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05-24-2018 | Devices and technology | Review | Article

Telemedicine in Complex Diabetes Management

Journal: Current Diabetes Reports

Author: Marie E. McDonnell

Publisher: Springer US



Purpose of Review

Telehealth has the potential to positively transform the quality and cost-effectiveness of complex diabetes management in adults. This review explores the landscape of telemedicine approaches and evidence for incorporation into general practice.

Recent Findings

Telemedicine for diabetes care is feasible based on over 100 randomized clinical trials. Evidence shows modest benefits in A1c lowering and other clinical outcomes that are better sustained over time vs. usual care. While telemedicine interventions are likely cost-effective in diabetes care, more research is needed using implementation science approaches.


Telehealth platforms have been shown to be both feasible and effective for health care delivery in diabetes, although there are many caveats that require tailoring to the institution, clinician, and patient population. Research in diabetes telehealth should focus next on how to increase access to patients who are known to be marginalized from traditional models of health care.
American Diabetes, A. Economic costs of diabetes in the U.S. in 2012. Diabetes Care. 2013;36(4):1033–46. CrossRef
Health Expenditure, total % of GDP. 2017 1/1/2018; Available from: https://​data.​worldbank.​org/​indicator/​SH.​XPD.​TOTL.​ZS?​locations=​US.
Hero JO, Blendon RJ, Zaslavsky AM, Campbell AL. Understanding what makes Americans dissatisfied with their health care system: an international comparison. Health Aff (Millwood). 2016;35(3):502–9. CrossRef
Gregg EW, Williams DE, Geiss L. Changes in diabetes-related complications in the United States. N Engl J Med. 2014;371(3):286–7. PubMed
Shojania KG, Ranji SR, McDonald KM, Grimshaw JM, Sundaram V, Rushakoff RJ, et al. Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis. JAMA. 2006;296(4):427–40. CrossRefPubMed
Seaquist ER. Addressing the burden of diabetes. JAMA. 2014;311(22):2267–8. CrossRefPubMed
UK Prospective Diabetes Study 6. Complications in newly diagnosed type 2 diabetic patients and their association with different clinical and biochemical risk factors. Diabetes Res. 1990;13(1):1–11.
DCCT. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The diabetes control and complications trial research group. N Engl J Med. 1993;329(14):977–86. CrossRef
Ashwood JS, Mehrotra A, Cowling D, Uscher-Pines L. Direct-to-consumer telehealth may increase access to care but does not decrease spending. Health Aff (Millwood). 2017;36(3):485–91. CrossRef
Sepah SC, Jiang L, Peters AL. Long-term outcomes of a Web-based diabetes prevention program: 2-year results of a single-arm longitudinal study. J Med Internet Res. 2015;17(4):e92. CrossRefPubMedPubMedCentral
Rushakoff RJ, Sullivan MM, MacMaster HW, Shah AD, Rajkomar A, Glidden DV, et al. Association between a virtual glucose management service and glycemic control in hospitalized adult patients: an observational study. Ann Intern Med. 2017;166(9):621–7. CrossRefPubMed
Duffy S, Lee TH. In-person health care as option B. N Engl J Med. 2018;378(2):104–6. CrossRefPubMed
Vidscrip. A series of videos about a health topic created by your very own healthcare provider [cited 2018 1/1/2018]; Available from: https://​www.​vidscrip.​com/.
Moy FM, et al. Techniques of monitoring blood glucose during pregnancy for women with pre-existing diabetes. Cochrane Database Syst Rev. 2017;6:CD009613. PubMed
Mileski M, Kruse CS, Catalani J, Haderer T. Adopting telemedicine for the self-management of hypertension: systematic review. JMIR Med Inform. 2017;5(4):e41. CrossRefPubMedPubMedCentral
•Faruque LI, et al. Effect of telemedicine on glycated hemoglobin in diabetes: a systematic review and meta-analysis of randomized trials. CMAJ. 2017;189(9):E341–64. In this meta-analysis of 111 trials, telemedicine interventions in diabetes were found overall to result in clinically significant A1c reductions. CrossRefPubMedPubMedCentral
•Shea S, et al. A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus: 5 year results of the IDEATel study. J Am Med Inform Assoc. 2009; 16(4):446–56. This is the first large randomized trial comparing synchronous virtual visits and remote data monitoring (glucose and blood pressure) to usual care in patients with diabetes. The trial demonstrated that the telemedicine approach improved A1c and blood pressure, and patients in the active group were overall more able to sustain improvement. CrossRefPubMedPubMedCentral
Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, et al. Diabetes in older adults: a consensus report. J Am Geriatr Soc. 2012;60(12):2342–56. CrossRefPubMedPubMedCentral
Garber AJ, Abrahamson MJ, Barzilay JI, Blonde L, Bloomgarden ZT, Bush MA, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of endocrinology on the comprehensive type 2 diabetes management algorithm—2017 executive summary. Endocr Pract. 2017;23(2):207–38. CrossRefPubMed
UKPDS. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):837–53. CrossRef
Kempf K, Altpeter B, Berger J, Reuß O, Fuchs M, Schneider M, et al. Efficacy of the telemedical lifestyle intervention program TeLiPro in advanced stages of type 2 diabetes: a randomized controlled trial. Diabetes Care. 2017;40(7):863–71. CrossRefPubMed
Bouchonville MF, Paul MM, Billings J, Kirk JB, Arora S. Taking telemedicine to the next level in diabetes population management: a review of the Endo ECHO model. Curr Diab Rep. 2016;16(10):96. CrossRefPubMed
Kerfoot BP, Gagnon DR, McMahon GT, Orlander JD, Kurgansky KE, Conlin PR. A team-based online game improves blood glucose control in veterans with type 2 diabetes: a randomized controlled trial. Diabetes Care. 2017;40(9):1218–25. CrossRefPubMed
Lauffenburger JC, Lewey J, Jan S, Nanchanatt G, Makanji S, Ferro CA, et al. Rationale and design of the ENhancing outcomes through goal assessment and generating engagement in diabetes mellitus (ENGAGE-DM) pragmatic trial. Contemp Clin Trials. 2017;59:57–63. CrossRefPubMed
Lewey J, Wei W, Lauffenburger JC, Makanji S, Chant A, DiGeronimo J, et al. Targeted adherence intervention to reach glycemic control with insulin therapy for patients with diabetes (TARGIT-diabetes): rationale and design of a pragmatic randomised clinical trial. BMJ Open. 2017;7(10):e016551. CrossRefPubMedPubMedCentral
Daskivich LP, Vasquez C, Martinez C Jr, Tseng CH, Mangione CM. Implementation and evaluation of a large-scale Teleretinal diabetic retinopathy screening program in the Los Angeles County Department of Health Services. JAMA Intern Med. 2017;177(5):642–9. CrossRefPubMedPubMedCentral
•Lee SWH, Ooi L, Lai YK. Telemedicine for the management of glycemic control and clinical outcomes of type 1 diabetes mellitus: a systematic review and meta-analysis of randomized controlled studies. Front Pharmacol. 2017; 8:330. This meta-analysis included 38 studies that investigated several telemedicine techniques in type 1 diabetes and found that adults are more likely to benefit than children. CrossRefPubMedPubMedCentral
NEJM Catalyst. Website 2017. Available from: https://​catalyst.​nejm.​org/​challenges-launching-telehealth-program/​. Accessed 2 February 2018.
The American Telemedicine Association policy resource center. Website 2018. Available from: www.​americantelemed.​org/​policy-page/​state-policy-resource-center. Accessed 4 April 2018
Kakkar A, Jacobson BC. Failure of an Internet-based health care intervention for colonoscopy preparation: a caveat for investigators. JAMA Intern Med. 2013;173(14):1374–6. CrossRefPubMed
Yusif S, Hafeez-Baig A, Soar J. e-Health readiness assessment factors and measuring tools: a systematic review. Int J Med Inform. 2017;107:56–64. CrossRefPubMed
McIntosh JRD, Jay S, Hadden N, Whittaker PJ. Do E-health interventions improve physical activity in young people: a systematic review. Public Health. 2017;148:140–8.
Tucker KL, et al. Self-monitoring of blood pressure in hypertension: a systematic review and individual patient data meta-analysis. PLoS Med. 2017;14(9):e1002389. CrossRefPubMedPubMedCentral
Hunter CM, McKinnon RA, Esposito L. News from the NIH: research to evaluate “natural experiments” related to obesity and diabetes. Transl Behav Med. 2014;4(2):127–9. CrossRefPubMedPubMedCentral

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