Warren, Robin, Carlisle, Karen, Mihala, Gabor, and Scuffham, Paul A. (2018) Effects of telemonitoring on glycaemic control and healthcare costs in type 2 diabetes: a randomised controlled trial. Journal of Telemedicine and Telecare, 24 (9). pp. 586-595.

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Abstract

Introduction: This study examined the effect of a telehealth intervention on the control of type 2 diabetes, and subsequent potential cost-savings to the health system.

Methods: This prospective randomised controlled trial randomised adults with type 2 diabetes to the intervention (diabetes program) or control (usual care) arm. Key eligibility criteria included an HbA1c level of at least 58 mmol/mol (7.5%) without severe or unstable comorbidities. All participants continued their usual healthcare, but participants in the intervention arm received additional diabetes care from a diabetes care coordinator via a home monitor that captured clinical measures. Data collected included biomedical, quality of life measures and healthcare (GP, outpatient and inpatient) costs. The primary outcome was HbA1c collected at baseline and six-months. Analysis was conducted on a complete case intention-to-treat basis. The healthcare system perspective was taken to calculate the incremental cost per percentage-point reduction in HbA1c.

Results: Results from 63 participants from each study arm were analysed. HbA1c in the intervention group decreased from a median 68 mmol/mol (8.4%) to 58 mmol/mol (7.5%), and remained unchanged in the control group at median 65 mmol/mol (8.1%) at the six-month endpoint. The intervention effect on HbA1c change was statistically significant (p=0.004). Total healthcare costs in the intervention group, including the intervention costs, were lower (mean $3,781 vs $4,662; p<0.001) compared to usual care.

Discussion: There was a clinically meaningful and statistically significant benefit from the telehealth intervention at a lower cost; thus, telehealth was cost-saving and produced greater health benefits compared to usual care.

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