Telemedicine intervention effects on waist circumference and body mass index in the IDEATel project. Impact of remote management of diabetes via computer: the 360 study--a proof-of-concept randomized trial. Glycemic Control and Health Disparities in Older Ethnically Diverse Underserved Adults With Diabetes Biphasic insulin aspart vs. human insulin in adolescents with type 1 diabetes on multiple daily insulin injections. Telemedicine improved diabetic management. Improved diabetes control in the elderly delays global cognitive decline Practical Telemedicine for Veterans with Persistently Poor Diabetes Control: A Randomized Pilot Trial. Improved Clinical Outcomes Using a Culturally Sensitive Diabetes Education Program in a Hispanic Population A telephone-delivered intervention to improve glycemic control in type 2 diabetic patients. Evaluation of a Telemedicine Service for the Secondary Prevention of Coronary Artery Disease Real-time continuous glucose monitoring together with telemedical assistance improves glycemic control and glucose stability in pump-treated patients. Depression and glycemic control in elderly ethnically diverse patients with diabetes: the IDEATel project. Hemoglobin A1c as a tool for the diagnosis of type 2 diabetes in 208 premenopausal women with polycystic ovary syndrome. Association between self-monitoring of blood glucose and glycemic control in patients with type 2 diabetes mellitus. Web-based telemedicine for management of type 2 diabetes through glucose uploads: a randomized controlled trial. Continuous subcutaneous insulin infusion and multiple dose of insulin regimen display similar patterns of blood glucose excursions in pediatric type 1 diabetes. A randomized controlled trial of the effect of real-time telemedicine support on glycemic control in young adults with type 1 diabetes (ISRCTN 46889446). A Telemedicine System That Includes a Personal Assistant Improves Glycemic Control in Pump-Treated Patients with Type 1 Diabetes An integrated wound-care pathway, supported by telemedicine, and competent wound management - Essential in follow-up care of adults with diabetic foot ulcers
BACKGROUND We examine the changes in waist circumference ( WC ) and body mass index ( BMI ) in older adults enrolled in a diabetes telemedicine program . The subjects were elderly Medicare beneficiaries participating in the rural ( upstate New York ) cohort of Informatics and Diabetes Education and Telemedicine , a r and omized , controlled trial using telemedicine to improve diabetes care in which the primary outcome was glycemic control . METHODS Ninety-two percent of the subjects had BMI > 25 kg/m(2 ) , and 65.8 % had a BMI > or = 30 kg/m(2 ) . Intervention subjects received home televisits with a dietitian or nurse educator every 4 - 6 weeks .  Blood glucose and blood pressure values  were review ed , and lifestyle and medication changes were recommended . Non-intervention subjects received usual care through their primary care physicians . Change in WC , BMI , diet , and exercise behaviors and knowledge were examined at baseline and 12 and 24 months . A mixed-effects path analysis was performed to examine direct and indirect effects . RESULTS The telemedicine participants increased diet and exercise knowledge over time ( P < 0.001 ) . It was estimated that women in the  telemedicine  group reduced their WC over the 2 years by 1.2 cm , whereas women in the usual care group increased their WC by almost 1 cm ( P = 0.02 ) . Path analysis demonstrated that the intervention , through improved diet and exercise knowledge , was related to the decrease in WC ( P = 0.006 ) and BMI ( P = 0.004 ) . CONCLUSIONS Diabetes case management using telemedicine improved self-reported diet and exercise knowledge , practice s , and behaviors , which in turn was associated with reductions in WC and BMI at 2 years 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 OBJECTIVE The Informatics for Diabetes Education and Telemedicine ( IDEATel ) project r and omized ethnically diverse underserved older adults with diabetes to a telemedicine intervention or usual care .  Intervention participants had lower A1C levels over 5 years . New analyses were performed to help better underst and this difference . RESEARCH DESIGN AND METHODS IDEATel r and omized Medicare beneficiaries with diabetes ( n = 1,665 ) to receive home video visits with a diabetes educator and upload glucose levels every 4–6 weeks or usual care ( 2000–2007 ) . Annual measurements included BMI , A1C ( primary outcome ) , and completion of question naires . Mixed-model analyses were performed using r and om effects to adjust for clustering within primary care physicians . RESULTS At baseline , A1C levels  ( mean ± SD ) were 7.02 ± 1.25 % in non-Hispanic whites ( n = 821 ) , 7.58 ± 1.78 % in non-Hispanic blacks ( n = 248 ) , and 7.79 ± 1.68 % in Hispanics ( n = 585 ) . Over time , lower A1C levels were associated with more glucose uploads ( P = 0.02 ) and female sex ( P = 0.002 ) . Blacks , Hispanics , and insulin-users had higher A1C levels than non-Hispanic whites ( P < 0.0001 ) . BMI was not associated with A1C levels . Blacks and Hispanics had significantly fewer uploads than non-Hispanic whites over time . Hispanics had the highest baseline A1C levels and showed the greatest improvement in the intervention , but , unlike non-Hispanic whites , Hispanics did not achieve A1C levels < 7.0 % at 5 years . CONCLUSIONS Racial/ethnic disparities were observed in this cohort of underserved older adults with diabetes . The IDEATel telemedicine intervention was associated with improvement in glycemic control , particularly in Hispanics , who had the highest baseline A1C levels , suggesting that telemedicine has the potential to help reduce disparities in diabetes management The aim was to compare clinical efficacy and safety of two treatment regimens : biphasic insulin aspart ( BIAsp ) injected at all three meals plus neutral protamine Hagedorn ( NPH ) insulin at bedtime vs. a human insulin regimen , premixed human insulin at breakfast and soluble insulin at lunch and dinner and NPH at bedtime . A total of 167 adolescents ( 80 males and 87 females ) with type 1 diabetes was included in the trial ( multinational , r and omized , open-label , and parallel group ) . Each subject received either of two treatment regimens for a 4-month period . BIAsp was injected immediately before main meals , human insulin products 30 min before meals , and NPH at night . Glycemic control was monitored by eight-point evaluations ( after 6 and 16 wks ) and hemoglobin A1c ( HbA1c ) ( after 2 , 6 , and 16 wks ) . Safety evaluations included adverse events and incidence of hypoglycemic episodes . HbA1c ( mean+/- SD ) after 4 months on BIAsp ( 9.39+/- 0.14 ) was not significantly different from that with human insulin ( 9.30+/- 0.15 ) . The average postpr and ial glucose increment in the BIAsp group was about half the increment in the human insulin group ; the difference not statistically significant . The body mass index ( BMI ) increased in both groups , but significantly ( p=0.005 ) less in the BIAsp group . However , in males on BIAsp , the BMI decreased compared with those on human insulin ( p=0.007 ) . No significant group differences were found for the rate of hypoglycemic episodes . We concluded that the BIAsp regimen was associated with similar glycemic control and similar incidence of hypoglycemic episodes as human insulin . However , the BIAsp regimen caused a significantly smaller increase in BMI , particularly in males , compared with the human insulin regimen Effective control of diabetes is known to delay or prevent the end-organ complications of this disease . Can telemedicine improve a patient 's ability to self-manage diabetes  ? Twenty-eight patients entered a study comparing home telemedicine consultation with st and ard outpatient care . A nurse case manager contacted the telemedicine group once a week under the direction of a primary care physician , who contacted the telemedicine group once a month . Laboratory studies and total body weight were measured at the beginning and at the end of the 3-month study . The hemoglobin A1c ( HbA1c ) and total body weight improved significantly in the intervention ( telemedicine ) group , as shown by a 16 % reduction in mean HbA1c level ( from 9.5 to 8.2 % ) and a 4 % mean weight reduction ( from 214.3 to 206.7 pounds ) . Based on our experience , we present a functionally based telemedicine classification system to improve the application of electronic medicine in future studies Objectives To examine whether improved diabetes control is related to better cognitive outcomes . Design R and omized control trial . Setting A r and omized trial of telemedicine vs. usual care in elderly persons with type 2 diabetes . Participants Participants were 2169 persons 55 years and older with type 2 diabetes from New York City and Upstate New York . InterventionThe diabetes case management intervention was implemented by a diabetes nurse , via a telemedicine unit in the participant ’s home , and in coordination with the primary care physician . Measurements Hemoglobin A1c ( HbA1c ) , systolic blood pressure ( SBP ) , and low density lipoprotein cholesterol ( LDL ) , were measured at a baseline visit and at up to 5 annual follow-up visits . Global cognition was measured at those visits with the Comprehensive Assessment and Referral Evaluation ( CARE ) . Result In mixed models the intervention was related to slower global cognitive decline in the intervention group ( p = 0.01 ) . Improvements in HbA1c ( p = 0.03 ) , but not SBP or LDL , mediated the effect of the intervention on cognitive decline . Conclusion Improved diabetes control in the elderly following existing guidelines through a telemedicine intervention was associated with less global cognitive decline . The main mediator of this effect seemed to be improvements in HbA1c BACKGROUND Telemedicine-based diabetes management improves outcomes versus clinic care but is seldom implemented by healthcare systems . In order to advance telemedicine-based management as a practical option for veterans with persistent poorly controlled diabetes mellitus ( PPDM ) despite clinic-based care , we evaluated a comprehensive telemedicine intervention that we specifically design ed for delivery using existing Veterans Health Administration ( VHA ) clinical staffing and equipment . MATERIAL S AND METHODS We conducted a 6-month r and omized trial among 50 veterans with PPDM ; all maintained hemoglobin A1c ( HbA1c ) levels continuously > 9.0 % for > 1 year despite clinic-based management . Participants received usual care or a telemedicine intervention combining telemonitoring , medication management , self-management support , and depression management ; existing VHA clinical staff delivered the intervention . Using linear mixed models , we examined HbA1c , diabetes self-care ( measured by the Self-Care Inventory-Revised question naire ) , depression , and blood pressure . RESULTS At baseline , the model-estimated common HbA1c intercept was 10.5 % . By 6 months , estimated HbA1c had improved by 1.3 % for intervention participants and 0.3 % for usual care ( estimated difference , -1.0 % , 95 % confidence interval [ CI ] , -2.0 % , 0.0 % ; p = 0.050 ) . Intervention participants ' diabetes self-care ( estimated difference , 7.0 ; 95 % CI , 0.1 , 14.0 ; p = 0.047 ) , systolic blood pressure ( -7.7 mm Hg ; 95 % CI , -14.8 , -0.6 ; p = 0.035 ) , and diastolic blood pressure ( -5.6 mm Hg ; 95 % CI , -9.9 , -1.2 ; p = 0.013 ) were improved versus usual care by 6 months . Depressive symptoms were similar between groups . CONCLUSIONS A comprehensive telemedicine intervention improved outcomes among veterans with PPDM despite clinic-based care . Because we specifically design ed this intervention with scalability in mind , it may represent a practical , real-world strategy to reduce the burden of poor diabetes control among veterans PURPOSE The purpose of this study was to evaluate the effects of a culturally sensitive diabetes education program for Hispanics with type 2 diabetes . METHODS This study is a prospect i ve cohort study to test the impact of a comprehensive diabetes education program on blood glucose control on Hispanics with type 2 diabetes . The educational program focused on maintaining glycemic control and general aspects of managing diabetes and complications . The study participants were recruited by flyers placed in Hispanic markets and in ambulatory care clinics . A total of 34 Hispanic male and female subjects with type 2 diabetes participated in the study . The concentrations of glucose , insulin , hemoglobin A1c ( HbA1c ) , total cholesterol , triglycerides , low-density lipoprotein and high-density lipoprotein ( HDL ) cholesterol were analyzed at baseline and at 3 months . RESULTS A significant mean change was observed for HbA1c , fasting plasma glucose , cholesterol/HDL ratio , and HDL after 3 months of education compared with baseline . There were significant reductions in weight , total fat , percent fat , trunk fat , and waist-to-hip ratio compared with baseline . After 3 months , subjects showed a significant positive correlation between changes in body mass index and insulin and weight , total fat , trunk fat , and fat free mass and insulin . CONCLUSIONS A culturally sensitive program conducted in Spanish had a significant impact on important clinical parameters in Hispanic subjects with diabetes in a relatively short time period . The study demonstrates the importance of design ing education intervention studies that are sensitive to cultural diversity , particularly in at-risk diabetic subjects 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 PURPOSE : Efficient ways are needed to implement the secondary prevention ( SP ) of coronary heart disease . Because few studies have investigated Web-based SP programs , our aim was to determine the usefulness of a new Web-based telemonitoring system , connecting patients provided with self-measurement devices and care managers via mobile phone text messages , as a tool for SP . METHODS : A single-blind , r and omized controlled , clinical trial of 203 acute coronary syndrome ( ACS ) survivors , was conducted at a hospital in Madrid , Spain . All patients received lifestyle counseling and usual-care treatment . Patients in the telemonitoring group ( TMG ) sent , through mobile phones , weight , heart rate , and blood pressure ( BP ) weekly , and capillary plasma lipid profile and glucose monthly . A cardiologist accessed these data through a Web interface and sent recommendations via short message service . Main outcome measures were BP , body mass index ( BMI ) , smoking status , low-density lipoprotein-cholesterol ( LDL-c ) , and glycated hemoglobin A1c ( HbA1c ) . RESULTS : At 12-month followup , TMG patients were more likely ( RR = 1.4 ; 95 % CI = 1.1−1.7 ) to experience improvement in cardiovascular risk factors profile than control patients ( 69.6 % vs 50.5 % , P = .010 ) . More TMG patients achieved treatment goals for BP ( 62.1 % vs 42.9 % , P = .012 ) and HbA1c ( 86.4 % vs 54.2 % , P = .018 ) , with no differences in smoking cessation or LDL-c . Body mass index was significantly lower in TMG ( −0.77 kg/m2 vs + 0.29 kg/m2 , P = .005 ) . CONCLUSIONS : A telemonitoring program , via mobile phone messages , appears to be useful for improving the risk profile in ACS survivors and can be an effective tool for secondary prevention , especially for overweight patients 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 OBJECTIVE The purpose of the study was to investigate the effect of comorbid depression on glycemic control and on response to a telemedicine case management intervention for elderly , ethnically diverse diabetic patients . RESEARCH DESIGN AND METHODS Medicare beneficiaries in underserved areas were participants ( n = 1,665 ) in the Informatics for Diabetes Education and Telemedicine ( IDEATel ) project and r and omized to a telemedicine case management intervention or usual care .  The data analyzed include baseline demographics ( age , sex , race/ethnicity , marital status , insulin use , years of education , years of diabetes , and pack-years smoked ) and measures of glycemic control ( HbA(1c ) [ A1C ] ) , comorbidity , diabetes symptom severity , functional disability and depression , and 1-year ( n = 1,578 ) A1C . The association between depression and glycemic control was analyzed cross-sectionally and prospect ively . RESULTS At baseline , there was a significant correlation between depression and A1C and a trend for depression to predict A1C when other factors were controlled . However , in prospect i ve analyses , depression did not predict change in A1C , either in the control or intervention group . CONCLUSIONS In this large sample of elderly diabetic patients , a weak relationship between depression and A1C was found , but depression did not prospect ively predict change in glycemic control . Thus , there is no evidence that depression should be used to exclude patients from interventions . Also , we should evaluate the impact of depression on outcomes other than glycemic control OBJECTIVE To study hemoglobin A1c ( HbA1c ) as a tool for diagnosing diabetes and to study HbA1c as a cardiovascular risk marker in patients with polycystic ovary syndrome ( PCOS ) . DESIGN Retrospective observational study . SETTING Academic tertiary-care medical center . PATIENT(S ) Two hundred eight premenopausal women with PCOS . INTERVENTION(S ) Patients underwent  clinical evaluation ( Ferriman-Gallwey score , body mass index , waist , blood pressure ) , hormone analyses ( T , sex hormone-binding globulin , fasting lipids , insulin , glucose , HbA1c ) , transvaginal ultrasound , and 2-hour oral glucose tolerance tests ( OGTT ) measuring capillary blood glucose ( BG ) at 0 ( BG 0 ) and 120 ( BG 120 ) minutes , insulin , and C-peptide . MAIN OUTCOME MEASURE(S ) Results of OGTT , HbA1c values . RESULT ( S ) Twenty patients were diagnosed with type 2 diabetes during OGTT . The sensitivity and specificity of HbA1c ≥6.5 % for the diagnosis of diabetes were 35 % and 99 % , respectively , compared with the diagnosis established by OGTT . Hemoglobin A1c showed closer correlation with waist , body mass index , and lipid profile than BG 120 , suggesting that HbA1c could be a cardiovascular risk marker . CONCLUSION ( S ) The clinical utility of HbA1c for diagnosing impaired glucose tolerance and type 2 diabetes in PCOS in daily practice is low . Long-term prospect i ve studies are needed to determine whether HbA1c is superior to glucose levels as a cardiovascular risk marker in patients with PCOS PURPOSE The relationship between the self-monitoring of blood glucose ( SMBG ) and glycemic control in patients with type 2 diabetes mellitus in a Veterans Affairs ( VA ) medical center was studied . METHODS Laboratory , inpatient , outpatient , and demographic data for patients with type 2 diabetes mellitus who were seen for three years continuously or receiving their care regularly from a single Texas VA facility between October 1 , 1999 , and September 30 , 2002 , were obtained . Local pharmacy data were used to identify patients who received blood-glucosemonitoring strips . Patients were assigned to one of four mutually exclusive groups : those who did not receive monitoring strips at all , those who received strips in fiscal year ( FY ) 2002 only , those who received strips in FYs 2001 and 2002 , and those who received strips during all three years ( FYs 2000 , 2001 , and 2002 ) . Frequency of monitoring and case-mix scores were measured . Nonparametric statistics were used to compare the demographic and clinical characteristics of the four groups . Robust regression was used to analyze the relationships between SMBG and glycemic control in FY 2002 . RESULTS Of the 1185 patients who received oral hypoglycemic medications during all three fiscal years , 976 patients met the criteria for inclusion in one of the four groups . There were no significant differences among the four groups in baseline hemoglobin A1c ( HbA1c ) values , body mass index , or case-mix scores . The Kruskal-Wallis test found no significant difference among the four groups in the number of laboratory blood glucose tests conducted , but there were significant differences in the number of HbA1c tests conducted among the groups . CONCLUSION SMBG was not associated with glycemic control in VA patients with type 2 diabetes mellitus managed on oral hypoglycemic medications 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 BACKGROUND Continuous subcutaneous insulin infusion ( CSII ) is believed to decrease glycemic variability and clinical hypoglycemia compared with the multiple daily insulin ( MDI ) regimen . To compare the indices of glycemic instability between CSII and MDI , we analyzed the continuous glucose monitoring system ( CGMS ) ( Medtronic MiniMed , Northridge , CA ) profiles of a group of children with type 1 diabetes mellitus with history of frequent blood glucose ( BG ) fluctuations and hypoglycemia . PATIENTS AND METHODS Data from 14 ( nine girls , five boys ) patients ( 3.9 - 16.8 years old ) on CSII and 14 age- and sex-matched ( nine girls , five boys ) patients ( 3.9 - 16.0 years old ) on MDI with similar glycemic control ( hemoglobin A1c : 7.9 + /- 1.0 % vs. 7.9 + /- 1.5 % ) and body mass index ( BMI ) ( 20.1 + /- 4.3 vs. 19.9 + /- 4.1 kg/m(2 ) ) were evaluated by the CGMS . Mean BG ( MBG ) , absolute means of daily differences ( MODD ) , mean amplitude of glycemic excursion ( MAGE ) , and number of hypoglycemic events ( BG < 60 mg/dL ) for 48 h were calculated . RESULTS The MBG , MODD , MAGE , and number and mean duration of hypoglycemia events in the CSII group were similar to those in the MDI group . The MAGE had an inverse correlation with age ( CSII : r ( 2 ) = 0.52 , P = 0.003 ; MDI : r ( 2 ) = 0.29 , P < 0.04 ) and BMI ( CSII : r ( 2 ) = 0.38 , P < 0.02 ; MDI : r ( 2 ) = 0.71 , P < 0.0002 ) . However , there was a positive relationship between MAGE and bolus : basal insulin ratio in the CSII ( r ( 2 ) = 0.28 , P < 0.05 ) and MDI ( r ( 2 ) = 0.33 , P < 0.03 ) groups . Also , the MAGE had a positive correlation with frequency of hypoglycemic events in the CSII ( r ( 2 ) = 0.44 , P < 0.01 ) and MDI ( r ( 2 ) = 0.35 , P < 0.03 ) groups . CONCLUSIONS The CSII and MDI regimens in children and adolescents with comparable glycemic control displayed similar patterns of glycemic excursions , implying that factors influencing glycemic instability in pediatric type 1 diabetes mellitus appear to be independent of treatment modality 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 : 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 INTRODUCTION Diabetic foot ulcers are a feared complication of diabetes . Care delivered via telemedicine is suggested to be a more integrated care pathway to manage diabetic foot ulcers than traditionally delivered healthcare . Our aim was to explore patients ' experiences with telemedicine follow-up care as compared to traditional care . METHODS Interpretive description was used as an analysis strategy . Data were collected using individual semi-structured interviews in the context of a larger ongoing clustered r and omized controlled trial . Twenty-four patients ( 13 in the intervention group ; 11 in the control group ) , aged 38 - 88 years were purposively recruited from the RCT in order to obtain a diverse sample in terms of group composition ( intervention vs. control ) , age , gender , marital status , setting , and comorbidities present . The control group received traditional care . RESULTS Three themes emerged from the interpretive analysis : competence of healthcare professionals , continuity of care , and easy access . This was independed of types of follow-up that had limited impact on the patients ' follow-up experiences . Competence of healthcare professionals and continuity of care were crucial , because they can either enhance or jeopardize wound care . If these two latter factors were absent , patients would lose confidence in the wound care process . If this happened , patients pointed out that the expert knowledge of a specialist clinic was essential to receive good care . When telemedicine functioned optimally , telemedicine was an advantage in the treatment , because the images quickly captured changes in the wound healing that immediately could be corrected . Easy access is important for patients , but the importance of accessibility appears to be primary when the other two factors were present . CONCLUSION The best wound care pathway for patients with diabetes foot ulcers is depended on a combination of competence and professional skills in wound management , and continuity of care . If telemedicine is functioning as intended , it can be an important additional tool
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
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 ) .