Type 2 Diabetes: Remote Monitoring vs. In-Person Care?

Type 2 diabetic woman scanning a patch on her arm to check her blood sugar levels.

November 9, 2021

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The Study‍

Evaluation of a Diabetes Remote Monitoring Program Facilitated by Connected Glucose Meters for Patients With Poorly Controlled Type 2 Diabetes: Randomized Crossover Trial (Amante DJ et al., JMIR Diabetes)

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The Story

‍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).

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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.

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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.

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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.

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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

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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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