Do electronic reminder systems help patients with T2DM to lose weight?
EVIDENCE-BASED ANSWER:
PROBABLY NOT—but they may augment self-management. Four-component telehealth systems—including electronic reminders, measuring devices, patient-driven data upload, and remote data analysis—likely don’t result in significant weight reductions in adults with type 2 diabetes (T2DM). However, their use may be associated with a decrease in hemoglobin A1C of about 0.4% (strength of recommendation [SOR]: B, meta-analysis of randomized controlled trials [RCTs] and conflicting smaller subsequent RCTs).
Telehealth is considered a reasonable option for augmenting diabetes self-management in patients who are facile with the technology (SOR: C, expert opinion).
After 3 months, BMI was reduced in both messaging groups but not the control group (tailored text = –0.6 kg/m2, nontailored text = –0.5 kg/m2, controls = 0.7 kg/m2; P < .05). A1C levels didn’t change significantly. One limitation of the study was that 30% to 35% of the patients in the intervention group had a university-level education, compared with 12% in the control group.
Recommendations
The Department of Veterans Affairs issued guidelines in 2017 regarding management of patients with T2DM in primary care.4 The guidelines state that all patients should receive individualized self-management education using “modalities tailored to their preferences” (strong recommendation). They further recommend “offering one or more bidirectional telehealth interventions” in coordination with patients’ health care providers (weak recommendation).
The 2017 diabetes self-management recommendations endorsed by the American Diabetes Association state that “strong evidence” shows that incorporating text messaging into diabetes care improves outcomes, enhances feedback loops, and empowers patients.5
Editor’s takeaway
Telehealth offers mechanisms for patients and physicians to enhance communication about health behaviors and health status. But does it alter outcomes? The cited literature suggests that benefits aren’t a forgone conclusion and that acceptability, ease of use, cost, and individualization are critical issues in telehealth design.
