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Effect of telehealth on glycaemic control: analysis of patients with type 2 diabetes in the Whole Systems Demonstrator cluster randomised trial.

Steventon A, Bardsley M, Doll H, Tuckey E, Newman SP - BMC Health Serv Res (2014)

Bottom Line: This difference, however, did not quite reach statistical significance (adjusted odds ratio 1.63, 95% CI, 0.99 to 2.68, p = 0.053).Telehealth modestly improved glycaemic control in patients with type 2 diabetes over 12 months.The scale of the improvements is consistent with previous meta-analyses, but was relatively modest and seems unlikely to produce significant patient benefit.

View Article: PubMed Central - HTML - PubMed

Affiliation: The Nuffield Trust, London, UK. Adam.Steventon@nuffieldtrust.org.uk.

ABSTRACT

Background: The Whole Systems Demonstrator was a large, pragmatic, cluster randomised trial that compared telehealth with usual care among 3,230 patients with long-term conditions in three areas of England. Telehealth involved the regular transmission of physiological information such as blood glucose to health professionals working remotely. We examined whether telehealth led to changes in glycosylated haemoglobin (HbA1c) among the subset of patients with type 2 diabetes.

Methods: The general practice electronic medical record was used as the source of information on HbA1c. Effects on HbA1c were assessed using a repeated measures model that included all HbA1c readings recorded during the 12-month trial period, and adjusted for differences in HbA1c readings recorded before recruitment. Secondary analysis averaged multiple HbA1c readings recorded for each individual during the trial period.

Results: 513 of the 3,230 participants were identified as having type 2 diabetes and thus were included in the study. Telehealth was associated with lower HbA1c than usual care during the trial period (difference 0.21% or 2.3 mmol/mol, 95% CI, 0.04% to 0.38%, p = 0.013). Among the 457 patients in the secondary analysis, mean HbA1c showed little change for controls following recruitment, but fell for intervention patients from 8.38% to 8.15% (68 to 66 mmol/mol). A higher proportion of intervention patients than controls had HbA1c below the 7.5% (58 mmol/mol) threshold that was targeted by general practices (30.4% vs. 38.0%). This difference, however, did not quite reach statistical significance (adjusted odds ratio 1.63, 95% CI, 0.99 to 2.68, p = 0.053).

Conclusions: Telehealth modestly improved glycaemic control in patients with type 2 diabetes over 12 months. The scale of the improvements is consistent with previous meta-analyses, but was relatively modest and seems unlikely to produce significant patient benefit.

Trial registration number: International Standard Randomized Controlled Trial Number Register ISRCTN43002091.

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Flow of patients into the study.
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Figure 1: Flow of patients into the study.

Mentions: The full WSD trial involved 3,230 patients from 179 general practices[19]. Of these, 817 patients had diabetes as their index condition and were recruited before 30 September 2009 (n = 379 control; 438 intervention). As previously stated, we excluded patients who were not linked to the routine data (n = 37 control; 32 intervention), did not have a continuous record of general practice registration (n = 94 control; 76 intervention), or did not have a confirmed diagnosis of type 2 diabetes within the general practice data (n = 35 control; 30 intervention). This left us with 513 patients with type 2 diabetes (n = 213 control; 300 intervention), from 112 general practices (Figure 1).


Effect of telehealth on glycaemic control: analysis of patients with type 2 diabetes in the Whole Systems Demonstrator cluster randomised trial.

Steventon A, Bardsley M, Doll H, Tuckey E, Newman SP - BMC Health Serv Res (2014)

Flow of patients into the study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4128403&req=5

Figure 1: Flow of patients into the study.
Mentions: The full WSD trial involved 3,230 patients from 179 general practices[19]. Of these, 817 patients had diabetes as their index condition and were recruited before 30 September 2009 (n = 379 control; 438 intervention). As previously stated, we excluded patients who were not linked to the routine data (n = 37 control; 32 intervention), did not have a continuous record of general practice registration (n = 94 control; 76 intervention), or did not have a confirmed diagnosis of type 2 diabetes within the general practice data (n = 35 control; 30 intervention). This left us with 513 patients with type 2 diabetes (n = 213 control; 300 intervention), from 112 general practices (Figure 1).

Bottom Line: This difference, however, did not quite reach statistical significance (adjusted odds ratio 1.63, 95% CI, 0.99 to 2.68, p = 0.053).Telehealth modestly improved glycaemic control in patients with type 2 diabetes over 12 months.The scale of the improvements is consistent with previous meta-analyses, but was relatively modest and seems unlikely to produce significant patient benefit.

View Article: PubMed Central - HTML - PubMed

Affiliation: The Nuffield Trust, London, UK. Adam.Steventon@nuffieldtrust.org.uk.

ABSTRACT

Background: The Whole Systems Demonstrator was a large, pragmatic, cluster randomised trial that compared telehealth with usual care among 3,230 patients with long-term conditions in three areas of England. Telehealth involved the regular transmission of physiological information such as blood glucose to health professionals working remotely. We examined whether telehealth led to changes in glycosylated haemoglobin (HbA1c) among the subset of patients with type 2 diabetes.

Methods: The general practice electronic medical record was used as the source of information on HbA1c. Effects on HbA1c were assessed using a repeated measures model that included all HbA1c readings recorded during the 12-month trial period, and adjusted for differences in HbA1c readings recorded before recruitment. Secondary analysis averaged multiple HbA1c readings recorded for each individual during the trial period.

Results: 513 of the 3,230 participants were identified as having type 2 diabetes and thus were included in the study. Telehealth was associated with lower HbA1c than usual care during the trial period (difference 0.21% or 2.3 mmol/mol, 95% CI, 0.04% to 0.38%, p = 0.013). Among the 457 patients in the secondary analysis, mean HbA1c showed little change for controls following recruitment, but fell for intervention patients from 8.38% to 8.15% (68 to 66 mmol/mol). A higher proportion of intervention patients than controls had HbA1c below the 7.5% (58 mmol/mol) threshold that was targeted by general practices (30.4% vs. 38.0%). This difference, however, did not quite reach statistical significance (adjusted odds ratio 1.63, 95% CI, 0.99 to 2.68, p = 0.053).

Conclusions: Telehealth modestly improved glycaemic control in patients with type 2 diabetes over 12 months. The scale of the improvements is consistent with previous meta-analyses, but was relatively modest and seems unlikely to produce significant patient benefit.

Trial registration number: International Standard Randomized Controlled Trial Number Register ISRCTN43002091.

Show MeSH
Related in: MedlinePlus