Effectiveness of Telemedicine and Electronic Call Reminder and Health Education Trial (TECARE Trial) for Type 2 Diabetes Mellitus: A Randomized Controlled Trial

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Introduction Lifestyle management plays a vital role in the care of patients with type 2 diabetes mellitus (T2DM). Empowering individuals through education on lifestyle and behavior can be effectively supported by technology. This study aimed to evaluate the impact of telemedicine services on glycemic control, medication adherence, and insulin resistance among patients with T2DM. Materials and methods This two-arm, double-blinded, randomized controlled trial was conducted at a diabetes clinic in a tertiary care hospital. A total of 200 patients were enrolled and randomly assigned to either the intervention or control group. A total of 100 patients were enrolled in each of the intervention and control arms. The intervention group received weekly interactive voice calls for one year, focusing on medication adherence and lifestyle modifications, including dietary changes and physical activity. Primary outcomes included changes in HbA1c levels, medication compliance, lifestyle behaviors, and insulin resistance. An intention-to-treat analysis was performed, with a p-value of <0.05 considered statistically significant. Results At baseline, the mean HbA1c was 7.3% (±0.25) in the intervention group and 7.1% (±0.17) in the control group. Insulin resistance, measured by Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), was 5.4 (±0.26) and 5.4 (±0.22), respectively. At 12 months, 91 participants were followed up in the intervention group, whereas 82 participants were followed up in the control group. The intervention group showed a significant reduction in HbA1c to 6.7% (±0.21), compared to 7.0% (±0.15) in the control group (p = 0.035). Fasting blood glucose and postprandial blood glucose levels also improved significantly in the intervention group (113 vs. 134 mg/dL, p = 0.046; and 142 vs. 163 mg/dL, p = 0.032, respectively). HOMA-IR was notably lower in the intervention group at 3.4 compared to 4.6 in the control group (p = 0.04). Conclusion Telemedicine interventions, in the form of regular health education and support, significantly improved glycemic control, lifestyle behaviors, and insulin resistance in patients with T2DM. These findings suggest that such an intervention could be further evaluated in community settings to determine its effectiveness in real-world conditions.

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