Telehealth Remote Monitoring Systematic Review: Structured Self-monitoring of Blood Glucose and Impact on A1C.
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Date
2014-05-30
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Abstract
The aim was to summarize research on telehealth remote patient monitoring interventions that incorporate key elements of structured self monitoring of blood glucose SMBG identified as essential for improving A1C A systematic review was conducted using the Medline Cumulative Index to Nursing and Allied Health Literature EMBASE and OVID Medline databases with search terms Telemedicine AND Monitoring Physiologic AND Diabetes Mellitus Type 2 Study selection criteria included original randomized clinical trials evaluating the impact of telehealth remote patient monitoring on A1C among adults with type 2 diabetes and incorporated 1 or more essential elements of SMBG identified by the International Diabetes Federation patient education provider education structured SMBG profile SMBG goals feedback data used to modify treatment interactive communication or shared decision making Fifteen studies were included with interventions ranging from 3 to 12 months mean 8 months with sample sizes from 30 to 1665 Key SMBG elements were grouped into 3 categories education SMBG protocols and feedback Research incorporating 5 of the 7 elements consistently achieved significant A1C improvements between study groups Interventions using more SMBG elements are associated with an improvement in A1C Studies with the largest A1C decrease incorporated 6 of the 7 elements and computer decision support Two studies with 5 of the 7 elements and active medication management achieved significant A1C decreases Telehealth remote patient monitoring interventions in type 2 diabetes have not included all structured monitoring elements recommended by the IDF Incorporating more elements of structured SMBG is associated with improved A1C