J Am Med Inform Assoc - The Diabetes Telemonitoring Study Extension: an exploratory randomized comparison of alternative interventions to maintain glycemic control after withdrawal of diabetes home telemonitoring.

Tópicos

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Resumo

CKGROUND: Telemonitoring interventions featuring transmission of home glucose records to healthcare providers have resulted in improved glycemic control in patients with diabetes. No research has addressed the intensity or duration of telemonitoring required to sustain such improvements.PURPOSE: The DiaTel study (10 January 2005 to 1 November 2007) compared active care management (ACM) with home telemonitoring (n=73) to monthly care coordination (CC) telephone calls (n=77) among veterans with diabetes and suboptimal glycemic control. The purpose of the DiaTel Extension was to assess whether initial improvements could be sustained with interventions of the same or lower intensity among participants who re-enrolled in a 6-month extension of DiaTel.METHODS: DiaTel participants receiving ACM were re-assigned randomly to monthly CC calls with continued telemonitoring but no active medication management (ACM-to-CCHT, n=23) or monthly CC telephone calls (ACM-to-CC, n=21). DiaTel participants receiving CC were re-assigned randomly to continued CC (CC-to-CC, n=28) or usual care (UC, ie, CC-to-UC, n=29). Hemaglobin A1c (HbA1c) was assessed at 3 and 6 months following re-randomization.RESULTS: Marked HbA1c improvements observed in DiaTel ACM participants were sustained 6 months after re-randomization in both ACM-to-CCHT and ACM-to-CC groups. Lesser HbA1c improvements observed in DiaTel CC participants were sustained in both CC-to-CC and CC-to-UC groups. No benefit was apparent for continued transmission of glucose data among DiaTel ACM participants or continued monthly telephone calls among DiaTel CC participants 6 months after re-randomization.CONCLUSION: Significant improvements in HbA1c achieved using home telemonitoring and active medication management for 6 months were sustained 6 months later with interventions of decreased intensity in VA Health System-qualified veterans. CLINICAL TRIAL REG. NO: NCT00245882, http://www.clinicaltrials.gov.

Resumo Limpo

ckground telemonitor intervent featur transmiss home glucos record healthcar provid result improv glycem control patient diabet research address intens durat telemonitor requir sustain improvementspurpos diatel studi januari novemb compar activ care manag acm home telemonitor n month care coordin cc telephon call n among veteran diabet suboptim glycem control purpos diatel extens assess whether initi improv sustain intervent lower intens among particip reenrol month extens diatelmethod diatel particip receiv acm reassign random month cc call continu telemonitor activ medic manag acmtoccht n month cc telephon call acmtocc n diatel particip receiv cc reassign random continu cc cctocc n usual care uc ie cctouc n hemaglobin ac hbac assess month follow rerandomizationresult mark hbac improv observ diatel acm particip sustain month rerandom acmtoccht acmtocc group lesser hbac improv observ diatel cc particip sustain cctocc cctouc group benefit appar continu transmiss glucos data among diatel acm particip continu month telephon call among diatel cc particip month rerandomizationconclus signific improv hbac achiev use home telemonitor activ medic manag month sustain month later intervent decreas intens va health systemqualifi veteran clinic trial reg nct httpwwwclinicaltrialsgov

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