Home telemonitoring of patients with diabetes: a systematic assessment of observed effects.

RATIONALE, AIMS AND OBJECTIVES Diabetes represents a common chronic disease continuously growing worldwide. Unless closely monitored, it can be associated with serious complications and high expenditures. Telemonitoring is a patient management approach increasingly used with chronic illnesses. It supports timely transmission and remote interpretation of patients' data for follow-up and preventive interventions. No comprehensive review exists on all aspects of diabetes 'home telemonitoring' and its effects. The objective of this study is to provide a systematic review of this approach and its effect at the informational, clinical, behavioural, structural and economical levels. METHODS A comprehensive literature review was conducted on Medline and Cochrane Library to identify relevant articles. The keywords used include diabetes, telemonitoring, home monitoring, telecare and telemedicine. RESULTS Seventeen studies using diverse technologies and transmitting different clinical, medical and behavioural data were found. Significant impacts were observed namely at the behavioural, clinical and structural levels. Minimal technical problems and no cost-benefit and cost-effectiveness analyses were reported. CONCLUSION Close management of diabetic patients through telemonitoring showed significant reduction in HbA(1c) and complications, good receptiveness by patients and patient empowerment and education. Yet, the magnitude of its effects remains debatable, especially with the variation in patients' characteristics (e.g. background, ability for self-management, medical condition), samples selection and approach for treatment of control groups. Further investigation of telemonitoring efficacy and cost-effectiveness over longer periods of time, and larger samples is needed. Assessment of the attitude of providers is also important in light of their heavy workload and issues of reimbursement.

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