Telemonitoring reduces diabetes patients’ blood sugar levels

A pharmacist-led telemonitoring program reduced blood sugar levels in diabetics, according to a new study.

Published in the September/ October issue of the Journal of the American Pharmacists Association, the study was led by Laura Shane-McWhorter, PharmD, certified diabetes educator and professor of clinical pharmacotherapy at the University of Utah in Salt Lake City.

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Shane-McWhorterThe Utah Community Health Centers, the Utah Telehealth Network and Shane-McWhorter set out to determine whether telemonitoring could improve diabetes disease measurements at clinics that provide care to underserved patients in Utah. The participating patients’ daily blood glucose (BG) and blood pressure (BP) values were reviewed, and Shane-McWhorter conducted follow-up phone calls with patients to assess and manage out-of-range BG and BP levels.

The change in A1c levels of the 75 patients who received diabetes education and management via telemonitoring was signficinatly greater than the 75 patients in the control group, who received usual medical care. There was a 2.07% decrease in the A1c level versus a .66% in the standard medical care group.

BP levels in the patients who received telemonitoring also dropped by a signficiant 8 points, from 126.2 mm Hg to 118.2 mm Hg. Although BP and LDL levels declined, the differences between the 2 groups were not statistically signficant, according to Shane-McWhorter.

“Pharmacists using technology can impact blood glucose and provide very good information between [physician] visits. That is really very important,” Shane-McWhorter said.

While the study originally was just going to examine the effectiveness of telemonitoring – utilizing a nurse practitioner or other qualified health professional – Shane-McWhorter suggested that pharmacists should monitor the program and help patients with medication management.

“It is a perfect venue for pharmacists. This is an emerging field: people are exploring different apps and telephone reminders,” Shane-McWhorter said.

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Patients received an Authentidate Electronic House Call (EHC) monitoring device, which has a touchscreen with built-in peripheral blood pressure monitor. Later, an Interactive Voice Response (IVR) system, which interacts with patients’ phones, was introduced later in the program. The EHC prompts patients to enter how they are feeling that day, and describe whether they have taken their medications. Patients entered their blood pressure, blood glucose and weight measurements.

The touchscreen then displayed a series of diabetes education messages, programmed by the pharmacist, in English or Spanish. Messages included advice on when to test blood glucose and how to obtain an appropriate sample, as well as managing hypoglycemia or hyperglycemica.

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Shane-McWhorter checked a secure website several times daily to assess patients’ blood glucose and blood pressure values and followed up by phone when the levels were out of predetermined ranges.

When Shane-McWhorter conducted follow-up phone calls, she would discover other things that the patients needed. “They would tell me, ‘I ran out of strips’, or would have me call in a prescription for them,” Shane-McWhorter said. “Or, perhaps they weren’t aware that we have low-cost scripts in the clinic.”

Shane-McWhorter attributes the effectiveness of the program to a “combination of the technology and the expertise that pharmacists have to be able to talk about the importance of medication adherence”.  “We can talk to patients about the reasons for medication adherence and the long-term implications.”

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