title: Telemedicine influence on the follow-up of type 2 diabetes patients. A Randomized Controlled Trial of an Internet-Based Mentoring Program for Type 1 Diabetes Patients with Inadequate Glycemic Control Diabetes intervention in the information age. The impact of telehome care on health status and quality of life among patients with diabetes in a primary care setting in Poland. Impact of Information Technology on the Therapy of Type-1 Diabetes: A Case Study of Children and Adolescents in Germany Cluster-Randomized Trial of a Mobile Phone Personalized Behavioral Intervention for Blood Glucose Control Improved Glycemic Control Without Hypoglycemia in Elderly Diabetic Patients Using the Ubiquitous Healthcare Service, a New Medical Information System Comprehensive Diabetes Management Program for Poorly Controlled Hispanic Type 2 Patients at a Community Health Center Impact of modem-transferred blood glucose data on clinician work efficiency and patient glycemic control. DialBetics: A Novel Smartphone-based Self-management Support System for Type 2 Diabetes Patients. Diabetes Interactive Diary: A New Telemedicine System Enabling Flexible Diet and Insulin Therapy While Improving Quality of Life Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial An evaluation of Birmingham Own Health® telephone care management service among patients with poorly controlled diabetes. a retrospective comparison with the General Practice Research Database TeleHealth Improves Diabetes Self-Management in an Underserved Community Transfer of knowledge from the specialist to the generalist by videoconferencing: effect on diabetes care A nurse short message service by cellular phone in type-2 diabetic patients for six months. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Weight loss in obese patients with type 2 diabetes: effects of telemonitoring plus a diet combination - the Active Body Control (ABC) Program. Influence of health care providers on the development of diabetes complications: long-term follow-up from the Pittsburgh Epidemiology of Diabetes Complications Study. Online disease management of diabetes: Engaging and Motivating Patients Online With Enhanced Resources-Diabetes (EMPOWER-D), a randomized controlled trial Effects of Self-Management Support on Structure, Process, and Outcomes Among Vulnerable Patients With Diabetes Active Care Management Supported by Home Telemonitoring in Veterans With Type 2 Diabetes A comparison of diabetes education administered through telemedicine versus in person. Spanish Diabetes Self-Management With and Without Automated Telephone Reinforcement A short message service by cellular phone in type 2 diabetic patients for 12 months. Effectiveness of general practice based, practice nurse led telephone coaching on glycaemic control of type 2 diabetes: the Patient Engagement And Coaching for Health (PEACH) pragmatic cluster randomised controlled trial Impact of remote management of diabetes via computer: the 360 study--a proof-of-concept randomized trial. Real-time continuous glucose monitoring together with telemedical assistance improves glycemic control and glucose stability in pump-treated patients. Managing diabetes care using an integrated regional e-health approach Clinic-Based Versus Outsourced Implementation of a Diabetes Health Literacy Intervention Effectiveness of mobile and internet intervention in patients with obese type 2 diabetes Reported Practice Behaviors for Medical Care of Patients With Diabetes Mellitus by Primary-Care Physicians in Pennsylvania A randomized controlled trial of the effect of real-time telemedicine support on glycemic control in young adults with type 1 diabetes (ISRCTN 46889446). Comparative effectiveness of weight-loss interventions in clinical practice. Reinforced follow-up for children and adolescents with type 1 diabetes and inadequate glycaemic control: a randomized controlled trial intervention via the local pharmacist and telecare. Mobile Phone-Based Video Messages for Diabetes Self-Care Support One-year efficacy and safety of Web-based follow-up using cellular phone in type 1 diabetic patients under insulin pump therapy: the PumpNet study. [Effects of Web-based health education on blood glucose and blood pressure improvement in postmenopausal women with impaired fasting blood glucose]. Effectiveness of medical nutrition therapy provided by dietitians in the management of non-insulin-dependent diabetes mellitus: a randomized, controlled clinical trial. A feasibility study of mobile phone text messaging to support education and management of type 2 diabetes in Iraq. Evaluating the impact of mobile telephone technology on type 2 diabetic patients' self-management: the NICHE pilot study. A randomized controlled trial of telephone calls to young patients with poorly controlled type 1 diabetes. UKPDS 26: Sulphonylurea failure in non-insulin-dependent diabetic patients over six years. UK Prospective Diabetes Study (UKPDS) Group. A Telemedicine System That Includes a Personal Assistant Improves Glycemic Control in Pump-Treated Patients with Type 1 Diabetes Telecare for teenagers with type 1 diabetes: a trial. A comparison of internet monitoring with continuous glucose monitoring in insulin-requiring type 2 diabetes mellitus. Are there time and cost savings by using telemanagement for patients on intensified insulin therapy?: A randomised, controlled trial A telephone-delivered intervention to improve glycemic control in type 2 diabetic patients. A mobile health intervention for weight management among young adults: a pilot randomised controlled trial. The Informatics for Diabetes and Education Telemedicine (IDEATel) project. Adherence to diabetes control recommendations: impact of nurse telephone calls. Feasibility of using videoconferencing to provide diabetes education: a pilot study Weighing every day matters: daily weighing improves weight loss and adoption of weight control behaviors. An automated telemedicine system improves patient-reported well-being. Web-based comprehensive information system for self-management of diabetes mellitus.
abstract: OBJECTIVE This study was design ed to evaluate the impact of a teleassistance system on the metabolic control of type 2 diabetes patients . RESEARCH DESIGN AND METHODS We conducted a 1-year controlled parallel-group trial comparing patients r and omized ( 1 ) to an intervention group , assigned to a teleassistance system using real-time transmission of blood glucose results , with immediate reply when necessary , and telephone consultations , or ( 2 ) to a control group , being regularly followed-up at their healthcare center . Study subjects were type 2 diabetes patients > 30 years of age followed in the primary care setting . RESULTS A total of 328 type 2 diabetes patients were recruited from 35 family practice s in the province of Málaga , Spain . There was a reduction in hemoglobin A1c after 12 months from 7.62 + /- 1.60 % to 7.40 + /- 1.43 % ( P = 0.027 ) in the intervention group and from 7.44 + /- 1.31 % to 7.35 + /- 1.38 % ( P = 0.303 ) in the control group . The difference in the change between groups was not statistically significant . There was also a significant decrease in systolic and diastolic blood pressure , total cholesterol , low-density lipoprotein cholesterol , and body mass index in the intervention group . In the control group , the only significant decline was in low-density lipoprotein cholesterol . CONCLUSIONS A teleassistance system using real-time transmission of blood glucose results with an option to make telephone consultations is feasible in the primary care setting as a support tool for family physicians in their follow-up of type 2 diabetes patients Background To determine whether an internet-based mentoring program can improve glycemic control in subjects with type 1 diabetes mellitus ( T1DM ) . Methods Subjects with T1DM on intensive insulin therapy and with hemoglobin A1c ( HbA1c ) ≥8.0 % were r and omized to mentored ( glucometer transmission with feedback from mentors ) or control ( glucometer transmission without feedback ) groups and were examined for 12 weeks . Five mentors were interviewed and selected , of which two were T1DM patients themselves and three were parents with at least one child diagnosed with T1DM since more than 5 years ago . Results A total of 57 T1DM adult subjects with a mean duration after being diagnosed with diabetes of 7.4 years were recruited from Samsung Medical Center . Unfortunately , the mentored group failed to show significant improvements in HbA1c levels or other outcomes , including the quality of life , after completion of the study . However , the mentored group monitored their blood glucose ( 1.41 vs. 0.30 ) and logged into our website ( http://ubisens.co.kr/ ) more frequently ( 20.59 times vs. 5.07 times ) than the control group . Conclusion A 12-week internet-based mentoring program for T1DM patients with inadequate glycemic control did not prove to be superior to the usual follow-up . However , the noted increase in the subjects ' frequency of blood glucose monitoring may lead to clinical benefits Sustained improvement in blood glucose control is the only treatment outcome which will reduce or eliminate the long term complications of diabetes mellitus . We have design ed and evaluated an electronic information system which facilitates this task . The system is voice-interactive , physician directed and affords , to remote patients , 24 h access via touch-tone telephone . Accordingly , patients access the system each day to report self-measured blood glucose levels or hypoglycaemic symptoms together with dietary changes , planned exercise , stress , illness or other lifestyle events . In turn they receive immediate advice with respect to medication dosing changes , and other pertinent feedback . Preliminary system beta-testing for safety and efficacy was performed for one year in an open study of 204 patients derived from two independent , health-care environments . Among the two testing centres , over 60,000 telephone cells were received by the computer systems during the start-up year . Safety and efficacy expectations were met . In addition , prevalence of diabetes related crises ( hyperglycaemia or hypoglycaemia ) fell approximately 3-fold . Glycated haemoglobin fell significantly ( 1.0 - 1.3 % ) in patients actively using the system . In control groups of patients not actively using the system , there were no improvements in metabolic control while body weights were stable in all groups . The new system was safe and effective in our h and s and empowered our health professionals to provide improved diabetes care BACKGROUND Telehome care has been proposed as a solution to the challenges of providing effective and affordable care for patients with diabetes . METHODS A total of 100 adult patients with type 2 diabetes-divided between insulin and noninsulin requiring-was enrolled in a r and omized , controlled trial aim ed at investigating the effects of telehome monitoring . The experimental group ( n = 50 ) received an in-home wireless glucose monitor and transmitter , whereas the control group ( n = 50 ) was instructed to follow the conventional arrangement . RESULTS There was an overall reduction in HbA1c values in both experimental and control groups after 6 months . A significant difference in HbA1c values between the groups was observed only among the noninsulin-requiring patients ( decline from 6.95 % ± 0.82 % to 6.66 % ± 0.86 % in IB vs. 7.21 % ± 2.02 % to 7.2 % ± 1.86 % in IIB ; p = 0.02 ) . The experimental group reported considerably less hyperglycemic and hypoglycemic events . The profile of the patient who benefited the most from telemonitoring consisted of older , more educated patient who had acquired the disease relatively recently , and who spends most of the time at home . The experimental group had higher overall scores on quality of life measures and sense of control over diabetes . There was a positive association between educational attainment and ability to use the telemonitoring system without help ( p = 0.045 ) . CONCLUSIONS Although not conclusive because of the small sample and short observation period , the study suggests that telehome monitoring is an effective tool in controlling type 2 diabetes in a primary care setting Being able to manage and adjust insulin doses is a key part of managing type-1 diabetes . Children and adolescents with type-1 diabetes mellitus often have serious difficulties with this dosage adjustment . Therefore , this paper aims to investigate the impact of using novel mobile , web and communication technologies in assisting their therapy and treatment . A trial was conducted in the north-eastern part of Germany to evaluate the impact of the “ Mobil Diab ” , a mobile diabetes management system , on the clinical outcome . 68 subjects aged between 8 and 18 years , divided r and omly into control and intervention groups , were included into the study . Metrics such as changes in the quality of metabolic control , changes in psychological parameters , usability and acceptance of the technology were used for evaluation purpose . Metabolic control was mainly assessed by the mean HbAlc . Analysis showed a good acceptance of the proposed system . An overall improvement in mean levels of HbA1c was observed , however further studies will be conducted to prove evidence of the weight and BMI improvements . Moreover , initial indications of positive impact on the improvement in psychological parameters were presumed based on the result of the conducted study . The system appeared to be an efficient and time saving tool in diabetes management OBJECTIVE To test whether adding mobile application coaching and patient/provider web portals to community primary care compared with st and ard diabetes management would reduce glycated hemoglobin levels in patients with type 2 diabetes . RESEARCH DESIGN AND METHODS A cluster-r and omized clinical trial , the Mobile Diabetes Intervention Study , r and omly assigned 26 primary care practice s to one of three stepped treatment groups or a control group ( usual care ) . A total of 163 patients were enrolled and included in analysis . The primary outcome was change in glycated hemoglobin levels over a 1-year treatment period . Secondary outcomes were changes in patient-reported diabetes symptoms , diabetes distress , depression , and other clinical ( blood pressure ) and laboratory ( lipid ) values . Maximal treatment was a mobile- and web-based self-management patient coaching system and provider decision support . Patients received automated , real-time educational and behavioral messaging in response to individually analyzed blood glucose values , diabetes medications , and lifestyle behaviors communicated by mobile phone . Providers received quarterly reports summarizing patient ’s glycemic control , diabetes medication management , lifestyle behaviors , and evidence -based treatment options . RESULTS The mean declines in glycated hemoglobin were 1.9 % in the maximal treatment group and 0.7 % in the usual care group , a difference of 1.2 % ( P = 0.001 ) over 12 months . Appreciable differences were not observed between groups for patient-reported diabetes distress , depression , diabetes symptoms , or blood pressure and lipid levels ( all P > 0.05 ) . CONCLUSIONS The combination of behavioral mobile coaching with blood glucose data , lifestyle behaviors , and patient self-management data individually analyzed and presented with evidence -based guidelines to providers substantially reduced glycated hemoglobin levels over 1 year OBJECTIVE To improve quality and efficiency of care for elderly patients with type 2 diabetes , we introduced elderly-friendly strategies to the clinical decision support system (CDSS)-based ubiquitous healthcare ( u-healthcare ) service , which is an individualized health management system using advanced medical information technology . RESEARCH DESIGN AND METHODS We conducted a 6-month r and omized , controlled clinical trial involving 144 patients aged > 60 years . Participants were r and omly assigned to receive routine care ( control , n = 48 ) , to the self-monitored blood glucose ( SMBG  , n = 47 ) group , or to the u-healthcare group ( n = 49 ) . The primary end point was the proportion of patients achieving A1C < 7 % without hypoglycemia at 6 months . U-healthcare system refers to an individualized medical service in which medical instructions are given through the patient ’s mobile phone . Patients receive a glucometer with a public switched telephone network-connected cradle that automatically transfers test results to a hospital-based server . Once the data are transferred to the server , an automated system , the CDSS rule engine , generates and sends patient-specific messages by mobile phone . RESULTS After 6 months of follow-up , the mean A1C level was significantly decreased from 7.8 ± 1.3 % to 7.4 ± 1.0 % ( P < 0.001 ) in the u-healthcare group and from 7.9 ± 1.0 % to 7.7 ± 1.0 % ( P = 0.020 ) in the SMBG group , compared with 7.9 ± 0.8 % to 7.8 ± 1.0 % ( P = 0.274 ) in the control group . The proportion of patients with A1C < 7 % without hypoglycemia was 30.6 % in the u-healthcare group , 23.4 % in the SMBG group ( 23.4 % ) , and 14.0 % in the control group ( P < 0.05 ) . CONCLUSIONS The CDSS-based u-healthcare service achieved better glycemic control with less hypoglycemia than SMBG and routine care and may provide effective and safe diabetes management in the elderly diabetic patients Technology and improved care coordination models can help diabetes educators and providers meet national care st and ards and provide culturally sensitive diabetes education that may improve diabetes outcomes . The purpose of the study was to evaluate the clinical usefulness of a nurse-led diabetes care program ( Comprehensive Diabetes Management Program , CDMP ) for poorly controlled Hispanic type 2 diabetes ( T2DM ) patients in an urban community health center setting . Patients were r and omized to the intervention condition ( IC ; n = 21 ) or an attention control condition ( AC ; n = 18 ) . IC and AC conditions were compared on rates of adherence to national clinical practice guidelines ( blood glucose , blood pressure , foot exam , eye exam ) , and levels of diabetes distress , depression , and treatment satisfaction . IC patients had a significant improvement in A1C from baseline to 12-month follow-up compared with AC ( −1.6 % ± 1.4 % versus −0.6 % ± 1.1 % ; P = .01 ) . The proportion of IC patients meeting clinical goals at follow-up tended to be higher than AC for A1c ( IC = 45 % ; AC = 28 % ) , systolic blood pressure ( IC = 55 % ; AC = 28 % ) , eye screening ( IC = 91 % ; AC = 78 % ) , and foot screening , ( IC = 86 % ; AC = 72 % ) . Diabetes distress and treatment satisfaction also showed greater improvement for IC than AC ( P = .05 and P = .06 , respectively ) , with no differences for depression . The CDMP intervention was more effective than an attention control condition in helping patients meet evidence -based guidelines for diabetes care BACKGROUND Communication of blood glucose ( BG ) results between patients and health care providers ( HCPs ) is of established benefit and remains a critical part of the diabetes management process . Currently , HCPs typically receive BG data from patients at the time of clinic visits or by telephone . The Accu-Chek Acculink modem ( Roche Diagnostics Corp. , Indianapolis , IN ) provides an additional and attractive option that can potentially facilitate this communication . METHODS To assess the impact of modem transfer of BG , we studied 47 participants with diabetes enrolled in a diabetes education program . Subjects were r and omized to weekly communication of BG data to their HCP by either telephone ( n = 23 ) or modem ( n = 24 ) for 4 weeks . Mean age ( + /- SD ) was 44 + /- 15 years , 62 % were female , 74 % used insulin , 53 % had type 1 diabetes , and mean baseline glycosylated hemoglobin ( A1C ) was 8.8 % ( range 5.2 - 13.2 % ) . RESULTS There were no differences between groups in the amount of time the HCP spent analyzing BG data and communicating with patients ( 12.6 + /- 6.1 min/week in the telephone group and 11.5 + /- 5.1 min/week in the modem group ) or in the number of patient and HCP attempts needed to make contact . There were similar improvements in A1C between groups ( change of -0.4 + /- 0.7 % in the telephone group and -0.9 + /- 1.4 % in the modem group , P = 0.18 ) . BG data provided by telephone had a 6 % error rate , in contrast to modem-sent data , which were transmitted without error . CONCLUSIONS Modem transfer of BG data can provide an accurate and clinical ly useful option for communication between patients and their HCP and has comparable effects on A1C Numerous diabetes-management systems and programs for improving glycemic control to meet guideline targets have been proposed , using IT technology . But all of them allow only limited-or no-real-time interaction between patients and the system in terms of system response to patient input ; few studies have effectively assessed the systems ' usability and feasibility to determine how well patients underst and and can adopt the technology involved . DialBetics is composed of 4 modules : ( 1 ) data transmission module , ( 2 ) evaluation module , ( 3 ) communication module , and ( 4 ) dietary evaluation module . A 3-month r and omized study was design ed to assess the safety and usability of a remote health- data monitoring system , and especially its impact on modifying patient lifestyles to improve diabetes self-management and , thus , clinical outcomes .  Fifty-four type 2 diabetes patients were r and omly divided into 2 groups , 27 in the DialBetics group and 27 in the non-DialBetics control group .  HbA1c and fasting blood sugar ( FBS ) values declined significantly in the DialBetics group : HbA1c decreased an average of 0.4 % ( from 7.1 ± 1.0 % to 6.7 ± 0.7 % ) compared with an average increase of 0.1 % in the non-DialBetics group ( from 7.0 ± 0.9 % to 7.1 ± 1.1 % ) ( P = .015 ) ; The DialBetics group FBS decreased an average of 5.5 mg/dl compared with a non-DialBetics group average increase of 16.9 mg/dl ( P = .019 ) . BMI improvement-although not statistically significant because of the small sample size-was greater in the DialBetics group . DialBetics was shown to be a feasible and an effective tool for improving HbA1c by providing patients with real-time support based on their measurements and inputs OBJECTIVE Widespread use of carbohydrate counting is limited by its complex education . In this study we compared a Diabetes Interactive Diary ( DID ) with st and ard carbohydrate counting in terms of metabolic and weight control , time required for education , quality of life , and treatment satisfaction . RESEARCH DESIGN AND METHODS Adults with type 1 diabetes were r and omly assigned to DID ( group A , n = 67 ) or st and ard education ( group B , n = 63 ) and followed for 6 months . A subgroup also completed the  SF-36 Health Survey ( SF-36 ) and World Health Organization-Diabetes Treatment Satisfaction Question naire ( WHO-DTSQ ) at each visit . RESULTS Of 130 patients ( aged 35.7 ± 9.4 years ; diabetes duration 16.5 ± 10.5 years ) , 11 dropped out .  Time for education was 6 h ( range 2–15 h ) in group A and 12 h ( 2.5–25 h ) in group B ( P = 0.07 ) . A1C reduction was similar in both groups ( group A from 8.2 ± 0.8 to 7.8 ± 0.8 % and group B from 8.4 ± 0.7 to 7.9 ± 1.1 % ; P = 0.68 ) . Nonsignificant differences in favor of group A were documented for fasting blood glucose and body weight . No severe hypoglycemic episode occurred . WHO-DTSQ scores increased significantly more in group A ( from 26.7 ± 4.4 to 30.3 ± 4.5 ) than in group B ( from 27.5 ± 4.8 to 28.6 ± 5.1 ) ( P = 0.04 ) . Role Physical , General Health , Vitality , and Role Emotional SF-36 scores improved significantly more in group A than in group B. CONCLUSIONS DID is at least as effective as traditional carbohydrate counting education , allowing dietary freedom for a larger proportion of type 1 diabetic patients . DID is safe , requires less time for education , and is associated with lower weight gain . DID significantly improved treatment satisfaction and several quality -of-life dimensions BACKGROUND Lifestyle changes soon after diagnosis might improve outcomes in patients with type 2 diabetes mellitus , but no large trials have compared interventions . We investigated the effects of diet and physical activity on blood pressure and glucose concentrations . METHODS We did a r and omised , controlled trial in southwest Engl and in adults aged 30 - 80 years in whom type 2 diabetes had been diagnosed 5 - 8 months previously . Participants were assigned usual care ( initial dietary consultation and follow-up every 6 months ; control group ) , an intensive diet intervention ( dietary consultation every 3 months with monthly nurse support ) , or the latter plus a pedometer-based activity programme , in a 2:5:5 ratio . The primary endpoint was improvement in glycated haemoglobin A(1c)(HbA(1c ) ) concentration and blood pressure at 6 months . Analysis was done by intention to treat . This study is registered , number IS RCT N92162869 . FINDINGS Of 593 eligible individuals , 99 were assigned usual care , 248 the diet regimen , and 246 diet plus activity . Outcome data were available for 587 ( 99 % ) and 579 ( 98 % ) participants at 6 and 12 months , respectively . At 6 months , glycaemic control had worsened in the control group ( mean baseline HbA(1c ) percentage 6·72 , SD 1·02 , and at 6 months 6·86 , 1·02 ) but improved in the diet group ( baseline-adjusted difference in percentage of HbA(1c ) -0·28 % , 95 % CI -0·46 to -0·10 ; p=0·005 ) and diet plus activity group ( -0·33 % , -0·51 to -0·14 ; p<0·001 ) . These differences persisted to 12 months , despite less use of diabetes drugs . Improvements were also seen in bodyweight and insulin resistance between the intervention and control groups . Blood pressure was similar in all groups . INTERPRETATION An intensive diet intervention soon after diagnosis can improve glycaemic control . The addition of an activity intervention conferred no additional benefit . FUNDING Diabetes UK and the UK Department of Health Background Telephone-based care management programmes have been shown to improve health outcomes in some chronic diseases . Birmingham Own Health ® is a telephone-based care service ( nurse-delivered motivational coaching and support for self-management and lifestyle change ) for patients with poorly controlled diabetes , delivered in Birmingham , UK . We used a novel method to evaluate its effectiveness in a real-life setting . Methods Retrospective cohort study in the UK . 473 patients aged ≥ 18 years with diabetes enrolled onto Birmingham Own Health ® ( intervention cohort ) and with > 90 days follow-up , were each matched by age and sex to up to 50 patients with diabetes registered with the General Practice Research Data base ( GPRD ) to create a pool of 21,052 controls ( control cohort ) . Controls were further selected from the main control cohort , matching as close as possible to the cases for baseline test levels , followed by as close as possible length of follow-up ( within + /-30 days limits ) and within + /-90 days baseline test date . The aim was to identify a control group with as similar distribution of prognostic factors to the cases as possible . Effect sizes were computed using linear regression analysis adjusting for age , sex , deprivation quintile , length of follow-up and baseline test levels . Results After adjusting for baseline values and other potential confounders , the intervention showed significant mean reductions among people with diabetes of 0.3 % ( 95%CI 0.1 , 0.4 % ) in HbA1c ; 3.5 mmHg ( 1.5 , 5.5 ) in systolic blood pressure , 1.6 mmHg ( 0.4 , 2.7 ) in diastolic blood pressure and 0.7 unit reduction ( 0.3 , 1.0 ) in BMI , over a mean follow-up of around 10 months . Only small effects were seen on average on serum cholesterol levels ( 0.1 mmol/l reduction ( 0.1 , 0.2 ) ) . More marked effects were seen for each clinical outcome among patients with worse baseline levels . Conclusions Despite the limitations of the study design , the results are consistent with the Birmingham Own Health ® telephone care management intervention being effective in reducing HbA1c levels , blood pressure and BMI in people with diabetes , to a degree comparable with r and omised controlled trials of similar interventions and clinical ly important . The effects appear to be greater in patients with poorer baseline levels and the intervention is effective in the most deprived population OBJECTIVE To conduct a 1-year r and omized clinical trial to evaluate a remote comprehensive diabetes self-management education ( DSME ) intervention , Diabetes TeleCare , administered by a dietitian and nurse/certified diabetes educator ( CDE ) in the setting of a federally qualified health center ( FQHC ) in rural South Carolina . RESEARCH DESIGN AND METHODS Participants were recruited from three member health centers of an FQHC and were r and omized to either Diabetes TeleCare , a 12-month , 13-session curriculum delivered using telehealth strategies , or usual care .  RESULTS Mixed linear regression model results for repeated measures showed a significant reduction in glycated hemoglobin ( GHb ) in the Diabetes TeleCare group from baseline to 6 and 12 months ( 9.4 ± 0.3 , 8.3 ± 0.3 , and 8.2 ± 0.4 , respectively ) compared with usual care ( 8.8 ± 0.3 , 8.6 ± 0.3 , and 8.6 ± 0.3 , respectively ) . LDL cholesterol was reduced at 12 months in the Diabetes TeleCare group compared with usual care . Although not part of the original study design , GHb was reduced from baseline to 12 and 24 months in the Diabetes TeleCare group ( 9.2 ± 0.4 , 7.4 ± 0.5 , and 7.6 ± 0.5 , respectively ) compared with usual care ( 8.7 ± 0.4 , 8.1 ± 0.4 , and 8.1 ± 0.5 , respectively ) in a post hoc analysis of a subset of the r and omized sample who completed a 24-month follow-up visit . CONCLUSIONS Telehealth effectively created access to successfully conduct a 1-year remote DSME by a nurse CDE and dietitian that improved metabolic control and reduced cardiovascular risk in an ethnically diverse and rural population We conducted a 12-month prospect i ve interventional study of videoconferencing between primary and secondary care . A treatment network consisting of a diabetes specialist and four general practitioners was established . The communications medium was PC-based videoconferencing via ISDN at 128 kbit/s . A total of 154 type 2 diabetic patients entered the study . The specialist was contacted 94 times via videoconferencing .  Metabolic and haemodynamic parameters were significantly improved over the course of the study : the mean HbA1c level fell from 8.1 % to 7.8 % , systolic blood pressure from 156 to 148 mmHg and diastolic blood pressure from 88 to 83 mmHg . The study demonstrated that therapeutic counselling by videoconferencing is feasible in diabetes care and suggests that it reduces hospital admissions and improves the quality of care AIM To investigate the effectiveness of a nurse short message service ( SMS ) by cellular phone and wire Internet on plasma glucose levels in people with diabetes for six months . BACKGROUND Blood glucose management system using telemedicine approaches may maintain the appropriate blood glucose levels in type-2 diabetic patients . DESIGN A control group pre-test-post-test design was used to assess the effectiveness of nurse 's education . METHODS Twenty-five patients were r and omly assigned to an intervention group and 26 to a control group . The intervention was applied for six months . The goal of the intervention was to keep blood glucose concentrations close to the normal range . Participants were requested to input their  blood glucose level , diet and exercise diary everyday in the website by cellular phone or wire Internet . The research er sends optimal recommendations to each patient using SMS by cellular phone and wire Internet weekly . RESULTS Glycosylated hemoglobin ( HbA(1)c ) decreased 1.15 % points at three months and 1.05 % points at six months compared with baseline in the intervention group . Patients in the intervention group had a decrease of two hours post meal glucose ( 2HPMG ) of 85.1 mg/dl at three months and 63.1 mg/dl at six months compared with baseline . CONCLUSION This web-based intervention using SMS of cellular phone improved HbA(1)c and 2HPMG for six months in type-2 diabetic patients . RELEVANCE TO CLINICAL PRACTICE An SMS of cellular phone intervention by a nurse can reduce HbA(1)c and 2HPMG for six months in type-2 diabetic patients H istorically , nutrition principles and recommendations for diabetes and related complications have been based on scientific evidence and diabetes knowledge when available and , when evidence was not available , on clinical experience and expert consensus . Often it has been difficult to discern the level of evidence used to construct the nutrition principles and recommendations . Furthermore , in clinical practice , many nutrition recommendations that have no scientific supporting evidence have been and are still being given to individuals with diabetes . To address these problems and to incorporate the research done in the past 8 years , this 2002 technical review provides principles and recommendations classified according to the level of evidence available . It review s the evidence from r and omized , controlled trials ; cohort and case-controlled studies ; and observational studies , which can also provide valuable evidence ( 1,2 ) , and takes into account the number of studies that have provided consistent outcomes of support . In this review , nutrition principles are grade d into four categories based on the available evidence : those with strong supporting evidence , those with some supporting evidence , those with limited supporting evidence and those based on expert consensus . Evidence -based nutrition recommendations attempt to translate research data and clinical ly applicable evidence into nutrition care . However , the best available evidence must still be moderated by individual circumstances and preferences . The goal of evidence -based recommendations is to improve the quality of clinical judgments and facilitate costeffective care by increasing the awareness of clinicians and patients with diabetes of the evidence supporting nutrition services and the strength of that evidence , both in quality and quantity . Before 1994 , the American Diabetes Association ’s ( ADA ’s ) nutrition principles and recommendations attempted to define an “ ideal ” nutrition prescription that would apply to everyone with diabetes ( 3–5 ) . Although individualization was a major principle of all recommendations , it was usually done within defined limits for recommended energy intake and macronutrient composition . The 1994 nutrition recommendations shifted this focus to one that emphasized effects of  nutrition therapy  on metabolic control ( 6,7 ) . The nutrition prescription is determined considering treatment goals and lifestyle changes the diabetic patient is willing and able to make , rather than predetermined energy levels and percentages of carbohydrate , protein , and fat . The goal of nutrition intervention is to assist and facilitate individual lifestyle and behavior changes that will lead to improved metabolic control . This focus continues with the 2002 nutrition principles and recommendations . Medical nutrition therapy ( MNT ) is an integral component of diabetes management ( 8,9 ) and diabetes sel fmanagement education ( 10 ) . ( Medical nutrition therapy is the preferred term and should replace other terms , such as diet , diet therapy , and dietary management .  ) MNT for diabetes includes the process and the system by which nutrition care is provided for diabetic individuals and the specific lifestyle recommendations for that care . However , recommendations should not only be based on scientific evidence but should also take into consideration lifestyle changes the ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● AIMS We evaluate the efficacy of the " Active Body Control ( ABC ) Program " for weight reduction in patients with type 2 diabetes . METHODS The ABC program combines telemonitoring of the physical activity with a low-calorie diet also preferring carbohydrates with low glycemic indexes . In this 6-month , r and omized , clinical trial 35 patients ( aged 57 ± 9 years ; BMI = 35.3 ± 5.7 kg/m(2 ) ) were treated according to the ABC program and 35 control patients ( aged 58 ± 7 years ; BMI = 34.8 ± 5.9 kg/m(2 ) ) received st and ard therapy . RESULTS After 6 months the mean weight loss in the intervention group was 11.8 kg ± 8.0 kg . Glucose and HbA1c were lowered by respectively 1.0 mmol/l and 0.8 percentage points ( p=0.000 , respectively ) . The proportion of patients with HbA1c>7 % fell from 57 % to 26 % . Antidiabetic drugs were discontinued in 13 patients ( 39 % ) and reduced in 14 ( 42 % ) . The reduction of costs on medication per patient was € 83 in 6 months . In the control group , there were no relevant changes in body weight , laboratory values or drug treatment . CONCLUSIONS The ABC program  effectively lowers body weight , Hb1Ac and antidiabetic drug use in patients with type 2 diabetes OBJECTIVE To quantify total diabetes care received ( generalist or specialist ) from diagnosis onward and its association with the incidence of diabetes complications in a representative cohort of patients with type 1 diabetes . RESEARCH DESIGN AND METHODS A total of 429 subjects from the Pittsburgh Epidemiology of Diabetes Complications Study , a prospect i ve follow-up study of childhood-onset type 1 diabetic subjects first seen between 1986 and 1988 ( mean age 28 years , mean duration 19 years ) , followed biennially for up to 10 years were studied . Specialist care was defined as care received from a board-certified endocrinologist , diabetologist , or diabetes clinic and quantified as the percent of diabetes duration spent in specialist care . RESULTS There was a significant trend for a higher incidence of neuropathy , overt nephropathy , and coronary artery disease with lower use of specialist care . Multivariate analyses controlling for diabetes duration , demographic characteristics , health care practice s , and physiological risk factors demonstrated that higher past use of specialist care was found to be significantly protective against the development of overt nephropathy ( risk ratio 0.43 , 95 % CI 0.21 - 0.88 ) and neuropathy ( 0.54 , 0.35 - 0.83 ) and weakly protective against coronary artery disease ( 0.65 , 0.37 - 1.1 ) . CONCLUSIONS A higher proportion of diabetes duration spent in specialist care may result in delayed development of certain diabetes complications independent of other risk factors . This study thus supports the concept that the benefits of specialist care should be available to all patients with type 1 diabetes OBJECTIVE To evaluate an online disease management system supporting patients with uncontrolled type 2 diabetes . MATERIAL S AND METHODS Engaging and Motivating Patients Online With Enhanced Re sources for Diabetes was a 12-month parallel r and omized controlled trial of 415 patients with type 2 diabetes with baseline glycosylated hemoglobin ( A1C ) values ≥7.5 % from primary care sites sharing an electronic health record . The intervention included : ( 1 ) wirelessly uploaded home glucometer readings with graphical feedback ; ( 2 ) comprehensive patient-specific diabetes summary status report ; ( 3 ) nutrition and exercise logs ; ( 4 ) insulin record ; ( 5 ) online messaging with the patient 's health team ; ( 6 ) nurse care manager and dietitian providing advice and medication management ; and ( 7 ) personalized text and video educational ' nuggets ' dispensed electronically by the care team . A1C was the primary outcome variable . RESULTS Compared with usual care ( UC , n=189 ) , patients in the intervention ( INT , n=193 ) group had significantly reduced A1C at 6 months ( -1.32 % INT vs -0.66 % UC ; p<0.001 ) . At 12 months , the differences were not significant ( -1.14 % INT vs -0.95 % UC ; p=0.133 ) . In post hoc analysis , significantly more INT patients had improved diabetes control ( > 0.5 % reduction in A1C ) than UC patients at 12 months ( 69.9 ( 95 % CI 63.2 to 76.5 ) vs 55.4 ( 95 % CI 48.4 to 62.5 ) ; p=0.006 ) . CONCLUSIONS A nurse-led , multidisciplinary health team can manage a population of diabetic patients in an online disease management program . INT patients achieved greater decreases in A1C at 6 months than UC patients , but the differences were not sustained at 12 months . More INT than UC patients achieved improvement in A1C ( > 0.5 % decrease ) . Trial registered in clinical trials.gov : # NCT00542204 OBJECTIVE Despite the importance of self-management support ( SMS ) , few studies have compared SMS interventions , involved diverse population s , or entailed implementation in safety net setting s. We examined the effects of two SMS strategies across outcomes corresponding to the Chronic Care Model . RESEARCH DESIGN AND METHODS A total of 339 out patients with poorly controlled diabetes from county-run clinics were enrolled in a three-arm trial . Participants , more than half of whom spoke limited English , were uninsured , and /or had less than a high school education , were r and omly assigned to  usual care , interactive weekly automated telephone self-management support with nurse follow-up ( ATSM ) , or monthly group medical visits with physician and health educator facilitation ( GMV ) . We measured 1-year changes in structure ( Patient Assessment of Chronic Illness Care [ PACIC ] ) , communication processes ( Interpersonal Processes of Care [ IPC ] ) , and outcomes ( behavioral , functional , and metabolic ) . RESULTS Compared with the usual care group , the ATSM and GMV groups showed improvements in PACIC , with effect sizes of 0.48 and 0.50 , respectively ( P < 0.01 ) . Only the ATSM group showed improvements in IPC ( effect sizes 0.40 vs. usual care and 0.25 vs. GMV , P < 0.05 ) . Both SMS arms showed improvements in self-management behavior versus the usual care arm ( P < 0.05 ) , with gains being greater for the ATSM group than for the GMV group ( effect size 0.27 , P = 0.02 ) . The ATSM group had fewer bed days per month than the usual care group ( −1.7 days , P = 0.05 ) and the GMV group ( −2.3 days , P < 0.01 ) and less interference with daily activities than the usual care group ( odds ratio 0.37 , P = 0.02 ) . We observed no differences in A1C change . CONCLUSIONS Patient-centered SMS improves certain aspects of diabetes care and positively influences self-management behavior . ATSM seems to be a more effective communication vehicle than GMV in improving behavior and quality of life 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 r and omly 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 OBJECTIVE To determine whether diabetes education can be provided as effectively through telemedicine technology as through in-person encounters with diabetes nurse and nutrition educators . RESEARCH DESIGN AND METHODS A total of 56 adults with diabetes were r and omized to receive  diabetes education in person ( control group ) or via telemedicine ( telemedicine group ) and were followed prospect ively . The education consisted of three consultative visits with diabetes nurse and nutrition educators . The in-person and telemedicine groups were compared using measures of glycemic control ( HbA(1c ) ) and question naires to assess patient satisfaction and psychosocial functioning as related to diabetes . Outcome measures were obtained at baseline , immediately after the completion of diabetes education , and 3 months after the third educational visit . RESULTS Patient satisfaction was high in the telemedicine group . Problem Areas in Diabetes scale scores improved significantly with diabetes education ( adjusted P < 0.05 , before vs. immediately after education and 3 months after education ) , and the attainment of behavior-change goals did not differ between groups . With diabetes education , HbA(1c ) improved from 8.6 + /- 1.8 % at baseline to 7.8 + /- 1.5 % immediately after education and 7.8 + /- 1.8 % 3 months after the third educational visit ( unadjusted P < 0.001 , P = 0.089 adjusted for BMI and age ) , with similar changes observed in the telemedicine and in-person groups . CONCLUSIONS Diabetes education via telemedicine and in person was equally effective in improving glycemic control , and both methods were well accepted by patients . Reduced diabetes-related stress was observed in both groups . These data suggest that telemedicine can be successfully used to provide diabetes education to patients OBJECTIVE —To determine 1 ) whether participants in the Spanish Diabetes Self-Management Program ( SDSMP ) , when compared at 6 months to r and omized control subjects , would demonstrate improvements in health status , health behaviors , and self-efficacy ; and 2 ) whether SDSMP participants receiving monthly automated telephone reinforcement would maintain improvements at 18 months better than those not receiving reinforcement . RESEARCH DESIGN AND METHODS —A total of 567 Spanish-speaking adults with type 2 diabetes were r and omized to a usual-care control group or 6-week community-based , peer-led SDSMP . SDSMP participants were re-r and omized to receive 15 months of automated telephone messages or no reinforcement . A1C was measured at baseline and 6 and 18 months . All other data were collected by self-administered question naires . RESULTS —At 6 months SDSMP participants compared with control subjects demonstrated improvements in A1C ( −0.4 % ) , health distress , symptoms of hypo- and hyperglycemia , and self-efficacy ( P < 0.05 ) . At 18 months all improvements persisted ( P < 0.05 ) . SDSMP participants also demonstrated improvements in self-rated health and communication with physicians , had fewer emergency room visits ( −0.18 visits in 6 months , P < 0.05 ) , and trended toward fewer visits to physicians . At 18 months the only difference between reinforced and nonreinforced participants was increased glucose monitoring for the reinforcement group . CONCLUSIONS —The SDSMP  demonstrated effectiveness in lowering A1C and improving health status . Reinforcement did not add to its effectiveness . Given the high needs of the Spanish-speaking population , the SDSMP deserves consideration for implementation OBJECTIVE Investigate the effectiveness of an educational intervention that used both the cellular phone with a short messaging service ( SMS ) and the Internet on the glycemic control of the patients with type 2 diabetes mellitus . METHODS Twenty-five patients were r and omly assigned to an  intervention  group and twenty-six to a  control group . The intervention was applied for 12 months . The goal of the intervention was to keep blood glucose concentrations close to the normal range ( HbA(1)c<7 % ) . Patients in the intervention group were asked to access a website by using a cellular phone or to wiring the Internet and input their blood glucose levels weekly . Participants were sent the optimal recommendations by both cellular phone and the Internet weekly . RESULTS Participants in the intervention group had lower HbA(1)c over 12 months when compared with the control group . At 12 months the change from baseline in HbA(1)c was -1.32 in the intervention group versus + 0.81 in the control group . Two hours post-meal glucose ( 2HPMG ) had a significantly greater decline in the intervention group after 12 months when compared with the control group ( -100.0 versus + 18.1mg/dl ) . CONCLUSION This educational intervention using the Internet and a SMS by cellular phone rapidly improved and stably maintained the glycemic control of the patients with type 2 diabetes mellitus Objective To evaluate the effectiveness of goal focused telephone coaching by practice nurses  in improving glycaemic control in patients with type 2 diabetes in Australia . Design Prospect i ve , cluster r and omised controlled trial , with general practice s as the unit of r and omisation . Setting General practice s in Victoria , Australia . Participants 59 of 69 general practice s that agreed to participate recruited sufficient patients and were r and omised . Of 829 patients with type 2 diabetes ( glycated haemoglobin ( HbA1c ) > 7.5 % in the past 12 months ) who were assessed for eligibility , 473 ( 236 from 30 intervention practice s and 237 from 29 control practice s ) agreed to participate . Intervention Practice nurses from intervention practice s received two days of training in a telephone coaching programme , which aim ed to deliver eight telephone and one face to face coaching episodes per patient . Main outcome measures The primary end point was mean absolute change in HbA1c between baseline and 18 months in the intervention group compared with the control group . Results The intervention and control patients were similar at baseline . None of the practice s dropped out over the study period ; however , patient attrition rates were 5 % in each group ( 11/236 and 11/237 in the intervention and control group , respectively ) . The median number of coaching sessions received by the 236 intervention patients was 3 ( interquartile range 1 - 5 ) , of which 25 % ( 58/236 ) did not receive any coaching sessions . At 18 months ’ follow-up the effect on glycaemic control did not differ significantly ( mean difference 0.02 , 95 % confidence interval −0.20 to 0.24 , P=0.84 ) between the intervention and control groups , adjusted for HbA1c measured at baseline and the clustering . Other biochemical and clinical outcomes were similar in both groups . Conclusions A practice nurse led telephone coaching intervention implemented in the real world primary care setting produced comparable outcomes to usual primary care in Australia . The addition of a goal focused coaching role onto the ongoing generalist role of a practice nurse without prescribing rights was found to be ineffective . Trial registration Current Controlled Trials IS RCT N50662837 BACKGROUND Previous studies have provided limited guidance regarding the clinical efficacy and cost-effectiveness of interventions using " telemedicine " models in the management of diabetes mellitus . We conducted a study to determine if routine clinical assessment s of diabetes patients could be effectively conducted via computer and telephone interaction with patients and still provide clinical results similar to traditional office care . SUBJECTS AND METHODS We enrolled 100 subjects with diabetes in this 12-month , r and omized , controlled , non-inferiority study . Subjects were r and omized ( 1:1 ratio ) to a control group ( CG ) or study group ( SG ) . Baseline characteristics were similar . CG subjects participated in quarterly office visits ; SG subjects participated in two office visits ( months 6 and 12 ) and two telemedicine interactions ( months 3 and 9 ) . Changes in clinical measurements ( hemoglobin A1c [ HbA1c ] , blood pressure , lipids , body mass index [ BMI ] , and body weight ) and clinician time requirements were assessed . RESULTS Seventy subjects completed the study ( CG , n=37 ; SG , n=33 ) . No significant between-group differences in HbA1c , blood pressure , lipids , or BMI were seen at 12 months . SG subjects showed significantly greater reductions in mean ( SD ) body weight compared with CG subjects : -5.2 ( 1.6 ) pounds versus -0.7 ( 1.5 ) pounds , respectively ( P=0.04 ) . Clinician time requirements for SG subjects were reduced by > 40 % . CONCLUSIONS Our study demonstrated that use of a telemedicine-based treatment protocol in diabetes patients is feasible and efficient and yields similar clinical outcomes compared with traditional , clinic-based protocol s. Telemedicine applications of computer software can potentially exp and access to care for patients and may reduce costs for patients , providers , and payers BACKGROUND Real-time continuous glucose monitoring ( CGM ) has recently been incorporated into routine diabetes management because of the potential advantages it offers for glycemic control . The aim of our study was to evaluate the impact of the use of real-time CGM together with a telemedicine system in hemoglobin A1c and glucose variability in patients with type 1 diabetes treated with insulin pumps . METHODS Ten patients ( five women , 41.2 [ range , 21 - 62 ] years old , duration of diabetes 14.9 [ range , 3 - 52 ] years ) were included in this r and omized crossover study . Patients used the DIABTel telemedicine system throughout the study , and real-time CGM was used for 3 days every week during the intervention phase . At the end of the control phase , a blind 3-day CGM was performed . Glucose variability was evaluated using the Glucose Risk Index ( GRI ) , a comparative analysis of continuous glucose values over two consecutive hours . RESULTS Hemoglobin A1c decreased significantly ( 8.1 + /- 1.1 % vs. 7.3 + /- 0.8 % ; P = 0.007 ) after the intervention phase , while no changes were observed during the control phase . The mean number of daily capillary glucose readings was higher during the intervention phase ( 4.7 + /- 1.1 vs. 3.8 + /- 1.0 ; P < 0.01 ) , because of an increase in r and om analyses ( 1.22 + /- 0.3 vs. 0.58 + /- 0.1 ; P < 0.01 ) , and there was also a significant increase in the mean number of bolus doses per day ( 5.23 + /- 1.1 vs. 4.4 + /- 0.8 ; P < 0.05 ) . The GRI was higher during the control phase than during the experimental phase ( 9.6 vs. 6.25 ; P < 0.05 ) . CONCLUSIONS Real-time CGM in conjunction with the DIABTel system improves glycemic control and glucose stability in pump-treated patients with type 1 diabetes A total of 175 patients with Types 1 and 2 diabetes in primary care and university hospital outpatient departments were r and omized into a study group ( n = 101 ) or usual care ( n = 74 ) . The study group used an e-health application with a diabetes management system and a home care link . Usual care did not involve e-health , i.e. the patients made regular general practitioner visits about every three months . After 12 months HbA1c decreased significantly in both groups of patients . The differences were small , but HbA1c was significantly lower in the study group than the controls . Diastolic blood pressure , fasting plasma glucose , serum total cholesterol , serum LDL-cholesterol and serum triglycerides were significantly lower in the study than in the control group . This was achieved with fewer visits by study patients to doctors and nurses . Use of e-health in diabetes care for 12 months was able to provide equivalent diabetic control to usual care , and improved cardiovascular risk factors ABSTRACT BACKGROUND We compared two implementation approaches for a health literacy diabetes intervention design ed for community health centers . METHODS A quasi-experimental , clinic-r and omized evaluation was conducted at six community health centers from rural , suburban , and urban locations in Missouri between August 2008 and January 2010 . In all , 486 adult patients with type 2 diabetes mellitus participated . Clinics were set up to implement either : 1 ) a clinic-based approach that involved practice re- design to routinely provide brief diabetes education and counseling services , set action-plans , and perform follow-up without additional financial re sources [ CARVE-IN ] ; or 2 ) an out source d approach where clinics referred patients to a telephone-based diabetes educator for the same services [ CARVE-OUT ] . The fidelity of each intervention was determined by the number of contacts with patients , self-report of services received , and patient satisfaction . Intervention effectiveness was investigated by assessing patient knowledge , self-efficacy , health behaviors , and clinical outcomes . RESULTS Carve-out patients received on average 4.3 contacts ( SD = 2.2 ) from the telephone-based diabetes educator versus 1.7 contacts ( SD = 2.0 ) from the clinic nurse in the carve-in arm ( p < 0.001 ) . They were also more likely to recall setting action plans and rated the process more positively than carve-in patients ( p < 0.001 ) . Few differences in diabetes knowledge , self-efficacy , or health behaviors were found between the two approaches . However , clinical outcomes did vary in multivariable analyses ; carve-out patients had a lower HbA1c ( β = −0.31 , 95 % CI −0.56 to −0.06 , p = 0.02 ) , systolic blood pressure ( β = −3.65 , 95 % CI −6.39 to −0.90 , p = 0.01 ) , and low-density lipoprotein ( LDL ) cholesterol ( β = −7.96 , 95 % CI −10.08 to −5.83 , p < 0.001 ) at 6 months . CONCLUSION An out source d diabetes education and counseling approach for community health centers appears more feasible than clinic-based models . Patients receiving the  carve-out  strategy also demonstrated better clinical outcomes compared to those receiving the carve-in approach . Study limitations and unclear causal mechanisms explaining change in patient behavior suggest that further research is needed PURPOSE The present study evaluated whether an intervention using the SMS by personal cellular phone and internet would improve the levels of plasma glucose of obese type 2 diabetes at 3 , 6 , 9 , and 12 months . METHODS This is a quasi-experimental design with pre- and follow-up tests . Participants were recruited from the endocrinology outpatient department of tertiary care hospital located in an urban city of South Korea . Eighteen patients were r and omly assigned to an intervention group and 16 to a control group . The goal of the intervention was to decrease body weight and keep blood glucose concentrations close to the normal range . Patients were requested to record their blood glucose level  in a weekly diary on the website by personal cellular phones or computer internet . The research er sent optimal recommendations to each patient , by both the cellular phone and the Internet weekly . The intervention was applied for 1 year . RESULTS Glycosylated hemoglobin ( HbA(1)c ) decreased 1.22 percentage points at 3 months , 1.09 percentage points at 6 months , 1.47 percentage points at 9 months , and 1.49 percentage points at 12 months compared with baseline in the intervention group ( all time points , p<0.05 ) . The percentage change in the control group was , however , not significant . Patients in the intervention group had a decrease of 2-h post-pr and ial test ( 2HPPT ) of 120.1mg/dl at 3 months , 58.9 mg/dl at 6 months , 62.0mg/dl at 9 months , and 102.9 mg/dl at 12 months compared with baseline ( all time points , p<0.05 ) . The mean change in the control group was , however , not significant . CONCLUSION This web-based intervention using SMS of personal cellular phone and Internet improved HbA(1)c and 2HPPT at 3 , 6 , 9 , and 12 months in patients with obese type 2 diabetes Objective To compare the American Diabetes Association st and ards for the medical care of diabetic patients with reported care patterns . Research Design and Methods These st and ards were compared with reported care patterns obtained from a stratified r and om telephone survey of general practitioners , family physicians , and general internists in Pennsylvania . A total of 610 physicians completed the survey for a response rate of 73 % . Results All primary -care physicians reported measurement of glycosylated hemoglobin , routine referrals to eye doctors , and patient self-monitoring of blood glucose < recommended . Nearly all physicians performed foot exams , but the exams were infrequent for many of the physicians . Significant and independent differences ( P < 0.05 ) were noted between different groups of physicians . Older physicians and general practitioners reported patterns of care most different from the recommended st and ards for referral to eye doctors , measurement of glycosylated hemoglobin , and use of patient self-monitoring of blood glucose . General practitioners reported the lowest frequency of foot exams . Conclusions Educational programs on diabetes for primary -care physicians should focus on reported behaviors most different from recommended st and ards and may need to target subgroups of physicians to achieve a more uniform level of care for all diabetic patients OBJECTIVE To determine whether a system of telemedicine support can improve glycemic control in type 1 diabetes . RESEARCH DESIGN AND METHODS A 9-month r and omized trial compared glucose self-monitoring real-time result transmission and feedback of results for the previous 24 h in the control group with real-time graphical phone-based feedback for the previous 2 weeks together with nurse-initiated support using a web-based graphical analysis of glucose self-monitoring results in the intervention group .  All patients aged 18 - 30 years with HbA(1c ) ( A1C ) levels of 8 - 11 % were eligible for inclusion . RESULTS A total of 93 patients ( 55 men ) with mean diabetes duration ( means + /- SD ) 12.1 + /- 6.7 years were recruited from a young adult clinic . In total , the intervention and control groups transmitted 29,765 and 21,400 results , respectively . The corresponding median blood glucose levels were 8.9 mmol/l ( interquartile range 5.4 - 13.5 ) and 10.3 mmol/l ( 6.5 - 14.4 ) ( P < 0.0001 ) . There was a reduction in A1C in the intervention group after 9 months from 9.2 + /- 1.1 to 8.6 + /- 1.4 % ( difference 0.6 % [ 95 % CI 0.3 - 1.0 ] ) and a reduction in A1C in the control group from 9.3 + /- 1.5 to 8.9 + /- 1.4 % ( difference 0.4 % [ 0.03 - 0.7 ] ) . This difference in change in A1C between groups was not statistically significant ( 0.2 % [ -0.2 to 0.7 , P = 0.3 ) . CONCLUSIONS Real-time telemedicine transmission and feedback of information about blood glucose results with nurse support is feasible and acceptable to patients , but to significantly improve glycemic control , access to real-time decision support for medication dosing and changes in diet and exercise may be required BACKGROUND Obesity and its cardiovascular complications are extremely common medical problems , but evidence on how to accomplish weight loss in clinical practice is sparse . METHODS We conducted a r and omized , controlled trial to examine the effects of two behavioral weight-loss interventions in 415 obese patients with at least one cardiovascular risk factor . Participants were recruited from six primary care practice s ; 63.6 % were women , 41.0 % were black , and the mean age was 54.0 years . One intervention provided patients with weight-loss support remotely -- through the telephone , a study -specific Web site , and e-mail . The other intervention provided in-person support during group and individual sessions , along with the three remote means of support . There was also a control group in which weight loss was self-directed . Outcomes were compared between each intervention group and the control group and between the two intervention groups . For both interventions , primary care providers reinforced participation at routinely scheduled visits . The trial duration was 24 months . RESULTS At baseline , the mean body-mass index ( the weight in kilograms divided by the square of the height in meters ) for all participants was 36.6 , and the mean weight was 103.8 kg . At 24 months , the mean change in weight from baseline was -0.8 kg in the control group , -4.6 kg in the group receiving remote support only ( P<0.001 for the comparison with the control group ) , and -5.1 kg in the group receiving in-person support ( P<0.001 for the comparison with the control group ) . The percentage of participants who lost 5 % or more of their initial weight was 18.8 % in the control group , 38.2 % in the group receiving remote support only , and 41.4 % in the group receiving in-person support . The change in weight from baseline did not differ significantly between the two intervention groups . CONCLUSIONS In two behavioral interventions , one delivered with in-person support and the other delivered remotely , without face-to-face contact between participants and weight-loss coaches , obese patients achieved and sustained clinical ly significant weight loss over a period of 24 months . ( Funded by the National Heart , Lung , and Blood Institute and others ; Clinical Trials.gov number , NCT00783315 . ) AIM To evaluate the effectiveness and feasibility of reinforced follow-up via telecare mediated by the local pharmacist in contact with the hospital team to improve glycaemic control in children and adolescents with type 1 diabetes ( DT1 ) . METHODS One hundred patients , aged 8 to 17 years , with a history of DT1 of more than 1 year , with HbA(1c ) > = 8 % , were r and omly assigned to either the " reinforced follow-up " group ( RFG ) or the " usual follow-up " group ( UFG ) . The intervention consisted in downloading and then printing data stored in a glucometer every two weeks , by the local pharmacist . Printouts were faxed to the hospital team which then communicated adapted instructions for better glycemic control directly to the family . RESULTS Fifty patients were assigned to each group . The two groups were comparable at the beginning . 71 children had a doctor 's visit at 6 + /- 1 months ( 36 in RFG and 35 in UFG ) . At this date , there was no significant difference between the average HbA(1c ) levels of the two groups ( 9.12 + /- 1.46 in RFG versus 9.27 + /- 1.20 in UFG ) . We had various difficulties setting up and gaining compliance with the intervention procedure , which explains why only 33 children in the RFG transmitted at least one fax . CONCLUSION At this stage , the reinforced follow-up has not proved to be superior to the usual follow-up . However , it would be possible to make numerous improvements in order to make the former more feasible and probably more efficient Background : This study examined whether mobile phone-based , one-way video messages about diabetes self-care improve hemoglobin A1c ( A1C ) and self-monitoring of blood glucose ( SMBG ) . Methods : This was a 1-year prospect i ve r and omized trial with two groups . The active intervention lasted 6 months . The study enrolled 65 people with A1C > 8.0 % who were established ( > 6 months ) patients in the endocrinology clinics of the Walter Reed Health Care System . Participants were r and omized to receive “ usual care ” or self-care video messages from their diabetes nurse practitioner . Video messages were sent daily to cell phones of study participants . Hemoglobin A1c and SMBG data were collected at 0 , 3 , 6 , 9 , and 12 months . Results : Participants who received the messages had a larger rate of decline in A1C than people who received usual care ( 0.2 % difference over 12 months , adjusting for covariates ; p = .002 and p = .004 for the interaction between time and group and for the quadratic effect of time by group , respectively ) . Hemoglobin A1c decline was greatest among participants who received video messages and viewed > 10 a month ( 0.6 % difference over 12 months , adjusting for covariates ; p < .001 for the interaction between time and group and the quadratic effect ) . Self-monitoring of blood glucose metrics were not related to the intervention . Conclusions : A one-way intervention using mobile phone-based video messages about diabetes self-care can improve A1C . Engagement with the technology is an important predictor of its success . This intervention is simple to implement and sustain AIM Conventional follow-up of type 1 diabetic patients treated with continuous subcutaneous insulin infusion ( CSII ) was compared with intensive coaching using the Web and the cellular phone network for retrospective data transmission and short message service ( SMS ) . METHODS Thirty poorly controlled patients ( HbA1c 7.5 - 10 % ) were enrolled in a bicenter , open-label , r and omized , 12-month , two-period , crossover study . After a 1-month run-in period , 15 patients were r and omly assigned to receive weekly medical support through SMS based upon weekly review of glucose values , while 15 patients continued to download self-monitored blood glucose ( SMBG ) values on a weekly basis without receiving SMS . After 6 months , patients crossed over to the alternate sequence for 6 additional months . Visits at the clinic were maintained every 3 months . RESULTS Patients with long-st and ing inadequately controlled diabetes ( 24 + /- 13 years ) were included . A non-significant trend to reduction in HbA(1c ) ( -0.25+/-0.94 % , P<0.10 ) and mean glucose values ( -9.2+/-25 mg/dl , P=0.06 ) during the 6-month SMS sequence was observed as compared with the no-SMS period . No safety issue ( hypoglycemia , glucose variability ) was reported . Adherence to SMBG was not affected by the trial . Quality of life analysis suggests a significant improvement in DQOL global score , as well as the DQOL satisfaction with life subscale , during the SMS sequence . CONCLUSIONS Long-term telemedical follow-up of insulin pump-treated patients using a cellular phone- , SMS- and Web-based platform is feasible , safe , does not alter quality of life and associated with a trend toward improved metabolic control PURPOSE The purpose of this study was to investigate the effectiveness of an educational intervention that used both cellular phones and the Internet to provide a short messaging service ( SMS ) relating to blood glucose , blood pressure , and serum lipid levels in postmenopausal women with impaired fasting glucose ( IFG ) . METHODS Twenty-eight postmenopausal women were assigned to an intervention group and twenty-one postmenopausal women to a control group . The intervention was provided for 12 weeks . Patients in the intervention group were asked to access a web site by using a cellular phone or to use the Internet directly and input their blood glucose and blood pressure levels weekly . Participants were sent the optimal recommendations weekly by both cellular phone and Internet . RESULTS The intervention group had a mean decrease in systolic blood pressure ( SBP ) level of 8.1 mmHg but changes for the control group were not significant . There was a significant mean change in diastolic blood pressure ( DBP ) level for the intervention group ( -7.7 mmHg ) . The mean change in the control group was not significant . CONCLUSION This educational intervention using the Internet and a SMS by cellular phone improved levels of SBP and DBP in postmenopausal women with IFG OBJECTIVE To assess the effect of medical nutrition therapy ( MNT ) provided by dietitians on medical and clinical outcomes for adults with non-insulin-dependent diabetes mellitus ( NIDDM ) , and to compare MNT administered according to practice guidelines nutrition care ( PGC ) to MNT administered with basic nutrition care ( BC ) . DESIGN A prospect i ve , r and omized , controlled clinical trial of two levels of MNT on metabolic control in persons newly diagnosed with or currently under treatment for NIDDM was conducted at diabetes centers in three states ( Minnesota , Florida , and Colorado ) .  BC consisted of a single visit with a dietitian ; PGC involved an initial visit with a dietitian followed by two visits during the first 6 weeks of the study period . Data were collected at entry to the study and at 3 and 6 months . SUBJECTS Results are reported for 179 men and women aged 38 to 76 years : 85 assigned r and omly to BC and 94 to PGC . This represents 72 % of the 247 subjects enrolled . An additional 62 adults with NIDDM at one site who had no contact with a dietitian were identified as a nonr and om comparison group . OUTCOMES Medical outcome measures included fasting plasma glucose ( FPG ) , glycated hemoglobin ( HbA1c ) , and serum lipid levels . Clinical outcomes included weight , body mass index , waist-to-hip ratio , and changes in medical therapy . STATISTICAL ANALYSES Initial analysis of the discrete variables was done using the chi 2 statistic with Yates ' correction . Initial analysis of continuous variables was done by analysis of variance . The changes in variables between time periods were analyzed by paired t test , and comparisons between groups were analyzed using a t test for independent groups . RESULTS At 6 months , PGC result ed in significant improvements in blood glucose control as indicated by FPG and HbA1c levels and BC result ed in significant improvements in HbA1c level . Participants assigned to the PGC group had a mean FPG level at 6 months that was 10.5 % lower than the level at entry , and those in the BC group had a 5.3 % lower value . Among subjects who had diabetes for longer than 6 months , those who received PGC had a significantly better HbA1c level at 3 months compared with those receiving BC . The comparison group showed no improvement in glycemic control over a comparable 6 months . PGC subjects had significant improvements in cholesterol values at 6 months , and subjects in both the PGC and the BC groups had significant weight loss . CONCLUSIONS MNT provided by dietitians result ed in significant improvements in medical and clinical outcomes in both the BC and PGC groups and is beneficial to persons with NIDDM . Persons with a duration of diabetes longer than 6 months tended to do better with PGC than with BC . Because of the upward trend in glucose levels after 3 months , ongoing MNT by dietitians is important for long-term metabolic control BACKGROUND We undertook a feasibility study to evaluate feasibility and utility of short message services ( SMSs ) to support Iraqi adults with newly diagnosed type 2 diabetes . SUBJECTS AND METHODS Fifty patients from a teaching hospital clinic in Basrah in the first year after diagnosis were recruited to receive weekly SMSs relating to diabetes self-management  over 29 weeks . Numbers of messages received , acceptability , cost , effect on glycated hemoglobin ( HbA1c ) , and diabetes knowledge were documented . RESULTS Forty-two patients completed the study , receiving an average 22 of 28 messages . Mean knowledge score rose from 8.6 ( SD 1.5 ) at baseline to 9.9 ( SD 1.4 ) 6 months after receipt of SMSs ( P=0.002 ) . Baseline and 6-month knowledge scores correlated ( r=0.297 , P=0.049 ) . Mean baseline HbA1c was 79 mmol/mol ( SD 14 mmol/mol ) ( 9.3 % [ SD 1.3 % ] ) and decreased to 70 mmol/mol ( SD 13 mmol/mol ) ( 8.6 % [ SD 1.2 % ] ) ( P=0.001 ) 6 months after the SMS intervention . Baseline and 6-month values were correlated ( r=0.898 , P=0.001 ) . Age , gender , and educational level showed no association with changes in HbA1c or knowledge score . Changes in knowledge score were correlated with postintervention HbA1c ( r=-0.341 , P=0.027 ) . All patients were satisfied with text messages and wished the service to be continued after the study . The cost of SMSs was € 0.065 per message . CONCLUSIONS This study demonstrates SMSs are acceptable , cost-effective , and feasible in supporting diabetes care in the challenging , re source -poor environment of modern-day Iraq . This study is the first in Iraq to demonstrate similar benefits of this technology on diabetes education and management to those seen from its use in better-re source d parts of the world . A r and omized controlled trial is needed to assess precise benefits on self-care and knowledge RATIONALE , AIMS AND OBJECTIVES Utilizing information technology , such as Internet and cellphones , holds great promise in enhancing diabetic care . Yet few studies have examined the impact of cellphone technology on type 2 diabetics ' self-care . The primary aim of the study is to examine the feasibility of utilizing this technology to assist with diabetes self-care in a clinic population as well as its impact on clinical outcomes . METHODS Thirty patients with a diagnosis of type 2 diabetes at two Community Health Centers were r and omized to intervention or control . Intervention patients participated in a brief intervention and received tailored daily messages via cellphone prompting them to enhance their diabetic self-care behaviour .  Patients at the control site continued with their st and ard diabetes self-management .  RESULTS A mean improvement in HbA1c levels was apparent ( -0.1 , SD = 0.3 % ; P = 0.1534 ) in the intervention group , compared with a mean deterioration in the control ( 0.3 , SD = 1.0 % ; P = 0.3813 ) , yet without statistical significance . Self-efficacy scores improved significantly in the intervention group ( -0.5 , SD = 0.6 ; P = 0.0080 ) compared with no improvement in the control ( 0.0 , SD = 1.0 ; P = 0.9060 ) . Participants encountered numerous technological barriers when attempting to adhere to the intervention protocol . CONCLUSION The results indicate the intervention had a positive impact on some clinical outcome and self-efficacy . Although the technology appears feasible in a clinical setting technology must be made more user-friendly before a larger phase II trial is conducted OBJECTIVE To determine if scheduled telephone calls from a pediatric diabetes educator to children who have type 1 diabetes improve hemoglobin A1c ( HbA1c ) level , hospital admissions , diabetes knowledge , compliance , and psychological well-being . RESEARCH DESIGN AND METHODS A r and omized controlled trial of 123 young subjects ( mean age 11.9 yr , 69 male ) with type 1 diabetes ( mean duration 3.65 yr ) . For 7 months , the intervention group held bimonthly 15 - 30 min scheduled supportive telephone discussion s. The primary outcome was change in the HbA1c level . Admission rates and changes in diabetes knowledge , psychological parameters , compliance , and patient perception were measured . RESULTS There was no significant difference between the treatment and control groups either before or after the intervention . The mean HbA1c level in the control group increased from 8.32 to 8.82 % and in the intervention group from 8.15 to 8.85 % ( p = 0.24 ) . Both groups showed an increase in admissions of 0.2 per yr ( p = 0.57 ) . There was no improvement in diabetes knowledge ( p = 0.34 ) , compliance , or psychological function . The intervention group viewed their contact with the clinic as more helpful ( p = 0.003 ) . Analysis of family function did not reveal subgroups with statistically significant differences . A mean of 13 calls was made to each subject at a cost of 36 Australian dollars per child per month . CONCLUSIONS Scheduled bimonthly phone support does not improve the HbA1c level , admission rates , diabetes knowledge , psychological function , or self-management but is perceived by patients as helpful . Further study into the effects of more frequent but shorter periods of support for patients experiencing specific difficulties is needed Patients with Type 2 ( non-insulin-dependent ) diabetes mellitus ( DM ) on sulphonylurea therapy convert to insulin progressively as the sulphonylureas ' fail ' . The rate of failure and the features of those who fail have been poorly described . To assess secondary failure rates of sulphonylureas , we report on the responses in 1305 patients with newly diagnosed Type 2 DM r and omly allocated to therapy with either chlorpropamide or glibenclamide in the UK Prospect i ve Diabetes Study ( UKPDS ) . These patients were initially treated by diet for 3 months and had a fasting plasma glucose > 6 mmol l(-1 ) ; mean age 53 ( SD 9 ) years ; BMI 26.8 ( SD 5.0 ) kg m(-2 ) ; and median fasting plasma glucose 9.1 ( 7.6 - 12.5 quartiles ) mmol l(-1 ) . If their fasting plasma glucose subsequently rose above 15.0 mmol l(-1 ) , or they developed hyperglycaemic symptoms , additional hypoglycaemic therapy was given : metformin , ultratard insulin , and soluble insulin as required . By 6 years , 44 % had required additional therapy . Of those r and omized to glibenclamide , 48 % required additional therapy by 6 years , compared with 40 % of those allocated to chlorpropamide ( p < 0.01 ) . Sixty-one per cent , 39 % , and 23 % , respectively , of patients with fasting plasma glucose > or = 10.0 mmol l(-1 ) , > or = 7.8 mmol l(-1 ) to < 10.0 mmol l(-1 ) and < 7.8 mmol l(-1 ) at r and omization required additional therapy ( p < 0.001 ) . In the initial 3 years , non-obese subjects ( BMI < 30 kg m(-2 ) ) were more likely to require additional therapy than obese patients ( BMI > or = 30 kg m(-2 ) ) ( 43 % vs 53 % at 6 years ; p < 0.001 ) . Modelled beta-cell function showed that those with lower function were more likely to fail ( p < 0.0001 ) . Thus sulphonylureas fail as a therapeutic agent at rates which are dependent both on the phenotype at presentation and perhaps on the agent used initially . Higher failure rates were found in those with higher glucose concentrations , those who were younger , those with lower beta-cell reserve and those r and omized to glibenclamide compared with chlorpropamide Background : The DIABTel system , a Web-based telemedicine application , integrates a whole communication system ( glucometer , insulin pump , wireless h and -held assistant ) for medical remote advice . We sought to evaluate , in terms of glycemic control , the DIABTel system in a r and omized crossover clinical study . Methods : Ten patients with type 1 diabetes [ 5 women , age 40.6 ( 21–62 ) years , diabetes duration 14.7 ( 3–52 ) years ] were included . During the 4-week active phase , data sent by patients were analyzed by the physician and modifications of the basal rate and bolus were advised in the following 24 hours . During the control phase , patients sent glucose data without any feedback from the medical center . Results : The mean numbers of daily glucose values and bolus sent by patients during the active period were 4.46 ± 0.91 and 4.58 ± 0.89 , respectively . The personal digital assistant functionalities used more frequently by patients were ( times per week ) data visualization ( 8.1 ± 6.8 ) , data download from the insulin pump ( 6.8 ± 3.3 ) , and synchronization with the telemedicine server ( 8.5 ± 4.9 ) . After the experimental phase , serum fructosamine decreased significantly ( 393 ± 32 vs 366 ± 25 μmol/liter ; p < 0.05 ) and hemoglobin A1c ( HbA1c ) tended to decrease ( 8.0 ± 0.6 vs 7.78 ± 0.6 ; p = 0.073 ) , whereas no changes were observed during the control phase . The number of treatment modifications proposed and performed by the patients correlated with the change observed in HbA1c during the active phase ( r = −0.729 , p = 0.017 ) . Conclusions : The DIABTel system , a telemedicine system that includes a wireless personal assistant for remote treatment advising , allows better glycemic control in pump-treated patients with type 1 diabetes . To our knowledge , this is the first study that demonstrates improved glycemic control with the use of a telemedicine system that incorporates insulin delivery data AIM The aim of this paper was to test in teenagers with type 1 diabetes mellitus ( T1DM ) the Glucobeeb ( Gb ) , a web based tool to support the diabetes care . METHODS Gb transfers glucometer 's data by phone and Internet to the PC of practitioner in files dedicated to each patient ; the response returns to patient as 1-min vocal message . From out patients paediatric clinic 28 teenagers ( mean 14.8 years , range 10 - 20 , male 14 ) with T1DM on multiple daily injections insulin therapy , with glicated haemoglobin ( HbA1c ) over 7 % and > 2 years ' duration of the disease ( 9.1 years , range 2 - 15 ) , were consequently r and omized to telecare ( glucometer transmission with feedback , group A ) or control ( st and ard communication by phone and face-to-face visits , group B ) .  Glycaemia was tested four times per day and data transmitted every 2 weeks ; clinician feedback returned within the following week . Two controls were excluded after r and omization . Outcomes of 14 patients of A were compared with 12 of B. RESULTS In intervention group average HbA1c% decreased from baseline at 3 and 6 months in comparison with controls ( 9.5 , 9.0 , 9.1 , vs 9.1 , 9.4 , 9.4 respectively ) . Controls after 6 months were introduced to Gb , and similar trend of HbA1c was observed in the following examinations at 3 and 6 month ( 9.4 , 8.9 , 8.7 ) . Then , in both groups HbA1c after 12 months of Gb increased , and after 18 reduced ( A : 9.2 , and 8.8 , B 9.1 and 8.5 respectively ) . The enhancement of HbA1c from baseline to end was significant ( P=0.01 ) . CONCLUSION The tool improves metabolic control in teenagers with T1DM OBJECTIVE To compare the effects of real-time continuous glucose monitoring ( RT-CGM ) and an Internet blood glucose monitoring system ( IBGMS ) on glycated hemoglobin levels in patients with type 2 diabetes mellitus treated with insulin . METHODS Fifty-seven patients with type 2 diabetes treated with insulin  were assigned r and omly to 1 of 2 groups . Group 1 had the results of their self-monitoring of blood glucose level monitored biweekly using an IBGMS . Group 2 used RT-CGM and were monitored biweekly . Both groups used a secure website to upload data and to receive feedback from their endocrinologist .  A1C and laboratory test results were collected at 0 , 3 and 6 months . RESULTS The baseline parameters were not significantly different . After a 6-month follow-up period , both IBGMS and RT-CGM showed significant within-group improvements in A1C level . In the IBGMS group , the A1C level decreased from 8.79%±1.25 % to 7.96%±1.30 % ( p<0.05 ) . The RT-CGM group decreased from 8.80%±1.37 % to 7.49%±0.70 % ( p<0.001 ) . IBGMS and RT-CGM did not show significantly different A1C levels at baseline , 3 and 6 months ( p>0.05 ) . CONCLUSIONS The use of both IBGMS and RT-CGM significantly improved A1C levels in patients with type 2 diabetes treated with insulin in a r and omized trial over a 6-month period . There were no significant differences in A1C values between groups after 6 months BACKGROUND Patients with insulin dependent diabetes require frequent advice if their metabolic control is not optimal . This study focuses on the fiscal and administrative aspects of telemanagement , which was used to establish a supervised autonomy of patients on intensified insulin therapy . METHODS A prospect i ve , r and omised trial with 43 patients on intensified insulin therapy  was conducted . Travelling distance to the diabetes centre was 50 min one way ; all patients had undergone a diabetes education course with lessons in dose adaptation . Patients were r and omly assigned to telecare ( n=27 ) or conventional care ( n=16 ) . They used BG-meters with a storage capacity of 120 values ( Precision QID Abbott/Medisense ) and transmitted their data over a combined modem/interface via telephone line to the diabetes centre . Data were displayed and stored by a customised software ( Precision Link Plus , Abbott/Medisense ) . Advice for proper dose adjustment was given by telephone . RESULTS Average time needed for instruction in the telemedical system was 15 min . Data were transmitted every 1 - 3 weeks and a teleconsultation was performed by phone every 2 - 4 weeks , depending on the extent of specific problems . On average , personal visits in the control group were performed once a month . Physician 's time expenditure for telemanagement , compared to conventional advice was moderately higher ( 50 vs. 42 min per month ) . A substantial amount of time on the patients side could be saved through replacing personal communications by telephone contacts and data transmission reduction ( 96 vs. 163 min/month including data transmission time ) . Setting up an optimal telemanagement scenario , a cost analysis was carried out yielding savings of approximately 650 euro per year per patient . HbA(1c ) dropped significantly from 8.2 to 7.0 % after 8 months of observation , but there was no significant difference between the intervention and control groups . Major technical problems with the telematic system did not occur during the study . CONCLUSIONS Telemanagement of insulin-requiring diabetic patients is a cost and time saving procedure for the patients and results in metabolic control comparable to conventional outpatient management This study was performed to investigate the effect of a telephone-delivered intervention on glycemic control and body mass index in Korean type 2 diabetic patients . 38 patients were r and omly selected , with 20 assigned to a telephone group and 18 to a control group . The goal of the intervention was to keep blood glucose concentrations close to the normal range . The intervention was applied to the telephone group for 12 weeks . It consisted of continuous education and reinforcement of diet , exercise and medication adjustment , as well as frequent self-monitoring of blood glucose levels . Telephone intervention was performed twice per week for the first month , and then weekly for the second and third months . Subjects were requested to write self- management logs , including blood glucose , diet and an exercise diary . The  diet diaries  were analyzed by a dietitian , and subjects instructed about the results by telephone counseling or mail . All medication adjustments were communicated to the subjects ' diabetes specialist . Glycosylated hemoglobin ( HbA1c ) , fasting blood glucose ( FBG ) and 2-hour postpr and ial glucose were measured before , and after , the intervention . Patients in the telephone group had a mean decrease of 1.2 % , with those in the control group having a mean increase of 0.6 % , in HbA1c . There were no significant differences in the body mass index ( BMI ) between the two groups . These findings indicated that a telephone-delivered intervention would improve HbA1c , but would not affect BMI BACKGROUND Today 's generation of young adults are gaining weight faster than their parents ; however , there remains insufficient evidence to inform interventions to prevent this weight gain .  Mobile phones are a popular means of communication that may provide a convenient , inexpensive means to deliver health intervention programmes . This pilot study aim ed to measure the effect of a 12-week mobile health ( mHealth ) intervention on body weight , body mass index and specific lifestyle behaviours addressed by the programme . METHODS University students and staff aged 18 - 35 years ( n = 51 ) were r and omised ( ratio 1 : 1 , intervention : control ) . Both groups received a printed diet booklet with instructions prepared by a dietitian . The intervention group also received Short Message Service ( SMS ) text messages ( four per week ) , e-mails ( four per week ) , and had access to smartphone applications and Internet forums . RESULTS Pre- to post-intervention , participants in the intervention group decreased their body weight [ mean ( SD ) ] [ -1.6 ( 2.6 ) kg ] , increased their light intensity activity [ 34 ( 35 ) min day(-1 ) ] and reported an increased vegetable ( 1.0 median serving day(-1 ) ) and decreased sugar-sweetened beverage intake [ -355 ( 836 ) mL week(-1 ) ] . Despite this , post-intervention changes in outcomes were not significantly different from controls . CONCLUSIONS The piloted mHealth programme provided some short-term positive changes in weight , nutrition and physical activity using a low cost , convenient delivery method for this population . However , changes were no different from those observed among controls . This might partly be explained by intervention participants ' low engagement with the programme , which is likely to require further modification to provide more regular , personalised , monitored support Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions who experience barriers to access to care or a high burden of illness . We conducted a r and omized controlled trial comparing telemedicine case management to usual care , with blinding of those obtaining outcome data , in 1,665 Medicare recipients with diabetes , aged 55 years or greater , and living in federally design ated medically underserved areas of New York State . In New York City , 98 % of participants were black or Hispanic , 69 % were Medicaid-eligible , and 93 % reported annual household income < or = $ 20,000 . In upstate New York , 91 % were white , 14 % Medicaid eligible , and 50 % reported annual household income < or = $ 20,000 . A baseline survey found that 95 % of participants in New York City and 67 % in upstate New York reported that they did not know how to use a computer . The primary endpoints were HgbA1c , blood pressure , and low density lipoprotein ( LDL ) cholesterol levels . In the intervention group ( N = 844 ) , mean HgbA1c improved over 1 year from 7.35 % to 6.97 % , and from 8.35 % to 7.42 % in the subgroup with baseline HgbA1c > or = 7 % ( N = 353 ) . In the usual care group ( N = 821 ) , mean HgbA1c improved over 1 year from 7.42 % to 7.17 % . Adjusted net reductions ( 1-year minus baseline mean values in each group , compared between groups ) favoring the intervention were as follows : HgbA1c , 0.18 % ( p = 0.006 ) , systolic and diastolic blood pressure , 3.4 ( p = 0.001 ) and 1.9 mmHg ( p < 0.001 ) , and LDL cholesterol , 9.5 mg/dl ( p < 0.001 ) . In the subgroup with baseline HgbA1c > or = 7 % , net adjusted reduction in HgbA1c favoring the intervention group was 0.32 % ( p = 0.002 ) . Mean LDL cholesterol level in the intervention group at one year was 95.7 mg/dl . The intervention effects were similar in magnitude in the subgroups living in New York City and upstate New York . A satisfaction survey of intervention group participants ( N = 346 respondents ) showed high levels of satisfaction with major intervention components . A satisfaction survey of participating primary care physicians ( N = 116 respondents ) showed positive perceptions for acceptability , impact on patients and communication .  Telemedicine case management  improved glycemic control , blood pressure levels , and total and LDL-cholesterol levels at 1 year of follow-up . Telemedicine is an effective method for translating modern approaches to disease management into effective care for underserved population BACKGROUND Type 2 diabetes mellitus is increasing in incidence and research has shown that normalization of blood glucose levels can moderate the risk of microvascular and neurological complications . AIM The purpose of this study was to investigate the effect of nurse telephone calls on glycosylated haemoglobin ( HbA1c ) levels and adherence to diabetes control recommendations . METHODS A r and omized design with control and experimental groups being assessed pre- and post intervention was used to assess the effectiveness of nurse telephone calls .  Twenty patients were r and omly assigned to an intervention group and 16 to a control group . The goal of the intervention was to keep blood glucose concentrations close to the normal range ( HbA1c < 7 % ) . The intervention was applied to the intervention group for 12 weeks , and consisted of continued education and reinforcement of diet , exercise , medication adjustment recommendations , as well as frequent self-monitoring of blood glucose levels . Telephone intervention was performed twice per week for the first month and then weekly for the second and third month . Participants were requested to write self-management logs including blood glucose levels , diet and an exercise diary . A dietitian analysed the diet diaries and participants were informed about their results by telephone or mail . All medication adjustments were communicated to participants ' doctors . The HbA1c and diabetes adherence were measured before and after the intervention . RESULTS Patients in the intervention group had a mean decrease of 1.2 % in HbA1c levels and those in the control group had a mean increase of 0.6 % in HbA1c levels . The intervention group had greater diet and blood glucose testing adherence than the control group . CONCLUSION These findings indicate that a nurse telephone intervention can improve HbA1c , and diet and blood glucose testing adherence We conducted a pilot study of the effectiveness of individual counselling sessions provided by a dietician through telemedicine for patients with diabetes . All participants received a single group education session via videoconference .  Those who were r and omized to the intervention also received two additional follow-up sessions , four and eight weeks later . Glycosylated haemoglobin and total cholesterol were measured at the start and again 16 weeks later . The patients completed diabetes quality -of-life and telemedicine patient satisfaction surveys . Thirty-two participants consented to participate . Complete data were collected on 13 intervention and 13 control patients . There was a 1 % fall in HbA1c in the intervention group from pre- to post- assessment , although this was not significant . The control group showed a significantly larger fall in HbA1c levels than the intervention group ( P = 0.043 ) . Total cholesterol decreased in both groups , although not significantly . All control and intervention group participants indicated that they would participate in videoconferencing nutritional counselling again . The results suggest that providing nutritional therapy via videoconferencing may be useful in assisting patients to manage their conditions BACKGROUND Daily weighing is emerging as the recommended self-weighing frequency for weight loss . This is likely because it improves adoption of weight control behaviors . OBJECTIVE To examine whether weighing every day is associated with greater adoption of weight control behaviors compared with less frequent weighing . DESIGN Longitudinal analysis of a previously conducted 6-month r and omized controlled trial . PARTICIPANTS / SETTING Overweight men and women in Chapel Hill , NC , participated in the intervention arm ( N=47 ) . INTERVENTION The intervention focused on daily weighing for weight loss using an e-scale that transmitted weights to a study website , along with weekly e-mailed lessons and tailored feedback on daily weighing adherence and weight loss progress . MAIN OUTCOME MEASURES We gathered objective data on  self-weighing frequency from the e-scales . At baseline and 6 months , weight change was measured in the clinic and weight control behaviors ( total items=37 ) , dietary strategies , and calorie expenditure from physical activity were assessed via question naires . Calorie intake was assessed using an online 24-hour recall tool . STATISTICAL ANALYSES We used χ(2 ) tests to examine variation in discrete weight control behaviors and linear regression models to examine differences in weight , dietary strategies , and calorie intake and expenditure by self-weighing frequency . RESULTS Fifty-one percent of participants weighed every day ( n=24 ) over 6 months . The average self-weighing frequency among those weighing less than daily ( n=23 ) was 5.4±1.2 days per week . Daily weighers lost significantly more weight compared with those weighing less than daily ( mean difference=-6.1 kg ; 95 % CI -10.2 to -2.1 ; P=0.004 ) . The total number of weight control behaviors adopted was greater among daily weighers ( 17.6±7.6 vs 11.2±6.4 ; P=0.004 ) . There were no differences by self-weighing frequency in dietary strategies , calorie intake , or calorie expenditure . CONCLUSIONS Weighing every day led to greater adoption of weight control behaviors and produced greater weight loss compared with weighing most days of the week . This further implicates daily weighing as an effective weight loss tool BACKGROUND Control of serum glucose levels is essential for the reduction of complications of diabetes . Telemedicine is one strategy through which serum glucose control can be improved . METHODS A total of 35 adult , insulin-treated patients with diabetes ( type 1 and type 2 ) were enrolled in the present study ( 63.0 + /- 10 years of age , 63 % female ) and r and omized to telemedicine monitoring ( including cordless , remote glucose monitor , and transmitter , n =  17  ) , or conventional follow-up ( n = 18 ) . Metabolic parameters were evaluated , and a quality of life question naire was administered both pre- and post-treatment . RESULTS Groups were similar at baseline in terms of demographic , quality of life , and metabolic parameters . Significant differences in post-treatment metabolic parameters were not observed , although serum glucose was marginally elevated in the control group compared to the telemedicine group ( 214 + /- 65 mg/dL vs. 171 + /- 77 mg/dL , P = 0.09 ) . On the other h and , being clinical ly symptom-free ( 71 % vs. 11 % , P = 0.003 ) , having no hypoglycemic events ( 82 % vs. 17 % , P = 0.0001 ) , and having no hyperglycemic events ( 65 % vs. 17 % , P = 0.004 ) were all significantly more frequently reported in the telemedicine group compared to the control group . Compared to the control group , the telemedicine group reported experiencing significantly less anxiety , treatment difficulty , depression , disease-associated life complications , and feelings of impotence or ineptitude and significantly greater improvement in personal control over glucose , weight , and overall diabetes . CONCLUSIONS Though post-treatment metabolic differences were not observed between treatment groups , the telemedicine group reported significantly greater post-treatment experiences of improved quality of life and sense of control over the disease . Thus patient satisfaction can be enhanced through the use of telemedicine BACKGROUND The aim of this study is to evaluate the effect of a web-based comprehensive information system , consisting of Internet and cellular phone use , on blood glucose control . METHODS We established eMOD ( electronic Management of Diabetes ) , a web-based ubiquitous information system , for cell phone users along with a website for Internet users to provide diabetes education . We examined whether this information system has the same impact on glycemic control as conventional education for the diabetes patient . Forty volunteers were enrolled and r and omly assigned to either the eMOD experimental group ( n = 20 ) or the control group ( n = 20 ) .  Blood glucose and glycated hemoglobin ( A1C ) levels were evaluated at baseline and after 6 months . RESULTS The two groups were homogeneous in terms of age , sex , and diabetes ' duration at baseline . A1C ( from 9.0 + /- 2.3 % to 7.5 + /- 1.4 % , P = 0.031 ) and postpr and ial glucose level ( 228.1 + /- 79.7 to 173.5 + /- 50.2 mg/dL , P = 0.030 ) were significantly decreased over time in the intervention group but not in the control group . There was a significant relationship between the change in A1C and the frequency of access to the eMOD system via cellular phone ( r = 0.766 , P = 0.03 ; coefficient -0.147 ) . CONCLUSIONS A1C was improved by a web-based intervention not only via computer but also via cellular phone at 6 months post-initiation in patients with type 2 diabetes . These results indicate that the use of a convenient web-based education system could be more effective for glycemic control than traditional education for diabetes patients
target: Results Telemedicine programs that include a nutritional component show similar effect in diabetes management as those programs that do not .
  Furthermore , subgroup analysis reveals that nutritional intervention via SMS such as email and text messages is at least as equally effective in reducing HbA1c when compared to personal nutritional counseling with a practitioner over videoconference or telephone .
  Conclusion The inclusion of nutritional counseling as part of a telemedicine program does not make a significant difference to diabetes outcomes .
  Incorporating nutritional counseling into telemedicine programs via SMS is at least as effective as counseling via telephone or videoconference
background: Background A growing number of studies and review s have documented the impact of telemedicine on diabetes management .
  However , no meta- analysis has assessed whether including nutritional counseling as part of a telemedicine program has a significant impact on diabetes outcomes or what kind of nutritional counseling is most effective .