Effectiveness and economic impact of a program of integrated care with telemedicine support on insulin-treated type 2 diabetic patients (Study GITDIABE)

Aim: To evaluate if insulin-treated type 2 diabetic patients with blood glucose self-monitoring (DIA), included in a program of integrated management of diabetes mellitus (DM), achieve a better level of metabolic control with telemedicine support than with conventional support, after 12 months follow-up. The impact on the use and cost of healthcare services, pharmaceutical expenditure, and consumption of test strips for blood glucose, was also assessed. Design: A prospective parallel cohorts study. Field: Four basic health areas of an integrated healthcare organisation. Participants: The study included 126 DIA patients aged 15 or more years, treated with rapid or intermediate Insulin and blood glucose self-monitoring, grouped into 42 cases and 84 controls, matched according to age, sex, level of metabolic control, and morbidity profile. Intervention: Telematics physician-patient communication and download of blood glucose self-monitoring data through the Emminens eConecta (R) platform; test strips home delivered according to consumption. Hidden controls with usual follow-up. Main measurements: Glycosylated haemoglobin (%HbAlc); perception of quality of life (EuroQol-5 and EsDQ0L); cardiovascular risk; use of healthcare resources;. consumption of test strips; pharmaceutical and healthcare expenditure. Results: Reduction of 0.38% in HbAlc in the cases (95% CI:-0.89% to 0.12%). No significant differences with regard to any of the activities registered, or any significant change in the quality of life. Conclusions: The results obtained are similar to other equivalent studies. The profile of the patient is elderly and with multiple morbidities, who still have technological limitations. To surpass these barriers, it would be necessary to devote more time to the training and to the resolution of possible technological problems. (C) 2016 Elsevier Espana, S.L.U.