S Franc1, S Borot2, O Ronsin3, J-L Quesada4, D Dardari5, C Fagour6, E Renard7, A-M Leguerrier8, C Vigeral9, F Moreau10, P Winiszewski11, A Vambergue12, H Mosnier-Pudar13, L Kessler10, S Reffet14, B Guerci15, L Millot16, S Halimi17, C Thivolet14, P-Y Benhamou18, A Penfornis2, G Charpentier19, H Hanaire20. 1. Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France; Centre d'Études et de Recherches pour l'Intensification du Traitement du Diabète (CERITD), Corbeil-Essonnes, France. Electronic address: sylvia.franc@ch-sud-francilien.fr. 2. Department of Endocrinology-Metabolism and Diabetology-Nutrition, Jean-Minjoz Hospital, Besançon, France. 3. Department of Diabetes, Sainte-Marguerite University Hospital, Marseille, France. 4. Department of Biostatistics, CIC-Inserm, University Hospital, Grenoble, France. 5. Centre d'Études et de Recherches pour l'Intensification du Traitement du Diabète (CERITD), Corbeil-Essonnes, France. 6. Department of Endocrinology, University Hospital Pessac, Pessac, France. 7. Department of Endocrinology, University Hospital, Montpellier, France. 8. Department of Endocrinology, University Hospital, Rennes, France. 9. Department of Diabetes, Hôtel-Dieu University Hospital, Paris, France. 10. Department of Endocrinology, University Hospital, Strasbourg, France. 11. Department of Endocrinology, Belfort Hospital, Belfort, France. 12. Clinique Marc Linquette, Department of Endocrinology and Diabetology, Lille, France. 13. Department of Diabetes, Cochin Hospital, Paris, France. 14. Department of Endocrinology, Édouard-Herriot Hospital, Lyon, France. 15. Diabetology, Nutrition, Metabolic disorders, Brabois Hospital and Center of Clinical Investigation ILCV, University Hospital, Nancy, France. 16. Department of Endocrinology, Bellevue Hospital, Saint-Étienne, France. 17. Department of Endocrinology, Diabetology, Nutrition University Hospital, Grenoble, France; University J Fourier 1, Grenoble, France. 18. Department of Endocrinology, Diabetology, Nutrition University Hospital, Grenoble, France. 19. Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France; Centre d'Études et de Recherches pour l'Intensification du Traitement du Diabète (CERITD), Corbeil-Essonnes, France. 20. Department of Diabetes, Rangueil University Hospital, Toulouse, France.
Abstract
AIM: In the TELEDIAB-1 study, the Diabeo system (a smartphone coupled to a website) improved HbA1c by 0.9% vs controls in patients with chronic, poorly controlled type 1 diabetes. The system provided two main functions: automated advice on the insulin doses required; and remote monitoring by teleconsultation. The question is: how much did each function contribute to the improvement in HbA1c? METHODS: Each patient received a smartphone with an insulin dose advisor (IDA) and with (G3 group) or without (G2 group) the telemonitoring/teleconsultation function. Patients were classified as "high users" if the proportion of "informed" meals using the IDA exceeded 67% (median) and as "low users" if not. Also analyzed was the respective impact of the IDA function and teleconsultations on the final HbA1c levels. RESULTS: Among the high users, the proportion of informed meals remained stable from baseline to the end of the study 6months later (from 78.1±21.5% to 73.8±25.1%; P=0.107), but decreased in the low users (from 36.6±29.4% to 26.7±28.4%; P=0.005). As expected, HbA1c improved in high users from 8.7% [range: 8.3-9.2%] to 8.2% [range: 7.8-8.7%] in patients with (n=26) vs without (n=30) the benefit of telemonitoring/teleconsultation (-0.49±0.60% vs -0.52±0.73%, respectively; P=0.879). However, although HbA1c also improved in low users from 9.0% [8.5-10.1] to 8.5% [7.9-9.6], those receiving support via teleconsultation tended to show greater improvement than the others (-0.93±0.97 vs -0.46±1.05, respectively; P=0.084). CONCLUSION: The Diabeo system improved glycaemic control in both high and low users who avidly used the IDA function, while the greatest improvement was seen in the low users who had the motivational support of teleconsultations.
AIM: In the TELEDIAB-1 study, the Diabeo system (a smartphone coupled to a website) improved HbA1c by 0.9% vs controls in patients with chronic, poorly controlled type 1 diabetes. The system provided two main functions: automated advice on the insulin doses required; and remote monitoring by teleconsultation. The question is: how much did each function contribute to the improvement in HbA1c? METHODS: Each patient received a smartphone with an insulin dose advisor (IDA) and with (G3 group) or without (G2 group) the telemonitoring/teleconsultation function. Patients were classified as "high users" if the proportion of "informed" meals using the IDA exceeded 67% (median) and as "low users" if not. Also analyzed was the respective impact of the IDA function and teleconsultations on the final HbA1c levels. RESULTS: Among the high users, the proportion of informed meals remained stable from baseline to the end of the study 6months later (from 78.1±21.5% to 73.8±25.1%; P=0.107), but decreased in the low users (from 36.6±29.4% to 26.7±28.4%; P=0.005). As expected, HbA1c improved in high users from 8.7% [range: 8.3-9.2%] to 8.2% [range: 7.8-8.7%] in patients with (n=26) vs without (n=30) the benefit of telemonitoring/teleconsultation (-0.49±0.60% vs -0.52±0.73%, respectively; P=0.879). However, although HbA1c also improved in low users from 9.0% [8.5-10.1] to 8.5% [7.9-9.6], those receiving support via teleconsultation tended to show greater improvement than the others (-0.93±0.97 vs -0.46±1.05, respectively; P=0.084). CONCLUSION: The Diabeo system improved glycaemic control in both high and low users who avidly used the IDA function, while the greatest improvement was seen in the low users who had the motivational support of teleconsultations.
Authors: Michael Joubert; Pierre-Yves Benhamou; Pauline Schaepelynck; Hélène Hanaire; Bogdan Catargi; Anne Farret; Pierre Fontaine; Bruno Guerci; Yves Reznik; Nathalie Jeandidier; Alfred Penfornis; Sophie Borot; Lucy Chaillous; Sylvia Franc; Pierre Serusclat; Yacine Kherbachi; Eric Bavière; Bruno Detournay; Pierre Simon; Guillaume Charpentier Journal: J Diabetes Sci Technol Date: 2019-03-12
Authors: Stephanie Veazie; Kara Winchell; Jennifer Gilbert; Robin Paynter; Ilya Ivlev; Karen B Eden; Kerri Nussbaum; Nicole Weiskopf; Jeanne-Marie Guise; Mark Helfand Journal: J Gen Intern Med Date: 2018-05-08 Impact factor: 5.128