Nitric oxide and blood pressure responses to short-term resistance training in adults with and without type-2 diabetes: a randomized controlled trial

Objective To examine whether video consultations preceded by measurements of blood glucose, weight and blood pressure as add-on to standard care could contribute to achieving and maintaining good diabetes control among patients with poorly regulated type 2 diabetes (T2D). Design Randomized controlled trial. Methods 165 patients with T2D were randomized 1:1 to telemedicine intervention as add-on to clinic-based care or control (clinic-based care). The intervention consisted of monthly video conferences with a nurse via a tablet computer and lasted for 32 weeks. Regularly self-monitored measurements of blood sugar, blood pressure and weight were uploaded and visible to patient and nurse. Both groups were followed up six months after the end of the intervention period. Primary endpoint HbA1c after eight months. Results Video conferences preceded by uploads of measurements as add-on to clinic-based care led to a significant reduction of HbA1c compared to that in standard care (0.69% vs 0.18%, P = 0.022). However, at six-month follow-up, the inter-group difference in HbA1c-reduction was no longer significant. Non-completers had higher HbA1c levels at baseline and a lower degree of education. Conclusion Video consultations preceded by uploading relevant measurements can lead to clinically and statistically significant improvements in glycemic control among patients who have not responded to standard regimens. However, continuing effort and attention are essential as the effect does not persist when intervention ends. Furthermore, future studies should focus on differentiation as the most vulnerable patients are at greater risk of non-adherence.

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Implementation and effectiveness from a randomized controlled trial of automated virtual type 2 diabetes self-management education: Diabetes Engagement and Activation Platform (Preprint)

10.2196/preprints.26621 ◽

2020 ◽

Author(s):

Roy Sabo ◽

Jo Robins ◽

Stacy Lutz ◽

Paulette Kashiri ◽

Teresa Day ◽

...

Keyword(s):

Blood Pressure ◽

Type 2 Diabetes ◽

Randomized Controlled Trial ◽

Management Education ◽

Controlled Trial ◽

Significant Proportion ◽

Self Management ◽

Patient Portals ◽

Randomized Controlled

UNSTRUCTURED Aims: To help patients with type 2 diabetes receive recommended self-management education and support (DSMES), we designed the Diabetes Engagement and Activation Platform (DEAP) – an automated patient education tool integrated into primary care workflow – and examined its implementation and effectiveness. Methods: We invited patients age 18-85 years with hemoglobin A1C (HbA1c) ≥ 8 to participate in a randomized controlled trial comparing DEAP to usual care. DEAP modules addressing DSMES domains were programmed into patient portals, each with self-guided educational readings, videos and questions. Care teams received patient summaries and were alerted to patients with low confidence or requesting additional help. HbA1c, body mass index (BMI), and blood pressure were measured. Results: Implementation: Out of the 680 patients invited to participate 337 (49%) agreed and were randomized. Of 189 intervention patients, all accessed the first module and 140 (74%) accessed all nine modules. Post-module knowledge and confidence scores were high. Only 18 patients requested additional help from the care team. Effectiveness: BMI was lower for intervention patients than controls at 3 months (31.7 versus 32.1 km/m2, p=.04) and 6 months (32.5 versus 33.0 km/m2, p=.003); improvements were even greater for intervention patients completing at least one module. There were no differences in 3 or 6 month HbA1c or blood pressure in the intention to treat analysis. However, intervention patients completing at least one module compared to controls had a better HbA1c (7.6% versus 8.2%, p=.03) and DBP (72.3 versus 75.9 mmHg, p-value = .01) at 3 months. Conclusions: A significant proportion of patients will participate in an automated virtual diabetes self-management program embedded into patient portals and system show promise in helping patients manage their diabetes, weight, and blood pressure.

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