JDC Gems

1. Telehomecare as a potential resource for better glycemic control in patients with diabetes

      The extreme surge in the prevalence of diabetes necessitates exploring diverse ways for the effective use of medical resources in diabetes management and care. Telehomecare (THC) is a remote mode of intervention through electronic data transmission for follow-up, education, prevention as well as clinical decision-making, and therapeutic adjustment with great potential for the diabetic population

      A recent prospective controlled clinical trial on this perspective attempted to assess the effect of clinical efficacy, nursing interventions, and medical visits on using telehomecare (THC) compared with the standard care in insulin-treated diabetes patients. Participants with at least 18 years of age and type 1 or type 2 diabetes treated with at least one injection of insulin per day with or without other oral/injectable antidiabetic agents were recruited during their clinical visits such as a medical visit or nursing visit follow-up. The THC group was advised to use medications provided by the health care team or access services through a web browser through their personal computer/tablet/phone and also to register their daily health activities personalized by the diabetes care provider. The study subjects were asked to record their capillary blood glucose values in fasting as well as before and/or 2 h after meals. Hypoglycemia alert was defined as capillary blood glucose <4.0 mmol/L and hyperglycemia alert as capillary blood glucose > 15.0 mmol/L. The blood glucose level assessment was done online daily and reviewed online of all data and charts with the medical team at least every 2 weeks.

      The study observed that out of a total of 105 participants, divided in to two groups such as the THC group & the control groups, participants in the THC group have a significant decrease in A1c compared with the group with standard care, which persisted 3 months after the end of the THC use. The results states that the impact on glycemic control found in the study, with a reduction of 0.61% in A1c, is similar to that observed with the use of some antidiabetic drugs. The improvement in glycemic control may be explained by the intensive glycemic monitoring and rapid therapeutic adjustments by the participants and care providers.

      Current studies suggest that diabetes education delivered through the internet or any other virtual platform is effective for the better improvement of glycemic control both in type 1 and type 2 diabetic populations. It is also useful for patients with difficult access to care and avoids the cost of medical visits and to encourage them in self-management of glycemic control and care adhering to THC programs.

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