Self-Management Behavior in Type 2 Diabetes: Remote Monitoring vs. In-Person Care

by Jaida Temperly
4 minute read

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The study: In a study from the Journal of Medical Internet Research (JMIR), a randomized crossover study evaluated the effects of a diabetes remote monitoring program in comparison to usual care received at specialty diabetes centers in adults living with poorly controlled type 2 diabetes (T2D).

Why it’s important: People living with poorly controlled T2D have both increased morbidity and mortality, as well as a higher cost of care. Patients may also struggle adhering to self-management behavior and/or accessing in-person clinician services due to socio-economic barriers. It is therefore vital that self-management programs be “accessible, responsive to varying patient health status, and effective in improving self-management skills, knowledge, and engagement”. One such critical component is self-monitoring blood glucose levels, for example, with a blood glucose monitor.

The tech: Blood glucose monitor technology for diabetes self-management has been rapidly evolving, allowing for improved sharing and monitoring of health data between patient and clinician. For example, some cellular-connected monitoring devices automatically upload recorded data to cloud-based databases, assisting clinicians in monitoring patients in real-time and consequently offering timely and personalized support when blood glucose readings are abnormal — without the potential socio-economic barrier of in-person clinician services.

The details: A two-arm, 12-month randomized crossover study of 119 adults living with poorly controlled T2D evaluated a diabetes remote monitoring program that included the following: 

  • A cellular-connected glucose meter
  • Access to a diabetes coach for questions, goal setting, and support when blood glucose readings were abnormal

Group 1 began the six-month intervention, and then proceeded to six months of usual care (IV/UC). Group 2 received six months of usual care, and then enrolled in the six-month intervention (UC/IV). The primary outcome evaluated was change in hemoglobin (HbA1c). The secondary outcome was change in treatment satisfaction. 

The outcomes:

  • During the first six months, average measured hemoglobin improved in both groups 
  • There was no significant difference in treatment effect between either group (IV vs UC) over the full 12 months
  • Both groups reported similar improvements in treatment satisfaction

The takeaway? Those enrolled in the remote monitoring program intervention experienced improvements in hemoglobin and treatment satisfaction similar to usual care at a specialty diabetes center. This suggests that implementation of a remote monitoring program by health organizations and/or insurers may be effective when making decisions for diabetes self-management support resources.

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Original StudyAmante D, Harlan D, Lemon S, McManus D, Olaitan O, Pagoto S, Gerber B, Thompson M. Evaluation of a Diabetes Remote Monitoring Program Facilitated by Connected Glucose Meters for Patients With Poorly Controlled Type 2 Diabetes: Randomized Crossover Trial. JMIR Diabetes 2021;6(1):e25574. URL: DOI: 10.2196/25574