4. Discussion
T2DM, diabetes
DIABETES
The TeLIPro RCT proved that in a real-life setting, T2DM patients with longer diabetes duration can significantly benefit from the evaluated telemedicine-based lifestyle intervention. After 12 months of intervention, patients in the TeLIPro group achieved a significantly greater reduction in HbAThe current TeLIPro study in health insurance patients with T2DM is the follow-up and real-life verification study of the TeLiPro study in T2DM patients with insufficient metabolic control [A possible explanation for this might be that the first study was advertised via general practitioners and newspaper articles, and the participants had registered of their own accord. In the later study, participation was offered to patients with T2DM by their health insurance; thus, patients with little motivation and less drive might have been included. But this represents the situation in real life. Nevertheless, after 12 months of intervention, 688 persons (84%) regularly transferred their steps and body weight, logged into the online portal at least once a week, and answered the care calls, though they were rated to be compliant. Therefore, the lack of meal replacement is seen as the main reason for the lower effects on HbAStandard care with basic diabetes education was assumed to enable patients to carry out a successful lifestyle intervention on their own; however, a variety of studies rejected this postulation [However, in the meantime, health devices with transfer functions have become state-of-the-art and are no longer a cost driver. Moreover, the open system architecture of the portal ensures interoperability. As an end-to-end solution, the online portal supports the elimination of fragmentation in healthcare. By integrating the numerous devices available on the market, patients can use their own and already available devices in the future. Personnel-intensive delivery methods are successful, and new communication approaches via apps show impressive results [This study has several strengths and limitations that need to be mentioned. More than 42.000 health-insured persons have been invited for participation in the study, of whom only 1.163 were interested. There was a relatively high number of persons who did not receive the allocated intervention. When they had been invited by their health insurance to participate in the study, they agreed in the first step but then withdrew consent after randomization. This is a common problem in real-life health insurance studies and might be overcome by performing the randomization in a later phase, e.g., after the first log-in to the online portal. However, the drop-out rate for the whole study population that received the allocated intervention was only 16% during the 12-month study period and a further 4% in the 6-month follow-up phase, largely without significant differences between completers and dropouts at baseline. It could be hypothesized that this randomization procedure might have led to a selection bias since the control group and the TeLIPro group differ in baseline HbAAn important strength and, at the same time, a limitation was the real-life study design, leaving patients in routine care at their general practitioner or diabetologist with the intervention as an on-top supply. A disadvantage and possibly the main limitation of the study is that due to the study design with the participants entering the data by themselves into the portal, the data sets were partly incomplete (also for HbAIt also might be criticized that the clinical variables had been measured in local laboratories. Nevertheless, since laboratory measurements were consistently performed at the same laboratory and were reported in written form by the attending physician using the standardized DMP documentation, intra-individual differences should not have been affected. Moreover, we observed a very high HbA