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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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Related in: MedlinePlus

Distribution of mean HbA1c during trial period. Bands are based on Currie et al. (2010)[32].
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Figure 2: Distribution of mean HbA1c during trial period. Bands are based on Currie et al. (2010)[32].

Mentions: Secondary analysis was restricted to the 457 patients with at least one HbA1c reading in the years before and after recruitment (Table 2). Among control patients, mean HbA1c was 8.41% (68 mmol/mol) during the year before recruitment, and 8.38% (68 mmol/mol) during the 12-month trial period. Mean HbA1c thus showed little change among control patients. However, it fell among intervention patients from 8.38% (68 mmol/mol) to 8.15% (66 mmol/mol). Differences between treatment groups were not statistically significant in the unadjusted analysis, though they reached significance when adjusting for baseline characteristics - see Table 2. Sensitivity analysis found that, although effect sizes did not depend heavily on the model specification, statistical significance was not always reached (Additional file2).Compared with controls, a smaller proportion of the intervention group appeared to have high mean HbA1c during the trial period (Figure 2). During the 12-month trial period, 30.4% of control patients had mean HbA1c less than the 7.5% threshold targeted by general practices (58 mmol/mol), compared with 38.0% of intervention patients. This difference was not statistically significant in the unadjusted analysis (odds ratio 1.43, 95% CI, 0.94 to 2.17, p = 0.095), though it approached significance when adjusting for baseline characteristics (adjusted odds ratio 1.63, 95% CI, 0.99 to 2.68, p = 0.053).


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)

Distribution of mean HbA1c during trial period. Bands are based on Currie et al. (2010)[32].
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Distribution of mean HbA1c during trial period. Bands are based on Currie et al. (2010)[32].
Mentions: Secondary analysis was restricted to the 457 patients with at least one HbA1c reading in the years before and after recruitment (Table 2). Among control patients, mean HbA1c was 8.41% (68 mmol/mol) during the year before recruitment, and 8.38% (68 mmol/mol) during the 12-month trial period. Mean HbA1c thus showed little change among control patients. However, it fell among intervention patients from 8.38% (68 mmol/mol) to 8.15% (66 mmol/mol). Differences between treatment groups were not statistically significant in the unadjusted analysis, though they reached significance when adjusting for baseline characteristics - see Table 2. Sensitivity analysis found that, although effect sizes did not depend heavily on the model specification, statistical significance was not always reached (Additional file2).Compared with controls, a smaller proportion of the intervention group appeared to have high mean HbA1c during the trial period (Figure 2). During the 12-month trial period, 30.4% of control patients had mean HbA1c less than the 7.5% threshold targeted by general practices (58 mmol/mol), compared with 38.0% of intervention patients. This difference was not statistically significant in the unadjusted analysis (odds ratio 1.43, 95% CI, 0.94 to 2.17, p = 0.095), though it approached significance when adjusting for baseline characteristics (adjusted odds ratio 1.63, 95% CI, 0.99 to 2.68, p = 0.053).

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