Active Care Management Supported by Home Telemonitoring in Veterans With Type 2 Diabetes

TLDR

The study aimed to compare the short‑term efficacy of home telemonitoring with nurse‑practitioner medication management versus monthly care‑coordination calls on glycemic control in veterans with type 2 diabetes and baseline A1C ≥ 7.5%. Veterans were randomized to either an active care‑management group using a Viterion 100 TeleHealth Monitor for glucose, blood pressure, and weight transmission to a nurse practitioner who adjusted medications, or a control group receiving monthly educational calls, with assessments at baseline, 3, and 6 months. The telemonitoring group achieved significantly greater A1C reductions at 3 months (1.7% vs 0.7%) and 6 months (1.7% vs 0.8%) compared to the control, though both interventions improved glycemic control.

Abstract

OBJECTIVE We compared the short-term efficacy of home telemonitoring coupled with active medication management by a nurse practitioner with a monthly care coordination telephone call on glycemic control in veterans with type 2 diabetes and entry A1C ≥7.5%. RESEARCH DESIGN AND METHODS Veterans who received primary care at the VA Pittsburgh Healthcare System from June 2004 to December 2005, who were taking oral hypoglycemic agents and/or insulin for ≥1 year, and who had A1C ≥7.5% at enrollment were randomly assigned to either active care management with home telemonitoring (ACM+HT group, n = 73) or a monthly care coordination telephone call (CC group, n = 77). Both groups received monthly calls for diabetes education and self-management review. ACM+HT group participants transmitted blood glucose, blood pressure, and weight to a nurse practitioner using the Viterion 100 TeleHealth Monitor; the nurse practitioner adjusted medications for glucose, blood pressure, and lipid control based on established American Diabetes Association targets. Measures were obtained at baseline, 3-month, and 6-month visits. RESULTS Baseline characteristics were similar in both groups, with mean A1C of 9.4% (CC group) and 9.6% (ACM+HT group). Compared with the CC group, the ACM+HT group demonstrated significantly larger decreases in A1C at 3 months (1.7 vs. 0.7%) and 6 months (1.7 vs. 0.8%; P < 0.001 for each), with most improvement occurring by 3 months. CONCLUSIONS Compared with the CC group, the ACM+HT group demonstrated significantly greater reductions in A1C by 3 and 6 months. However, both interventions improved glycemic control in primary care patients with previously inadequate control.