IDEATel is a project initiated in December of 2005 following receipt of a $28 million grant from the Health Care Financing Administration (HCFA)(USA). American TeleCare, a supplier of home telemedicine programmes, and Gentiva Health Services, a provider of speciality pharmaceutical and home health care services collaborated with Columbia University College of Physicians and Surgeons to put into place this unique study on telemedicine and diabetes. As Dr. Rodney Hornbake, Senior VP and Chief Medical Officer at Gentiva Health Services said in a publication in 2000, “An important aspect of this study is addressing the needs of patients who live in areas where specialized care is not easily accessible”.
As subsequently reported on the web site clinical trials.gov, http://clinicaltrials.gov/ct2/show/NCT00271739, the project was designed as a randomized controlled trial (RCT) with an estimated enrollment of approximately 1665 subjects. Approximately 750 subjects were randomized to receive a telemedicine intervention and approximately 750 received usual care. Eligibility requirements included having diabetes, being a Medicare beneficiary, and living in a medically underserved area. There were three locations. It was run through a consortium of participating institutions based at SUNY Upstate Medical University at Syracuse.
The intervention utilized a home telemedicine unit (HTU). The HTU is a specially designed, web-enabled device with a data port connected to a home glucometer and home blood pressure cuff whereby measurements obtained with these devices can be directly uploaded to a computer database. A diabetes nurse case manager interacted regularly with intervention participants through videoconference via the HTU.
Primary outcome measures for diabetes assessment included Hemoglobin A1c levels, blood pressure levels, and serum lipid levels. Secondary measures were cost effectiveness and patient acceptability of telemedicine.
Initial results from the study were published in 2007. At this time it was found that after one year diabetes case management delivered using telemedicine improved hemoglobin A1c, blood pressure, and LDL cholesterol levels at follow-up, compared to usual care. The intervention effect on diabetes control was greater in the subgroup with hemoglobin A1c ≥7% at baseline, with an absolute change from 8.35% to 7.42% within the intervention group. In terms of the use of telemedicine, it was reported that there was generally high satisfaction with participation in the project in both patients and primary care providers (S Shea, The informatics for diabetes and educational telemedicine (IDEATel) project; Trans Am Clin Climatol Assoc, 2007; 118:289-304).
In 2009 the 5 year results of the study were reported in the Journal of the American Medical Information Association (J Am Med Inform Assoc. 2009, 16(4):446-56). The authors: S Shea, et al, found using intention-to-treat mixed model analysis that there were net reductions over five years of follow-up for the endpoints of the three primary diabetes variables. They concluded, based on the results, that telemedicine case management resulted in significant improvements in the assessed parameters. They also pointed out that mortality was not different between the two groups (telemedicine managed and controls).
In contrast to the above findings, a 2010 research article titled: The impact of telemedicine interventions involving routine transmission of blood glucose data with clinician feedback on metabolic control in youth with type 1 diabetes: a systematic review and meta analysis, the authors R. Shulman, C. O’Gorman, and M. Palmert report that there were no apparent effects of Telemedicine interventions on hemoglobin A1c, severe hypoglycemia, or diabetic ketoacidosis with meta analysis of over 10 studies with 609 subjects meeting their eligibility requirements for study review. (Rayzel et al, International J of Pediatric Endocrinology, Vol 2010, article ID 536957, 1-9)
Written by Jeff Burgess DDS MSD
Editor in chief of Dental-Health Imaging Hub
Editor’s Comment: The last review article notwithstanding, the IDEATel research suggests that there may be important patient monitoring considerations within the realm of dentistry that could be incorporated into a comprehensive teledentistry model of care.
