Mobile County Health Department
Mobile County, Alabama
Diabetes
African American

Project

Patients’ glucose levels are monitored remotely.

During a routine clinic visit, the provider prescribes a regimen of self-monitoring of blood glucose levels and determines a range of acceptable glucose values. The nurse coordinator then meets with the patient to show them how to use the glucometer and transmit glucose measurements through an interactive voice-response telephone system. Written instructions are provided, along with the phone number to contact the automated system, information on how to contact the nurse coordinator for any issues related to the program, and the dates of scheduled return visits. Before the visit ends, the nurse coordinator ensures that the patient has access to glucose monitoring supplies and diabetic medicines.

Glucose measurements are monitored through an automated system that generates email alerts to the nurse coordinator if values outside of acceptable range are transmitted. Once the nurse receives an alert, the value is evaluated and the patient is contacted and offered nursing advice. When a patient exhibits a sustained pattern of aberrant glucose values, the nurse discusses the situation with the patient’s provider and acts according to the provider’s recommendations.

Rationale

Obtaining glycemic control is important to diabetes care and effective care regimens require both pharmacological treatment and patient self-management. Along with ongoing diet and exercise modifications, the self-monitoring of blood glucose is an essential part of diabetes self-management.

Advances in information technology have given rise to innovative interventions that facilitate the real-time transmission of glucose levels from patients at home to providers. Providers can give immediate feedback to patients when glucose levels are outside prescribed parameters, potentially preventing acute complications that might require emergency care (e.g., severe hyper- or hypoglycemia). Such distant interactions may be especially valuable in the provision of care to disadvantaged populations in settings where both lack of transportation and visit costs deter indigent patients from seeking face-to-face health care. Additionally, providers will have access to better information during the office visit, including their patient’s longitudinal, date- and time-stamped glucose reading history.

Summary Results

Tele-monitoring glucose levels resulted in an average improvement in HbA1c levels by 1.95 absolute percentage points, which was comparable to the improvement of 2.06 percentage points seen in patients who monitored glucose levels using a paper-and-pencil log. Both of these interventions resulted in statistically significant improvement in HbA1c levels compared to controls, which experienced an improvement of 0.95 percentage points. Among the 73% of tele-monitoring intervention patients who completed the study, a majority reported that tele-monitoring glucose levels was not a burden and that logging glucose data helped them to take care of their diabetes.

Publications

Principal Investigators

• Bernard H. Eichold, MD, DrPH, FACP (Mobile County Health Department)
• Martha I. Arrieta, MD, MPH, PhD (University of South Alabama, Center for Healthy Communities)
• Errol Crook, MD (University of South Alabama, Center for Healthy Communities)