Telemedicine and type 1 diabetes: Is technology per se sufficient to improve glycaemic control?

Aim.-In the TELEDIAB-1 study, the Diabeo system (a smartphone coupled to a website) improved HbA(1c) by 0.9% vs controls in patients with chronic, poorly controlled type 1 diabetes. The system provided two main functions: automated advice on the insulin doses required; and remote monitoring by teleconsultation. The question is: how much did each function contribute to the improvement in HbA(1c)? Methods. Each patient received a smartphone with an insulin dose advisor (IDA) and with (G3 group) or without (G2 group) the telemonitoring/teleconsultation function. Patients were classified as ``high users'' if the proportion of ``informed'' meals using the IDA exceeded 67% (median) and as ``low users'' if not. Also analyzed was the respective impact of the IDA function and teleconsultations on the final HbA(1c) levels. Results. Among the high users, the proportion of informed meals remained stable from baseline to the end of the study 6 months later (from 78.1 +/- 21.5% to 73.8 +/- 25.1%; P=0.107), but decreased in the low users (from 36.6 +/- 29.4% to 26.7 +/- 28.4%; P=0.005). As expected, HbA(1c) improved in high users from 8.7% [range: 8.3-9.2%] to 8.2% [range: 7.8-8.7%] in patients with (n = 26) vs without (n = 30) the benefit of telemonitoring/teleconsultation (-0.49 +/- 0.60% vs -0.52 +/- 0.73%, respectively; P=0.879). However, although HbA(1c) also improved in low users from 9.0% [8.5-10.1] to 8.5% [7.9-9.6], those receiving support via teleconsultation tended to show greater improvement than the others (-0.93 +/- 0.97 vs -0.46 +/- 1.05, respectively; P=0.084). Conclusion. The Diabeo system improved glycaemic control in both high and low users who avidly used the IDA function, while the greatest improvement was seen in the low users who had the motivational support of teleconsultations. (C) 2013 Elsevier Masson SAS. All rights reserved.