A comparison of diabetes education administered through telemedicine versus in person

Journal of Physical Therapy Education, Spring 2004 by Lamboley, Wendy

Izquierdo RE, Knudson PE, Meyer SA, et al. A comparison of diabetes education administered through telemedicine versus in person. Diabetes. 2003;26(4):1002-1007.

The role of diabetes self-management education (DSME) is imperative for the patient with diabetes. However, not all individuals with diabetes are able to attend educational events for a variety of reasons. Some may not have transportation to the facility sponsoring the event, while others might lack the financial means to attend. Certified diabetes educators have been able to provide some education via the telephone with good results, but with new technology it is now possible to provide more detailed information through telemedicine.

The purpose of this study was to test the hypothesis that telemedicine technology could provide diabetes education as effectively as in-person education. The study's subjects were patients with diabetes between the ages of 18 to 75 years old. Subjects were randomly selected to either meet with educators in person (control group) or through videoconferencing (telemedicine group). A stratified randomization procedure was used to assure that there was equal distribution of Type 1 and Type 2 diabetics in each of the two groups. A total of 56 patients participated in the study with five dropouts in the in-person group and five in the telemedicine group, leaving 22 subjects to receive their education in person and 24 subjects receiving their education through teleconferencing.

The primary measure was glycemie control (HbA) with secondary measures including LDL cholesterol, HDL cholesterol, triglyceride levels, weight, and body mass index (BMI). Also included in this study was a Problem Areas in Diabetes (PAID) scale, the Diabetes Quality of Life (DQOL) scale, and one measure of cognitive appraisal, the Appraisal of Diabetes Scale (ADS). Participants also completed the Diabetes Treatment Satisfaction Questionnaire (I)TSQ).

Glycemie control (HbA levels) was recorded at baseline, immediately after education, and 3 months after the third educational visit. The HbA level improved from 8.6 ± 1.6% at baseline to 7.8 ± 1.5% immediately after education and to 7.8 ± 1.8% 3 months after the third educational visit. This improvement in glycemie control was demonstrated in both the telemedicine group as well as the in-person group suggesting that telemedicine is an effective means of providing diabetes education to patients. Glycemie control, however, did not significantly change when adjusted for age and BMI.

Along with improved HbA levels, results showed improvement in LDL cholesterol and in PAID scores. No significant changes were noted in triglycerides, HDI. cholesterol, or total cholesterol. Patient satisfaction in DQOL and DTSQ scores were high in both the in-person and the telemedicine groups with no difference in satisfaction scores between groups. Those who received diabetes education via telemedicine indicated that they found it very convenient, and overall satisfaction was high with a score of 4.3 out of 5.

Though a limitation to this study was a small sample size, the authors do conclude that high-quality diabetes education using telemeclicine technology is a feasible option. In particular, education can be provided to those who live in rural areas and to those with low incomes who are often treated in public health care systems.

Wendy Lamboley, PT

Illinois Valley Community Hospital

Peru, Ill