The Diabeo software enabling individualized insulin dose adjustments combined with telemedicine support improves HbA1c in poorly controlled type 1 diabetic patients: a 6-month, randomized, open-label, parallel-group, multicenter trial (TeleDiab 1 Study)

Guillaume Charpentier, Pierre-Yves Benhamou, Dured Dardari, Annie Clergeot, Sylvia Franc, Pauline Schaepelynck-Belicar, Bogdan Catargi, Vincent Melki, Lucy Chaillous, Anne Farret, Jean-Luc Bosson, Alfred Penfornis, TeleDiab Study Group, Guillaume Charpentier, Pierre-Yves Benhamou, Dured Dardari, Annie Clergeot, Sylvia Franc, Pauline Schaepelynck-Belicar, Bogdan Catargi, Vincent Melki, Lucy Chaillous, Anne Farret, Catherine Vigeral, Anne-Marie Leguerrier, Helen Mosnier-Pudar, François Moreau, Patrice Winiszewski, Anne Vambergue, Bruno Guerci, Sophie Reffet, Luc Millot, Jean-Louis Quesada, Sophie Borot, Serge Halimi, Olivia Ronsin, Cédric Fagour, Hélène Hanaire, Eric Renard, Laurence Kessler, Charles Thivolet, Jean-Luc Bosson, Alfred Penfornis, Guillaume Charpentier, Pierre-Yves Benhamou, Dured Dardari, Annie Clergeot, Sylvia Franc, Pauline Schaepelynck-Belicar, Bogdan Catargi, Vincent Melki, Lucy Chaillous, Anne Farret, Jean-Luc Bosson, Alfred Penfornis, TeleDiab Study Group, Guillaume Charpentier, Pierre-Yves Benhamou, Dured Dardari, Annie Clergeot, Sylvia Franc, Pauline Schaepelynck-Belicar, Bogdan Catargi, Vincent Melki, Lucy Chaillous, Anne Farret, Catherine Vigeral, Anne-Marie Leguerrier, Helen Mosnier-Pudar, François Moreau, Patrice Winiszewski, Anne Vambergue, Bruno Guerci, Sophie Reffet, Luc Millot, Jean-Louis Quesada, Sophie Borot, Serge Halimi, Olivia Ronsin, Cédric Fagour, Hélène Hanaire, Eric Renard, Laurence Kessler, Charles Thivolet, Jean-Luc Bosson, Alfred Penfornis

Abstract

Objective: To demonstrate that Diabeo software enabling individualized insulin dose adjustments combined with telemedicine support significantly improves HbA(1c) in poorly controlled type 1 diabetic patients.

Research design and methods: In a six-month open-label parallel-group, multicenter study, adult patients (n = 180) with type 1 diabetes (>1 year), on a basal-bolus insulin regimen (>6 months), with HbA(1c) ≥ 8%, were randomized to usual quarterly follow-up (G1), home use of a smartphone recommending insulin doses with quarterly visits (G2), or use of the smartphone with short teleconsultations every 2 weeks but no visit until point end (G3).

Results: Six-month mean HbA(1c) in G3 (8.41 ± 1.04%) was lower than in G1 (9.10 ± 1.16%; P = 0.0019). G2 displayed intermediate results (8.63 ± 1.07%). The Diabeo system gave a 0.91% (0.60; 1.21) improvement in HbA(1c) over controls and a 0.67% (0.35; 0.99) reduction when used without teleconsultation. There was no difference in the frequency of hypoglycemic episodes or in medical time spent for hospital or telephone consultations. However, patients in G1 and G2 spent nearly 5 h more than G3 patients attending hospital visits.

Conclusions: The Diabeo system gives a substantial improvement to metabolic control in chronic, poorly controlled type 1 diabetic patients without requiring more medical time and at a lower overall cost for the patient than usual care.

Trial registration: ClinicalTrials.gov NCT00629304.

Figures

Figure 1
Figure 1
Trial profile.
Figure 2
Figure 2
Efficacy of electronic logbook ± teleconsultation. A: HbA1c values (means ± SE), from 3 months before baseline to month 6. *P = 0.0103, **P = 0.0019 compared with control group. B: Change in HbA1c values (means ± SE) from baseline to month 6.

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