exam during the 1-year study (81.2%), as compared with usual care (38.8%) (P < 0.0001). However, having an eye exam during the study period compared with not having an eye exam was not associated with glycated hemoglobin in univariate analysis (P = 0.84) or in the final mixed model (P = 0.88).


TeleHealth improves diabetes self-management in an underserved community: diabetes TeleCare.

Davis RM, Hitch AD, Salaam MM, Herman WH, Zimmer-Galler IE, Mayer-Davis EJ - Diabetes Care (2010)

Comparison of GHb in intervention and control groups.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2909047&req=5

Figure 1: Comparison of GHb in intervention and control groups.
Mentions: Table 3 provides least square means by intervention status over time from the linear mixed models for the primary and secondary outcomes and corresponding P values. The improvement in glycated hemoglobin was significantly greater in the intervention group compared with usual care from baseline to 6 and 12 months (Fig. 1). Improvement in LDL cholesterol was significantly greater in the intervention group compared with usual care from baseline to 12 months only. There was no difference in improvement in systolic blood pressure, diastolic blood pressure, BMI, waist circumference, or albumin-to-creatinine ratio. At the 12-month measurement visit, a significantly greater proportion of participants in the intervention group reported receiving an eye exam during the 1-year study (81.2%), as compared with usual care (38.8%) (P < 0.0001). However, having an eye exam during the study period compared with not having an eye exam was not associated with glycated hemoglobin in univariate analysis (P = 0.84) or in the final mixed model (P = 0.88).

Bottom Line: Mixed linear regression model results for repeated measures showed a significant reduction in glycated hemoglobin (GHb) in the Diabetes TeleCare group from baseline to 6 and 12 months (9.4 +/- 0.3, 8.3 +/- 0.3, and 8.2 +/- 0.4, respectively) compared with usual care (8.8 +/- 0.3, 8.6 +/- 0.3, and 8.6 +/- 0.3, respectively).LDL cholesterol was reduced at 12 months in the Diabetes TeleCare group compared with usual care.Telehealth effectively created access to successfully conduct a 1-year remote DSME by a nurse CDE and dietitian that improved metabolic control and reduced cardiovascular risk in an ethnically diverse and rural population.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina, USA. richard_davis@med.unc.edu

ABSTRACT

Objective: To conduct a 1-year randomized clinical trial to evaluate a remote comprehensive diabetes self-management education (DSME) intervention, Diabetes TeleCare, administered by a dietitian and nurse/certified diabetes educator (CDE) in the setting of a federally qualified health center (FQHC) in rural South Carolina.

Research design and methods: Participants were recruited from three member health centers of an FQHC and were randomized to either Diabetes TeleCare, a 12-month, 13-session curriculum delivered using telehealth strategies, or usual care.

Results: Mixed linear regression model results for repeated measures showed a significant reduction in glycated hemoglobin (GHb) in the Diabetes TeleCare group from baseline to 6 and 12 months (9.4 +/- 0.3, 8.3 +/- 0.3, and 8.2 +/- 0.4, respectively) compared with usual care (8.8 +/- 0.3, 8.6 +/- 0.3, and 8.6 +/- 0.3, respectively). LDL cholesterol was reduced at 12 months in the Diabetes TeleCare group compared with usual care. Although not part of the original study design, GHb was reduced from baseline to 12 and 24 months in the Diabetes TeleCare group (9.2 +/- 0.4, 7.4 +/- 0.5, and 7.6 +/- 0.5, respectively) compared with usual care (8.7 +/- 0.4, 8.1 +/- 0.4, and 8.1 +/- 0.5, respectively) in a post hoc analysis of a subset of the randomized sample who completed a 24-month follow-up visit.

Conclusions: Telehealth effectively created access to successfully conduct a 1-year remote DSME by a nurse CDE and dietitian that improved metabolic control and reduced cardiovascular risk in an ethnically diverse and rural population.

Show MeSH
Related in: MedlinePlus