Managing Diabetes Mellitus in Underserved Subjects of Western China Using a Telemedicine System— a Clinical Trial

Ya Li (Department of endocrinology, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China)
Weiguo Ma (Department of endocrinology, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China)
Jiao Bai (Department of endocrinology, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China)
Chuanqing Xie (Department of endocrinology, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China)
Yuanyuan Huo (Department of endocrinology, The First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China)


Objective: To evaluate the effectiveness of Internet and telephone-based telemedicine system managing on patients’ glycemic index, blood pressure, and lipid level control in underserved subjects with type 2 diabetes in Western China. Research designs and methods: In a 3 years, randomized, controlled, single-blind, parallel-group treat-to-target study, 412 subjects with type 2 diabetes were randomized to telemedicine (Tel; n =208) group and usual care (control; n =204) group. We evaluated the effects of the intervention on blood sugar, blood pressure, and lipid levels at 1, 2, 3 years point, and investigated the cause of the loss during follow-up by phone call. Results: Intra-group comparison: in the Tel group, the FBS, 2HPG, HbA1c, and SBP at 1, 2, 3 years and DBP, TC, TG, BMI at 2, 3 years were significantly decreased compared with baseline level  (P<0.05). Moreover, the Tel group had an obvious better control of their HbA1c  at 2 and 3 years and 2HPG  at 3 years of follow-up respectively compared with the outcomes at 1 year (P<0.05).Inter-group comparison: the FBS, 2HPG, and HbA1c of Tel group decreased significantly from the baseline to the 1 year more than those of control group (P<0.05 or P<0.01 ). In this analysis, all clinical measures of Tel group had a significant downward compared with the outcomes of Control group  at 2 years, the FBS, HbA1c and BMI (P<0.001), the 2HPG and SBP (P<0.01) and DBP, TC, and TG (P<0.05) were statistically significant respectively. Logistic regression analysis showed that the subject loss during follow-up was associated with worse diabetes management (OR=3.842), low income (OR=3.201), low education level (OR=0.923), and greater distance to the hospital (OR=0.921).Conclusions: The study results indicated that the telemedicine may be a useful tool for managing diabetes mellitus.


Clinical trial; Diabetes care; Insulin resistance; Glycaemic control; Type 2 diabetes

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