Managing diabetes mellitus in underserved subjects of Western China using a telemedicine system— A clinical trial

Objective: To evaluate the effectiveness of Internet and telephone-based telemedicine system managing on patients’ glycemic index, blood pressure, and lipid level control in underserved subjects with type 2 diabetes in Western China. Research designs and methods: In a 3 years, randomized, controlled, single-blind, parallel-group treat-to-target study, 412 subjects with type 2 diabetes were randomized to telemedicine (Tel; n =208) group and usual care (control; n =204) group. We evaluated the effects of the intervention on blood sugar, blood pressure, and lipid levels at 1, 2, 3 years point, and investigated the cause of the loss during follow-up by phone call.Results: Intra-group comparison: in the Tel group, the FBS, 2HPG, HbA1c, and SBP at 1, 2, 3 years and DBP, TC, TG, BMI at 2, 3 years were significantly decreased compared with baseline level  (P<0.05). Moreover, the Tel group had an obvious better control of their HbA1c  at 2 and 3 years and 2HPG  at 3 years of follow-up respectively compared with the outcomes at 1 year (P<0.05).Inter-group comparison: the FBS, 2HPG, and HbA1c of Tel group decreased significantly from the baseline to the 1 year more than those of control group (P<0.05 or P<0.01 ). In this analysis, all clinical measures of Tel group had a significant downward compared with the outcomes of Control group  at 2 years, the FBS, HbA1c and BMI (P<0.001), the 2HPG and SBP (P<0.01) and DBP, TC, and TG (P<0.05) were statistically significant respectively. Logistic regression analysis showed that the subject loss during follow-up was associated with worse diabetes management (OR=3.842), low income (OR=3.201), low education level (OR=0.923), and greater distance to the hospital (OR=0.921).Conclusions: The study results indicated that the telemedicine may be a useful tool for managing diabetes mellitus.