title: The impact of telehome care on health status and quality of life among patients with diabetes in a primary care setting in Poland. Improved Glycemic Control Without Hypoglycemia in Elderly Diabetic Patients Using the Ubiquitous Healthcare Service, a New Medical Information System Role of Mobile Technology to Improve Diabetes Care in Adults with Type 1 Diabetes: The Remote-T1D Study iBGStar® in Type 1 Diabetes Management Randomized Trial of Long-Acting Insulin Glargine Titration Web Tool (LTHome) Versus Enhanced Usual Therapy of Glargine Titration (INNOVATE Trial). Telecare Provides comparable efficacy to conventional self-monitored blood glucose in patients with type 2 diabetes titrating one injection of insulin glulisine-the ELEONOR study. Optimizing Insulin Glargine Plus One Injection of Insulin Glulisine in Type 2 Diabetes in the ELEONOR Study Glycemia and corrected QT interval prolongation in young type 1 diabetic patients: what is the relation? Severe hypoglycemia and risks of vascular events and death. Hypoglycemic symptoms in patients with type 2 diabetes in Asia-Pacific-Real-life effectiveness and care patterns of diabetes management: the RECAP-DM study. Multifactorial intervention in diabetes care using real-time monitoring and tailored feedback in type 2 diabetes Glycemic control after hospital discharge in insulin-treated type 2 diabetes: a randomized pilot study of daily remote glucose monitoring. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study Welltang - A smart phone-based diabetes management application - Improves blood glucose control in Chinese people with diabetes. Web-based telemedicine for management of type 2 diabetes through glucose uploads: a randomized controlled trial. MD‐Logic overnight type 1 diabetes control in home settings: A multicentre, multinational, single blind randomized trial Diabetes telemonitoring reduces the risk of hypoglycaemia during Ramadan: a pilot randomized controlled study. Effects of intensive glucose lowering in type 2 diabetes. An automated telemedicine system improves patient-reported well-being. The Diabeo Software Enabling Individualized Insulin Dose Adjustments Combined With Telemedicine Support Improves HbA1c in Poorly Controlled Type 1 Diabetic Patients
abstract: 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 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 Introduction The role of mobile technology in patient-reported outcomes ( PRO ) and glycemic control in adults with type 1 diabetes ( T1D ) needs further evaluation . Methods The single-center , prospect i ve , 6-month , open-label , investigator-initiated study r and omized 100 subjects with T1D in a 1:1 fashion to a  control group using self-monitoring of blood glucose ( SMBG ) with Accu-Chek Nano ® and an intervention group using SMBG with iPhone plus glucose meter ( iBGStar ® ) . The primary endpoint was the change in PRO ( hypoglycemia fear score , behavior and worry subscores ) . Secondary outcomes were the improvement in glycemic variability indices and the reduction in A1c values . Results Baseline demographics and glycosylated hemoglobin ( A1c ) values were similar in the two groups . There was a significant decrease in A1c value at 6 months in iBGStar ® group compared to the control group ( −0.16 vs. −0.51 , p = 0.04 ) . The total insulin dose increased significantly in the iBGStar ® group at 3 months but did not change at 6 months . The hypoglycemia fear scale ( PRO ) improved in both groups at 6 months ( −1.4 ± 10.0 vs. −3.9 ± 12.5 , p = 0.32 ) . Conclusion The use of iBGStar ® result ed in better glycemic control and improvement in some PRO ( hypoglycemia fear and behavior scores ) compared to the control group at 6 months with no increased risk of hypoglycemia . Clinical trial registration Clinical Trials.gov : NCT01825382 . Funding Sanofi BACKGROUND Basal insulin titration in the real world is often unsuccessful . LTHome , a web tool , applies a rules engine-based algorithm providing insulin titration advice directly to the patient . METHODS This pilot , r and omized trial evaluates basal insulin glargine titration by LTHome compared to enhanced usual therapy ( [EUT]-diabetes education program ) over 12 weeks . Important inclusion criteria : 18 - 75 years , type 2 diabetes , computer literacy , and HbA1c > 7.0 % . Trial protocol was approved by ethics board . RESULTS We r and omized 139 subjects . The achievement of primary composite outcome ( four out of seven fasting plasma glucose [ FPG ] within 5 - 7.2 mmol/L + mean for three consecutive FPG within 5 - 7.2 mmol/L + no severe hypoglycemia ) was 15 % in LTHome versus 41 % in EUT ( noninferiority not met , P-value = 0.92 ) . Other outcomes were similar between the LTHome and EUT arms : alternate composite outcome achievement ( last five FPG mean within the range of 5 - 7.2 mmol/L + no hypoglycemia , 47 % and 51 % , P = 0.73 ) ; A1c reduction ( -1.0 % and -1.1 % , P = 0.66 ) ; proportion achieving A1c ≤7 % ( 14 % and 20 % , P = 0.36 ) ; and hypoglycemia incidence ( 31 % and 37 % , P = 0.4 ) , respectively . Patient satisfaction score improvements were greater in LTHome versus EUT ( change in fear of hypoglycemia score P = 0.04 and change in diabetes distress score P = 0.04 ) . The mean number of additional healthcare provider visits was 0.13 for LTHome and 1.22 for EUT ( P < 0.01 ) . CONCLUSION INNOVATE trial suggests clinical utility of LTHome compared to EUT in real-life setting s. Further research is needed to evaluate the efficacy and safety of automated insulin titration algorithms BACKGROUND We compared telecare and conventional self-monitored blood glucose ( SMBG ) programs for titrating the addition of one bolus injection of insulin glulisine in patients with type 2 diabetes uncontrolled on oral hypoglycemic agents for ≥3 months who were first titrated with basal insulin glargine . METHODS This r and omized , multicenter , parallel-group study included 241 patients ( mean screening glycosylated hemoglobin [ HbA(1c ) ] , 8.8 % [ 73 mmol/mol ] ) . In the run-in phase , any antidiabetes medication , except for metformin , was discontinued . Metformin was then up-titrated to 2 g/day ( 1 g twice daily ) until study completion . Following run-in , all patients started glargine for 8 - 16 weeks , targeting fasting plasma glucose ( FPG ) ≤5.6 mmol/L using conventional SMBG . Patients with FPG ≤7 mmol/L added a glulisine dose at the meal with the highest postpr and ial plasma glucose excursion , titrated to target 2-h postpr and ial plasma glucose level < 7.8 mmol/L using telecare or SMBG for 24 weeks . Patients with FPG > 7 mmol/L at week 16 were withdrawn from the study . RESULTS After glargine titration , 224 patients achieved FPG ≤7 mmol/L , without any difference between telecare and SBMG groups ( mean±SD , 6.2±0.8 vs. 6.0±0 . 9 mmol/L , respectively ) . HbA(1c ) levels were lower following titration and were similar for telecare and SMBG ( 7.9±0.9 % vs. 7.8±0.9 % [ 63 vs. 62 mmol/mol ] , respectively ) . Adding glulisine  further reduced HbA(1c ) in both groups ( -0.7 % vs. -0.7 % ) ; 45.2 % and 54.8 % ( P=0.14 ) , respectively , of patients achieved HbA(1c ) ≤7.0 % ( ≤53 mmol/mol ) . Weight change and hypoglycemia were similar between groups . CONCLUSIONS Patients adding one dose of glulisine at the meal with the highest postpr and ial plasma glucose excursion to titrated basal glargine achieved comparable improvements in glycemic control irrespective of traditional or telecare blood glucose monitoring OBJECTIVE To determine the functional health status and treatment satisfaction in patients with type 2 diabetes from the Evaluation of Lantus Effect ON Optimization of use of single dose Rapid insulin ( ELEONOR ) study that investigated whether a telecare program helps optimization of basal insulin glargine with one bolus injection of insulin glulisine . RESEARCH DESIGN AND METHODS Functional health status and treatment satisfaction were investigated using the 36-Item Short-Form ( SF-36 ) Health Survey , the World Health Organization Well-Being Question naire ( WBQ ) , and the Diabetes Treatment Satisfaction Question naire . RESULTS Of 291 r and omized patients , 238 completed the study ( telecare : 114 ; self-monitoring blood glucose : 124 ) . Significant improvements were detected in most SF-36 domains , in WBQ depression and anxiety scores , and in treatment satisfaction , without differences between study groups . CONCLUSIONS An insulin regimen that substantially improves metabolic control , while minimizing the risk of hypoglycemia , can positively affect physical and psychologic well-being and treatment satisfaction irrespective of the educational support system used The relationship between a prolonged QT interval and an increased risk of sudden death has been extensively explored in familial long QT syndrome , sudden infant death , and ischemic heart disease ( 1–3 ) . Several recent studies also describe the relation between corrected QT interval ( QTc ) prolongation , diabetes complications , and an increased mortality in adults ( 4,5 ) . We recently described QTc prolongation and a larger QT dispersion in a cohort of children and adolescents with type 1 diabetes ( 6 ) . The influence of changes in glycemia on the length of the QT or QTc remains a controversial issue . Experimental hypoglycemia and , just recently , spontaneous clinical episodes of hypoglycemia proved to lead to QTc lengthening ( 7–9 ) . There is some evidence that prolonged cardiac repolarization contributes to sudden death associated with nocturnal hypoglycemia in young people with diabetes ( 10–13 ) . On the other h and , a relation between hyperglycemia and abnormal cardiac repolarization has also been described ( 14 ) . We therefore simultaneously recorded QT and QTc values  using 24-h Holter registration and glucose levels with a continuous glucose monitoring system in children and adolescents with type 1 diabetes . Nine children and adolescents with stable type 1 diabetes ( five males and four females aged 9–19 years ) were prospect ively recruited from the patient population that regularly attends the Diabetes Clinic for BACKGROUND Severe hypoglycemia may increase the risk of a poor outcome in patients with type 2 diabetes assigned to an intensive glucose-lowering intervention .  We analyzed data from a large study of intensive glucose lowering to explore the relationship between severe hypoglycemia and adverse clinical outcomes . METHODS We examined the associations between severe hypoglycemia and the risks of macrovascular or microvascular events and death among 11,140 patients with type 2 diabetes , using Cox proportional-hazards models with adjustment for covariates measured at baseline and after r and omization . RESULTS During a median follow-up period of 5 years , 231 patients ( 2.1 % ) had at least one severe hypoglycemic episode ; 150 had been assigned to intensive glucose control ( 2.7 % of the 5571 patients in that group ) , and 81 had been assigned to st and ard glucose control ( 1.5 % of the 5569 patients in that group ) . The median times from the onset of severe hypoglycemia to the first major macrovascular event , the first major microvascular event , and death were 1.56 years ( interquartile range , 0.84 to 2.41 ) , 0.99 years ( interquartile range , 0.40 to 2.17 ) , and 1.05 years ( interquartile range , 0.34 to 2.41 ) , respectively . During follow-up , severe hypoglycemia was associated with a significant increase in the adjusted risks of major macrovascular events ( hazard ratio , 2.88 ; 95 % confidence interval [ CI ] , 2.01 to 4.12 ) , major microvascular events ( hazard ratio , 1.81 ; 95 % CI , 1.19 to 2.74 ) , death from a cardiovascular cause ( hazard ratio , 2.68 ; 95 % CI , 1.72 to 4.19 ) , and death from any cause ( hazard ratio , 2.69 ; 95 % CI , 1.97 to 3.67 ) ( P<0.001 for all comparisons ) . Similar associations were apparent for a range of nonvascular outcomes , including respiratory , digestive , and skin conditions ( P<0.01 for all comparisons ) . No relationship was found between repeated episodes of severe hypoglycemia and vascular outcomes or death . CONCLUSIONS Severe hypoglycemia was strongly associated with increased risks of a range of adverse clinical outcomes . It is possible that severe hypoglycemia contributes to adverse outcomes , but these analyses indicate that hypoglycemia is just as likely to be a marker of vulnerability to such events . ( Funded by Servier and the National Health and Medical Research Council of Australia ; Clinical Trials.gov number , NCT00145925 . ) Symptoms of hypoglycemia were reported by 35.8 % of patients with type 2 diabetes treated with oral antihyperglycemic agents in the Asia-Pacific region . Symptoms were severe in 11.6 % and very severe in 8.2 % of patients experiencing hypoglycemia Aims In 2011 , we demonstrated that an individualized health management system employing advanced medical information technology , design ated ubiquitous (u)-healthcare , was helpful in achieving glycemic control without hypoglycemia in patients with diabetes . Following this , we generated a new multidisciplinary u-healthcare system by upgrading our clinical decision support system ( CDSS ) rule engine and integrating a physical activity-monitoring device and dietary feedback into a comprehensive package . Methods In a r and omized , controlled clinical trial , patients with type 2 diabetes aged over 60 years were assigned r and omly to a self-monitored blood glucose ( SMBG ) group  ( N = 50 ) or u-healthcare group ( N = 50 ) for 6 months . The primary endpoint was the proportion of patients achieving glycated hemoglobin ( HbA1c ) < 7 % without hypoglycemia . Changes in body composition and lipid profiles were also investigated . The u-healthcare group was educated to use a specially design ed glucometer and an activity monitor that automatically transferred test results to a hospital-based server . An automated CDSS rule engine generated and sent patient-specific messages about  glucose , diet , and physical activity to their mobile phones and a Web site . Results After 6 months of follow-up , the HbA1c level was significantly decreased in the u-healthcare group [ 8.0 ± 0.7 % ( 64.2 ± 8.8 mmol/mol ) to 7.3 ± 0.9 % ( 56.7 ± 9.9 mmol/mol ) ] compared with the SMBG group [ 8.1 ± 0.8 % ( 64.9 ± 9.1 mmol/mol ) to 7.9 ± 1.2 % ( 63.2 ± 12.3 mmol/mol ) ] ( P < 0.01 ) . The proportion of patients with HbA1c < 7 % without hypoglycemia was greater in the u-healthcare group ( 26 % ) than in the SMBG group ( 12 % ; P < 0.05 ) . Body fat mass decreased and lipid profiles improved in the u-healthcare group but not in the SMBG group . Conclusion This u-healthcare service provided effective management for older patients with type 2 diabetes ( Clinical Trial . Gov : NCT01137058 ) OBJECTIVE Little is known about glycemic control in type 2 diabetes patients treated with insulin in the high-risk period between hospital discharge and follow-up . We sought to assess the impact of remote glucose monitoring on postdischarge glycemic control and insulin titration . METHODS We r and omly assigned 28 hospitalized type 2 diabetes patients who were discharged home on insulin therapy to routine specialty care ( RSC ) or RSC with daily remote glucose monitoring ( RGM ) .  We compared the primary outcome of mean blood glucose and exploratory outcomes of hypoglycemia/hyperglycemia rates , change in hemoglobin A1c and glycated albumin , and insulin titration frequency between groups . RESULTS Mean blood glucose was not significantly different between the treatment arms ( 144 ± 34 mg/dL in the RSC group and 172 ± 41 mg/dL in the RGM group ; not significant ) , nor were there significant differences in any of the other measures of glycemia during the month after discharge . Hypoglycemia ( glucometer reading < 60 mg/dL ) was common , occurring in 46 % of subjects , with no difference between groups . In as-treated analysis , insulin dose adjustments ( 29 % with an increase and 43 % with decrease in insulin dose ) occurred more frequently in the patients who used RGM ( average of 2.8 vs. 1.2 dose adjustments ; P = .03 ) . CONCLUSION In this pilot trial in insulin-treated type 2 diabetes , RGM did not affect glycemic control after hospital discharge ; however , the high rate of hypoglycemia in the postdischarge transition period and the higher frequency of insulin titration in patients who used RGM suggest a safety role for such monitoring in the transition from hospital to home Abstract Objective : To determine the relation between exposure to glycaemia over time and the risk of macrovascular or microvascular complications in patients with type 2 diabetes . Design : Prospect i ve observational study . Setting : 23 hospital based clinics in Engl and , Scotl and , and Northern Irel and . Participants : 4585 white , Asian Indian , and Afro-Caribbean UKPDS patients , whether r and omised or not to treatment , were included in analyses of incidence ; of these , 3642 were included in analyses of relative risk . Outcome measures : Primary predefined aggregate clinical outcomes : any end point or deaths related to diabetes and all cause mortality . Secondary aggregate outcomes : myocardial infa rct ion , stroke , amputation ( including death from peripheral vascular disease ) , and microvascular disease ( predominantly retinal photo-coagulation ) . Single end points : non-fatal heart failure and cataract extraction . Risk reduction associated with a 1 % reduction in up date d mean HbA1c adjusted for possible confounders at diagnosis of diabetes . Results : The incidence of clinical complications was significantly associated with glycaemia . Each 1 % reduction in up date d mean HbA1c was associated with reductions in risk of 21 % for any end point related to diabetes ( 95 % confidence interval 17 % to 24 % , P<0.0001 ) , 21 % for deaths related to diabetes ( 15 % to 27 % , P<0.0001 ) , 14 % for myocardial infa rct ion ( 8 % to 21 % , P<0.0001 ) , and 37 % for microvascular complications ( 33 % to 41 % , P<0.0001 ) . No threshold of risk was observed for any end point . Conclusions : In patients with type 2 diabetes the risk of diabetic complications was strongly associated with previous hyperglycaemia . Any reduction in HbA1c is likely to reduce the risk of complications , with the lowest risk being in those with HbA1c values in the normal range ( < 6.0 % ) AIMS The primary objective was to evaluate the impact of the smart phone-based diabetes management application , Welltang , on glycated hemoglobin ( HbA1c ) . The second objective was to measure whether Welltang improves blood glucose , low-density lipoprotein cholesterol , weight , blood pressure , hypoglycemic events , satisfaction of patients to use Welltang , diabetes knowledge of patients , and self-care behaviors . METHODS One hundred evenly r and omized subjects with diabetes , aged 18 - 74years , were recruited from the outpatient Department of Endocrinology for a 3-month study . The Welltang intervention group received training for the use of Welltang , while the control group received their usual st and ard of care .  HbA1c , blood glucose , low-density lipoprotein cholesterol , weight , blood pressure , hypoglycemic events , satisfaction of patients to use Welltang , diabetes knowledge of patients , and self-care behaviors were measured . Patient data were analyzed using independent t test and paired sample test using SPSS version 12 . RESULTS The average decrease in HbA1c was 1.95 % ( 21mmol/mol ) in the intervention group and 0.79 % ( 8mmol/mol ) in the control group ( P<0.001 ) . Measures of self-monitored blood glucose , diabetes knowledge , and self-care behaviors improved in patients in the intervention group . Eighty four percent of patients in the intervention group were satisfied with the use of Welltang . Differences in hypoglycemic events , low-density lipoprotein cholesterol , weight , and blood pressure were not statistically significant . CONCLUSION Diabetes patients using the Welltang application achieved statistically significant improvements in HbA1c , blood glucose , satisfaction of patients to use of Welltang , diabetes knowledge , and self-care behaviors AIMS To evaluate the feasibility and effectiveness of a telemedicine system based on internet in the follow-up of patients with type 2 diabetes mellitus ( T2DM ) . METHODS A prospect i ve r and omized telemedicine study with two parallel groups was design ed . 114 patients diagnosed T2DM were r and omly divided into telemedicine group and traditional face-to-face visit group as control . 57 cases were included for each group . 108 patients completed the trial , in which 53 cases in telemedicine group and 55 cases in control group . Patients in telemedicine group were taught to use telemedicine software to upload their blood glucose and other metabolic information at home at least every 2 weeks , and the research ers gave proper advices according to patients ' key behaviors . The telemedicine interval is 3 months . RESULTS Compared to control group , telemedicine group exhibited better HbA1c and fasting blood glucose controlling ( P < 0.05 ) . Moreover , telemedicine intervention decreased hypoglycemia risk ( P = 0.044 ) , and contributed to levels of HbA1c less than 7 % which is the target of our study ( P = 0.049 ) . CONCLUSIONS Telemedicine system can provide a tighter glycemic control for the treatment of T2DM patients , especially in cases with difficulties to access to the medical centre AIMS To evaluate the safety , efficacy and need for remote monitoring of the MD-Logic closed-loop system during short-term overnight use at home . METHODS Seventy-five patients ( 38 male ; aged 10 - 54 years ; average A1c , 7.8 % ± 0.7 % , 61.8 ± 7.2 mmol/mol ) were enrolled from 3 clinical sites . Patients were r and omly assigned to participate in 2 overnight crossover periods , each including 4 consecutive nights , 1 under closed-loop control and 1 under sensor-augmented pump ( SAP ) therapy in the patient 's home . Both study arms were supervised using a remote-monitoring system in a blinded manner . Primary endpoints were time spent with glucose levels below 70 mg/dL and percentage of nights in which mean overnight glucose levels were within 90 to 140 mg/dL. RESULTS The median [ interquartile range ] percentage of time spent in hypoglycaemia was significantly lower on nights when MD-Logic was used , compared to SAP therapy ( 2.07 [ 0 , 4.78 ] and 2.6 [ 0 , 10.34 ] , respectively ; P = .004 ) and the percentage of individual nights with a mean overnight glucose level in target was significantly greater ( 75 [ 42 , 75 ] and 50 [ 25,75 ] , respectively ; P = .008 ) . The time spent in target range was increased by a median of 28 % ( P = .001 ) , with the same amount of insulin ( 10.69 [ 7.28 , 13.94 ] and 10.41[6.9 , 14.07 ] , respectively ; P = .087 ) . The remote monitoring triggered calls for hypoglycaemia at twice the rate during SAP therapy compared to closed-loop control ( 62 and 29 , respectively ; P = .002 ) . CONCLUSIONS The MD-Logic system demonstrated a safe and efficient profile during overnight use by children , adolescents and adults with type 1 diabetes and , therefore , provides an effective means of mitigating the risk of nocturnal hypoglycaemia AIM This pilot study evaluated the short-term benefits of a telemonitoring-supplemented focused diabetic education compared with education alone in participants with Type 2 diabetes who were fasting during Ramadan . METHODS In this pilot mixed- method study , we identified 37 participants and r and omly allocated them to either a telemonitoring group ( n = 18 ) or a group receiving Ramadan-focused pre-education only ( usual care ; n = 19 ) . The telemonitoring group received goal - setting and personalized feedback . RESULTS The telemonitoring group was less likely to experience hypoglycaemia than the usual care group ( odds ratio : 0.1273 ; 95 % confidence interval : 0.0267 - 0.6059 ) . No significant differences were noted in glycaemic control at the end of study . Participants viewed telemedicine as a more convenient alternative although technological barriers remain a concern . CONCLUSIONS The results of this study reinforce the need for monitoring as well as educational initiatives for Muslims with diabetes who fast during Ramadan . Telemonitoring offers an attractive option requiring further research . ( Clinical Trial Registry No. NCT02189135 ) BACKGROUND Epidemiologic studies have shown a relationship between glycated hemoglobin levels and cardiovascular events in patients with type 2 diabetes . We investigated whether intensive therapy to target normal glycated hemoglobin levels would reduce cardiovascular events in patients with type 2 diabetes who had either established cardiovascular disease or additional cardiovascular risk factors . METHODS In this r and omized study , 10,251 patients ( mean age , 62.2 years ) with a median glycated hemoglobin level of 8.1 % were assigned to receive intensive therapy ( targeting a glycated hemoglobin level below 6.0 % ) or st and ard therapy ( targeting a level from 7.0 to 7.9 % ) . Of these patients , 38 % were women , and 35 % had had a previous cardiovascular event . The primary outcome was a composite of nonfatal myocardial infa rct ion , nonfatal stroke , or death from cardiovascular causes . The finding of higher mortality in the intensive-therapy group led to a discontinuation of intensive therapy after a mean of 3.5 years of follow-up . RESULTS At 1 year , stable median glycated hemoglobin levels of 6.4 % and 7.5 % were achieved in the intensive-therapy group and the st and ard-therapy group , respectively . During follow-up , the primary outcome occurred in 352 patients in the intensive-therapy group , as compared with 371 in the st and ard-therapy group ( hazard ratio , 0.90 ; 95 % confidence interval [ CI ] , 0.78 to 1.04 ; P=0.16 ) . At the same time , 257 patients in the intensive-therapy group died , as compared with 203 patients in the st and ard-therapy group ( hazard ratio , 1.22 ; 95 % CI , 1.01 to 1.46 ; P=0.04 ) . Hypoglycemia requiring assistance and weight gain of more than 10 kg were more frequent in the intensive-therapy group ( P<0.001 ) . CONCLUSIONS As compared with st and ard therapy , the use of intensive therapy to target normal glycated hemoglobin levels for 3.5 years increased mortality and did not significantly reduce major cardiovascular events . These findings identify a previously unrecognized harm of intensive glucose lowering in high-risk patients with type 2 diabetes . ( Clinical Trials.gov number , NCT00000620 . 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 OBJECTIVE To demonstrate that Diabeo software enabling individualized insulin dose adjustments combined with telemedicine support significantly improves HbA1c in poorly controlled type 1 diabetic patients . RESEARCH DESIGN AND METHODS In a six-month open-label parallel-group , multicenter study , adult patients ( n = 180 ) with type 1 diabetes ( > 1 year ) , on a basal-bolus insulin regimen ( > 6 months ) , with HbA1c ≥8 % , were r and omized to usual quarterly follow-up ( G1 ) , home use of a smartphone recommending insulin doses with quarterly visits ( G2 ) , or use of the smartphone with short teleconsultations every 2 weeks but no visit until point end ( G3 ) . RESULTS Six-month mean HbA1c in G3 ( 8.41 ± 1.04 % ) was lower than in G1 ( 9.10 ± 1.16 % ; P = 0.0019 ) . G2 displayed intermediate results ( 8.63 ± 1.07 % ) . The Diabeo system gave a 0.91 % ( 0.60 ; 1.21 ) improvement in HbA1c over controls and a 0.67 % ( 0.35 ; 0.99 ) reduction when used without teleconsultation . There was no difference in the frequency of hypoglycemic episodes or in medical time spent for hospital or telephone consultations . However , patients in G1 and G2 spent nearly 5 h more than G3 patients attending hospital visits . CONCLUSIONS The Diabeo system gives a substantial improvement to metabolic control in chronic , poorly controlled type 1 diabetic patients without requiring more medical time and at a lower overall cost for the patient than usual care
target: Discussion Compared to usual care , the use of telemedicine was found to improve HbA1c and reduce the risk of moderate hypoglycaemia  in diabetic patients , but without significant difference in BMI
background: Introduction Hypoglycaemia is a clinical syndrome from various causes , which happens when the blood glucose concentration is too low .
  Many studies show that telemedicine intervention can improve glycemic control and has a positive impact on the management of diabetic patients .
  The purpose of this study was to evaluate the effect of telemedicine intervention on hypoglycemic event occurrences and results on hemoglobin A1c ( HbA1c ) and body mass index ( BMI ) .