Article

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

Division of General Medicine, New York, NY, USA.
Journal of the American Medical Informatics Association (Impact Factor: 3.93). 05/2009; 16(4):446-56. DOI: 10.1197/jamia.M3157
Source: PubMed

ABSTRACT Context: Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions and lower access to care.
Objectives: To examine the effectiveness of a telemedicine intervention to achieve clinical management goals in older, ethnically diverse, medically underserved patients with diabetes.
Design, Setting, and Patients: A randomized controlled trial was conducted, comparing telemedicine case management to usual care, with blinded outcome evaluation, in 1,665 Medicare recipients with diabetes, aged ≥ 55 years, residing in federally designated medically underserved areas of New York State.
Interventions: Home telemedicine unit with nurse case management versus usual care.
Main Outcome Measures: The primary endpoints assessed over 5 years of follow-up were hemoglobin A1c (HgbA1c), low density lipoprotein (LDL) cholesterol, and blood pressure levels.
Results: Intention-to-treat mixed models showed that telemedicine achieved net overall reductions over five years of follow-up in the primary endpoints (HgbA1c, p = 0.001; LDL, p < 0.001; systolic and diastolic blood pressure, p = 0.024; p < 0.001). Estimated differences (95% CI) in year 5 were 0.29 (0.12, 0.46)% for HgbA1c, 3.84 (−0.08, 7.77) mg/dL for LDL cholesterol, and 4.32 (1.93, 6.72) mm Hg for systolic and 2.64 (1.53, 3.74) mm Hg for diastolic blood pressure. There were 176 deaths in the intervention group and 169 in the usual care group (hazard ratio 1.01 [0.82, 1.24]).
Conclusions: Telemedicine case management resulted in net improvements in HgbA1c, LDL-cholesterol and blood pressure levels over 5 years in medically underserved Medicare beneficiaries. Mortality was not different between the groups, although power was limited.
Trial Registration: http://clinicaltrials.gov Identifier: NCT00271739.

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    • "Over half of the research participants represented in the meta-analysis came from a single trial (the IDEATel trial), which recruited 1,665 participants from medically underserved areas of New York State. In this trial, the improvements in HbA1c associated with telehealth were sustained over five years, and amounted to 0.29% at the end of that period (3.2 mmol/mol) [11-13]. IDEATel, however, began recruiting participants in 2002 when telehealth was relatively new. "
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    • "In the Informatics for Diabetes Education and Telemedicine (IDEATel) study,32 1,665 middle-aged Medicare recipients with diabetes were randomized to usual care or an intervention with a home telemedicine unit used for web access, videoconferencing with a health care professional and monitoring of glucose and BP. After 12 months, SBP and DBP were respectively lower in the intervention group (3.4 mmHg [P = 0.001] and 1.9 mmHg [P < 0.001]). "
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