Impact of telemedicine on glycemic control in type 2 diabetes mellitus during the COVID-19 lockdown period

Use of telephone calls to manage glycemic control at Mexico's northern border

Introduction

Telephone calls were used for glycemic control in type 2 diabetes mellitus (T2DM) patients during the Covid-19 pandemic. The study's objective was to determine the factors that favor glycemic control in patients with T2DM using telephone calls in the Mexico's northern border.

Methods

A retrospective cohort study was conducted with T2DM patients from the Family Medicine Unit 33 in Reynosa, Tamaulipas, from June 2021 to June 2022. The evaluation of glycemic control involved measuring glycated hemoglobin at the beginning and end of telephone follow-up. Clinical, demographic, social, and laboratory factors were analyzed using univariate and bivariate statistical methods to compare initial and final glycemic control, finally, two logistic regression models were estimated considering glycemic control as a binary variable.

Results

A total of 287 participants were followed up, comprising 122 men and 165 women, where 71.78% received nine or more phone calls. Initially, 49.13% had glycemic control, but by the end of the follow-up, it increased by 7%. Females show an Odds Ratio (OR) of 0.475 (95% CI 0.269-0.838), high-density lipid levels with an OR = 0.982 (p=0.078), and 11 follow-up telephone calls with an OR = 0.403 (95% CI 0.165-0.985), which represented factors contributing to glycemic control. Poor glycemic control is more likely in individuals with a high cardiovascular risk, with an OR of 2.193 (p=0.085).

Conclusion

Cell phone calls can effectively control glycemia in T2DM patients. Therefore, they can be used as a substitute for in-person medical care.

Comparison of the Effect of Teleconsultations, Hybrid Visits, and In-Person Visits on Glycemic and Metabolic Parameters Among Individuals With Type 2 Diabetes in India

AIM

We compared biochemical and clinical data of individuals with type 2 diabetes (T2D) who opted for only teleconsultation (ie, no in-person visit at all), hybrid visits (combining home blood tests and in-person consultation), and fully in-person visits (both tests and consultation in person) at a tertiary care diabetes center.

METHODS

In this observational cohort study, we retrieved demographic, anthropometric, and biochemical data of 8197 individuals with T2D who sought diabetes care between 2021 and 2023 (384 participants with only teleconsultations, 721 with hybrid visits, and 7092 with fully in-person visits) from the electronic medical records of a chain of tertiary diabetes care centers across India.

RESULTS

Individuals who opted for teleconsultation had a shorter duration of diabetes compared with those who opted for hybrid or fully in-person visits. Although participants who opted for a teleconsultation had better glycemic and lipid control at baseline, those who underwent hybrid and in-person visits showed greater improvements in fasting plasma glucose, glycated hemoglobin (A1c), and LDL cholesterol (LDL-C) during follow-up. Improvements in overall ABC target achievement (A1c, Blood pressure, and LDL-C) were greater in participants who had in-person visits compared with the other two groups.

CONCLUSION

While teleconsultation is a useful complement to in-person visits, the latter results in better glycemic and lipid control, perhaps due to more effective engagement with the diabetes care team.

Age-dependent effects of lockdown and post-lockdown periods on HbA1c during the COVID-19 pandemic: A 3-year longitudinal cohort study

The impact of COVID-19 lockdown on glycemic control in patients with diabetes mellitus (DM) remains unclear. This study aimed to investigate the effects of lockdown measures on the metabolic parameters of patients with DM, with particular emphasis on geriatric populations. In this retrospective, longitudinal cohort study, 1224 patients were analyzed. Three periods were identified to examine the effects of the lockdown: pre-lockdown, lockdown, and post-lockdown. Each period spanned 1-year. Within each 1-year period, at least 2 measurements were taken at least 3 months apart, and their arithmetic mean was calculated. Only patients who presented to the hospital for DM management during all 3 periods were included in the study. While HbA1c levels significantly increased in patients over 65 years old during the lockdown period (P = .017), we observed a significant decrease in HbA1c levels in patients under 65 years old (P = .014). Upon further stratification of patients over 65 by age groups, HbA1c levels increased the most among those aged 75 to 85 years, with a significant rise also observed in those aged 65 to 75 years during the lockdown. However, there was no change in HbA1c levels for patients over 85 years old during the lockdown. These findings highlight the need for careful monitoring of elderly patients with DM during lockdown periods, facilitated via home care or telehealth services. Structured diet and exercise programs should also be provided for at home adherence.

Assessment of knowledge, perception, and readiness for telepharmacy-assisted pharmaceutical services among young pharmacists in rural Indonesia

Background

The implementation of telepharmacy technology has expanded significantly, particularly during the COVID-19 pandemic, to ensure continuous pharmaceutical care services. This practice is vital in rural and underserved areas where access to healthcare is limited.

Objective

This study aims to assess the knowledge, perception, and readiness of young pharmacists in rural Indonesia towards telepharmacy-assisted pharmaceutical services.

Methods

A cross-sectional study was conducted from January to July 2023 in rural areas of Java, Sumatra, and Kalimantan, Indonesia. A convenience sampling method was employed with the aim of recruiting 520 registered pharmacists under 35 years of age (23-34 years old). Data were collected using an online questionnaire adapted for the local context and analyzed using SPSS version 26.0.

Results

The study achieved an 86.67 % response rate. Most participants were female (73.1 %) and aged between 26 and 30 years (53.8 %). Nearly all pharmacists (97.1 %) held a Pharm.D degree. The knowledge assessment showed high awareness of telepharmacy's importance and its role during the COVID-19 pandemic, with 96.15 % recognizing the need for a strong internet connection. Positive perception was noted, with 90.38 % agreeing that telepharmacy enhances medication access in rural areas. However, concerns about increased error rates and workload were highlighted. A substantial proportion of pharmacists expressed readiness for conducting drug counselling via video consultation (44.23 %) and showed a willingness to undergo relevant training (59.62 %).

Conclusion

Young pharmacists in rural Indonesia demonstrate a good level of knowledge and generally positive perceptions about telepharmacy, with notable readiness among pharmacists with less than five years of experience. While there is notable willingness to engage in telepharmacy practices and training, addressing concerns about workload and data security through targeted support and training will be crucial for the successful implementation of telepharmacy, potentially enhancing healthcare access in rural areas.

A Hybrid Model of In-Person and Telemedicine Diabetes Education and Care for Management of Patients with Uncontrolled Type 2 Diabetes Mellitus: Findings and Implications from a Multicenter Prospective Study

Background

Patients with uncontrolled type 2 diabetes mellitus (T2DM) require close follow-up, support, and education to achieve glycemic control, especially during the initiation or intensification of insulin therapy and self-care management. This study aimed to describe and evaluate the impact of implementing a hybrid model of in-person and telemedicine care and education on glycemic control for patients with uncontrolled T2DM (hemoglobin A1c [HbA1c] ≥9%) during the coronavirus disease pandemic.

Methods

This prospective multicenter-cohort pre-/post-intervention study was conducted on patients with uncontrolled T2DM. This study included three chronic illness centers affiliated with the Family and Community Medicine Department at Prince Sultan Military Medical City in Riyadh, Saudi Arabia. A hybrid model of in-person (onsite) and telemedicine care and education was developed. This involved implementing initial in-person care at the physicians' clinic and initial in-person education at the diabetes education clinic, followed by telemedicine services of tele-follow-ups, support, and education for an average 4-month follow-up period.

Results

Of the enrolled 181 patients, more than half of the participants were women (n = 103, 56.9%). The mean age of participants (standard deviation) was 58.64 ± 11.23 years and the mean duration of diabetes mellitus was 13.80 ± 8.55 years. The majority of the patients (n = 144; 79.6%) were on insulin therapy. Overall, in all three centers, the hybrid model had significantly reduced HbA1c from 10.47 ± 1.23% to 7.87 ± 1.59% (mean difference of reduction 2.59% [95% confidence interval (CI) = 2.34-2.85%], p < 0.001). At the level of each center, HbA1c was reduced significantly with mean differences of 3.17% (95% CI = 2.81-3.53%), 2.49% (95% CI = 1.92-3.06%), and 2.16% (95% CI = 1.76-2.57%) at centers A, B, and C, respectively (all p < 0.001).

Conclusion

The findings showed that the hybrid model of in-person and telemedicine care and education effectively managed uncontrolled T2DM. Consequently, the role of telemedicine in diabetes management could be further expanded as part of routine diabetes care in primary settings to achieve better glycemic control and minimize nonessential in-person visits when appropriate.

Efficacy of Insulin Titration Driven by SMS in Improving Glycemic Control in People with Type 2 Diabetes

AIM

To evaluate the efficacy of the self-management of insulin titration based on information received by the Short Message Service (SMS).

METHODS

A case-control study including 59 subjects in each arm with 16 weeks of follow-up was performed. The inclusion criteria were: (1) Subjects with type 2 diabetes (T2D) under basal insulin treatment; (2) Suboptimal glycemic control: HbA1c ≥ 7.5% and fasting capillary blood glucose (FCBG) > 140 mg/dL (>3 times per week). Subjects were invited to use an insulin titration service based on SMS feedback aimed at optimizing glycemic control depending on fasting blood glucose levels. Psychological aspects were evaluated in the interventional group by means of validated questionnaires (DDS, HADS and SF-12).

RESULTS

The intervention group achieved a lower mean FCBG (126 mg/dL ± 34 vs. 149 mg/dL ± 46, p = 0.001) and lower HbA1c (7.5% ± 1.3 vs. 7.9% ± 0.9, p = 0.021) than the control group. In addition, the intervention group showed a significant improvement in psychological aspects related to Emotional Burden (p = 0.031), Regimen Distress (p < 0.001), Depression (p = 0.049) and Mental Health (p < 0.01).

CONCLUSIONS

The SMS-guided titration was effective in terms of improving glucometric parameters in comparison with the standard of care and improved significant psychological aspects-mainly, the stress associated with insulin treatment.

Telemedicine in Elderly Hypertensive and Patients with Chronic Diseases during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

BACKGROUND

One aspect of the distancing measures imposed in response to the COVID-19 pandemic is that telemedicine consultations have increased exponentially. Among these consultations, the assessment and follow-up of patients with chronic diseases in a non-presential setting has been strengthened considerably. Nevertheless, some controversy remains about the most suitable means of patient follow-up.

OBJECTIVE

To analyze the impact of the telemedicine measures implemented during the COVID-19 period on chronic patients.

MATERIAL AND METHODS

A systematic review was carried out using the following databases: PubMed, Pro-Quest, and Scopus. The systematic review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search equation utilized descriptors sourced from the Medical Subject Headings (MeSH) thesaurus. The search equation was: "hypertension AND older AND primary care AND (COVID-19 OR coronavirus)" and its Spanish equivalent.

RESULTS

The following data were obtained: 14 articles provided data on 6,109,628 patients and another 4 articles focused on a study population of 9684 physicians. Telemedicine was less likely to be used by elderly patients (OR 0.85; 95% C.I. 0.83-0.88; p = 0.05), those of Asian race (OR 0.69; 95% C.I. 0.66-0.73; p = 0.05), and those whose native language was not English (OR 0.89; 95% C.I. 0.78-0.9; p = 0.05). In primary care, lower use of telemedicine was associated with residents of rural areas (OR 0.81; p = 0.05), patients of African American race (OR 0.65, p = 0.05), and others (OR 0.64; p = 0.05). A high proportion (40%) of physicians had no prior training in telemedicine techniques. The highest quality in terms of telephone consultation was significantly associated with physicians who did not increase their prescription of antibiotherapy during the pandemic (OR = 0.30, p = 0.05) or prescribe more tests (OR 0.06 p = 0.05), i.e., who maintained their former clinical criteria despite COVID-19.

CONCLUSIONS

Telemedicine is of proven value and has been especially useful in the COVID-19 pandemic. A mixed remote-presential model is most efficient. Appropriate training in this area for physicians and patients, together with correct provision, is essential to prevent errors in implementation and use.