In a randomized control trial conducted at the Palo Alto Medical Foundation (PAMF) in California, researchers showed that patients with uncontrolled type 2 diabetes benefited from an online disease management program conducted with wireless blood glucose equipment and a smartphone.
The trial, conducted over twelve months, involved 415 patients, 193 of which received a wireless home glucometer that uploaded readings through a smartphone to PAMF’s integrated EHR. The patients could view their information online and log in to information about diabetes management, including tips on diet, blood pressure, exercise, insulin management, and weight control. Dieticians and nurse managers communicated with the test group through secure messaging, and the participants received regular feedback about their progress.
After six months, the test subjects had significantly better control over their glycosylated hemoglobin (AC1) values as compared to the control group, and showed an overall decrease in AC1 levels after 12 months. Paul C. Tang, MD, VP and chief innovation and technology officer at PAMF, told InformationWeek Healthcare that it was important that more patients in the test group achieved a lower average AC1 level though the test program. In fact, he said, it’s a better quality measure than looking at the average A1C of a group of patients with diabetes, because it is a more accurate indicator of population health.
An additional finding of the study was that patients in the wireless monitoring group had their medications adjusted more frequently than those who received standard care. Tang noted that one of the problems for patients with uncontrolled diabetes is a lack of properly adjusted medications. Patients may not be using the right medicines or taking the right doses, since standard care only schedules appointments two to four times a year. With the constant monitoring and direct nurse involvement of the wireless care program, patients had more frequent contact with their providers, facilitating changes when needed.
Tang concludes that patients could safely reduce the number of necessary appointments as long as they continue with the online monitoring system. “In between visits with the doctor, the nurse is watching over you and giving you advice. If you’re out of control and are getting worse, the nurse can intensify your medication, for example. You can safely manage people and improve on the outcomes using primarily online tools,” Tang said. “The nurses still could call patients and see them physically, but most of the interactions were online. That’s important.”
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