The emergence of telemedicine, defined as the use of communication technology such as the Internet, has sparked interest in the healthcare community over whether using such technology to reach patients may result in as good, or possibly better, treatment outcomes than face-to-face visits with a provider. Research published in January 2020 in Diabetes Care highlights the role of telemedicine in avoiding suboptimal management of diabetes.
Lead author, Maria S. Ruiz de Adana, of the Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, Málaga, Spain, Instituto de Investigación Biomédica de Málaga, and Ciber de Diabetes y Enfermedades Metabólicas, Madrid, Spain, and colleagues set out to explore the impact and potential value of a telemedicine visit compared with an in-person, face-to-face visit with a healthcare provider on clinical outcomes as well as patients’ health-related quality of life (HRQoL). The team also examined physician satisfaction with telemedicine for patients with type 1 diabetes to determine whether physicians viewed this as a viable alternative to engage patients in active participation in health education, especially if in-person office-visit nonadherence is a concern.
Building on previous research that has demonstrated telemedicine’s association with increased adherence rates and enhanced patient satisfaction, the team conducted a multicenter, randomized, open-label, parallel-group, 6-month controlled study of 379 patients with type 1 diabetes with poor glycemic control (defined as requiring multiple daily injections of insulin and with an HbA1c less than 8%). The subjects were randomized into two groups who had three physician visits. Both groups had a face-to-face meeting at the beginning of the study and at Month 6. For the second visit, one group had a face-to-face visit and the second group had a telemedicine visit. The primary outcome was the mean change of HbA1c levels at 6 months compared with baseline. The study also examined episodes of hypoglycemia, hyperglycemia, patients’ self-reported concerns (such as fear of hypoglycemia), and physician satisfaction measured by a questionnaire.
The researchers reported no statistically significant difference between the groups at the end of the 6-month study. In the in-person visit group, 73 patients achieved HbA1c less than 7% (<53 mmol/mol) compared with 78 patients in the telemedicine group, and the mean change in HbA1c levels was –0.04 ± 0.5% (–0.5 ± 5.8 mmol/mol) in person and 0.01 ± 0.6% (0.1 ± 6.0 mmol/mol) in the telemedicine group (P = .4941). In addition, there were no significant differences in secondary outcomes, such as self-reported fear of hypoglycemia (FH-15 score ≥28) or difference in HRQoL between the first baseline visit and the final visit at 6 months (P <.05) in either group.
The authors concluded, “The use of telemedicine in patients with type 1 diabetes with HbA1c less than 8% (<64 mmol/mol) provides similar efficacy and safety outcomes as face-to-face visits.”
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