Stepwise self-titration of oral glucose-lowering medication using a mobile telephone-based telehealth platform in type 2 diabetes: a feasibility trial in primary care.
No Thumbnail Available
Date
2013-02-26
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
BACKGROUND Telehealth supported clinical interventions may improve diabetes self management We explored the feasibility of stepwise self titration of oral glucose lowering medication guided by a mobile telephone based telehealth platform for improving glycemic control in type 2 diabetes METHODS We recruited 14 type 2 diabetes patients to a one year feasibility study with 1 1 randomization Intervention group patients followed a stepwise treatment plan for titration of oral glucose lowering medication with self monitoring of glycemia using real time graphical feedback on a mobile telephone and remote nurse monitoring using a Web based tool We carried out an interim analysis at 6 months RESULTS We screened 3476 type 2 diabetes patients 94 of the ineligible did not meet the eligibility criteria for hemoglobin A1c HbA1c or current treatment Mean standard deviation patient age at baseline was 58 11 years HbA1c was 65 12 mmol mol 8 1 1 1 body mass index was 32 9 6 4 kg m2 median interquartile range IQR diabetes duration was 2 6 0 6 to 4 7 years and 10 71 were men The median IQR change in HbA1c from baseline to six months was 10 21 to 3 mmol mol 0 9 1 9 to 0 in the intervention group and 5 13 to 6 mmol mol 0 5 1 2 to 0 6 in the control group Six out of seven intervention group patients and four out of seven control group patients changed their oral glucose lowering medication p 24 CONCLUSIONS Self titration of oral glucose lowering medication in type 2 diabetes with self monitoring and remote monitoring of glycemia is feasible and further studies using adapted recruitment strategies are required to evaluate whether it improves clinical outcomes