The Efficiency of Telemedicine to Optimize Metabolic Control in Patients with Type 1 Diabetes Mellitus: Telemed Study

Objective: This study evaluated the impact of an Internet-based telematic system on the economic and clinical management of patients with type 1 diabetes mellitus. Research Design and Methods: This 6-month prospective, randomized, comparative, open, multicenter study included patients with type 1 diabetes >18 years old treated with multiple insulin doses and with a glycated hemoglobin (HbA(1c)) level of >8%. We compared an intervention group (IG) (two face-to-face and five telematic appointments) with a control group (CG) (seven face-to-face appointments). The variables studied were (1) patient and healthcare team costs, (2) metabolic control, (3) knowledge of diabetes, (4) quality of life, and (5) self-care treatment adherence. Results: Of the 154 patients included, 118 (76.6%) completed the study (IG, 54; CG, 64). The time used by the CG to follow the program was 823 +/- 645 min versus 353 +/- 222 min in the IG (P < 0.0001). Compared with the CG, the IG required less healthcare time from the professionals (288 +/- 105 min vs. 232 +/- 89 min; P < 0.001). HbA1c improved in both groups (IG, 9.2 +/- 1.5% [77.0 +/- 17.0 mmol/mol] vs. 8.7 +/- 1.5% [71.6 +/- 17.0 mmol/mol] [P < 0.001]; CG, 9.2 +/- 0.9% [77.0 +/- 10.0 mmol/mol] vs. 8.6 +/- 0.9% [70.5 +/- 10.0 mmol/mol] [P < 0.001], as did knowledge and self-care treatment adherence. Conclusions: The use of interactive telematic appointments in subjects with type 1 diabetes and inadequate metabolic control is an efficient strategy, providing results comparable to those of face-to-face appointments in relation to improvement in glycemic control, knowledge acquisition, and self-care treatment adherence, with a significant reduction in the time used, especially by patients.