The study was presented from Jothydev’s Diabetes Research Center, Trivandrum at the
International Diabetes Federation Congress 2019, organized by IDF at Busan. The Research
team headed by Dr.Jothydev Kesavadev included Dr.Arun Shankar, Bhavya Balan Chandrika,
Geethu Sanal, Gopika Krishnan and Sunitha Jothydev.
Aging parameters have demonstrated to impact both the prevalence and development of insulin
resistance, impaired glucose tolerance and diabetes complications. Therefore achieving glycemic
targets, preventing diabetes comorbidities and reducing diabetes related mortality among older
adult subjects present significant individual, social, economic and clinical challenges.
Appropriate diabetes care for elderly thus demand rigorous continued monitoring accompanied by
integrated individual-centric approach together to ensure customized titration of medications,
diabetes education, behavioural modifications to assure the quality of life.
Virtual consultation via telemedicine program (Diabetes Tele Management System DTMS launched
in 1998) is demonstrated to be an effective strategy to guarantee close monitoring of diabetes
patients attending our center. The study assesses the impact of continuous and systematic
monitoring towards achieving sustained glycemic control and prevention of diabetes complications
in elderly type 2 patients over ten years.
Patients attending our diabetes centre are encouraged to participate in our telemedicine program(DTMSR)
which allows for customised titration of medications, diabetes education and behavioural modifications
through virtual consultations while precluding frequent physical visits. It empowers the healthcare
team to ensure that each patient is adherent to medications, visits the clinic for laboratory investigations
to change therapies accordingly, is performing recommended SMBG, and largely ensures that apart from
diabetes control, all other major targets of therapy are achieved.
In this study, T2DM patients ≥ 60 years with A1c ≥ 7%, undergoing regular follow-upof virtual
consultation ≥ 1 in 3 months, physical visit ≥ 1 in 3y, & attended group diabetes education ≥
1 in 3y) for consecutive ten years via DTMS were identified. Exclusion criteria include CKD
(4&5), A1c targets were customized depending on co-morbidities. The data of 413 (67% males and 33% females)
with average age of 64+4 years and 13 ± 5 years of diabetes duration and having mean A1c 8.17 ± 2.31 % were
analysed. Mean A1c of the cohort at baseline and at ten years were compared. Cardiac and renal
outcomes were assessed during physical visits.
Significant improvement in A1c was demonstrated in older adult diabetes subjects undergoing
routine follow- up and integrated medical care over ten years. Male subjects showed improved
and sustained glycemic control with a statistically significant reduction in A1c (-0.98,
p-value 0.00027) than women (-0.73, p-value 0.05). Longitudinal analysis of the ten years
follow up data showed lesser instances of severe hypoglycemia for subjects with frequent
follow-up. The laboratory parameters demonstrated improved cardiac and renal outcomes
through integrated care and telemonitoring. In contrast, elderly subjects with irregular
follow-ups presented worsened glycemic control.
This study demonstrated the impact of integrated care and continuous follow-up in
achieving glycemic targets thus preventing diabetes-related complications in a cohort
of older adults with diabetes.