Efficacy of telemedicine on glycaemic control in nursing home residents with type 2 diabetes on basal-bolus insulin therapy: A randomised controlled trial

Abstract

Aims: Management of insulin therapy in elderly individuals with type 2 diabetes (T2D) residing in nursing homes is often challenging due to comorbidities, cognitive impairment and limited access to specialist care. Continuous glucose monitoring (CGM) and telemedicine may help optimise glycaemic control in this vulnerable population. Materials and Methods: In order to assess the efficacy and safety of a CGM and telemedicine-based management of insulin therapy in nursing home residents with T2D, a 12-week, randomised, controlled and open-label trial has been designed. Eighty-five patients on stable basal-bolus insulin therapy were assigned to either telemedicine-assisted insulin titration based on CGM data (intervention group) or standard care with capillary blood glucose monitoring (control group). The primary endpoint was the change in time in range (TIR, 70–180 mg/dL), with secondary outcomes including time below range (TBR), time above range (TAR), haemoglobin A1c (HbA1c), insulin dose and safety endpoints. Results: TIR increased significantly in the intervention, but not in the control group, with a significant difference between study groups (p = 0.010). TBR showed a reduction in the intervention arm and an increase in the control arm with a significant difference between groups (p = 0.007). HbA1c and mean insulin daily units significantly also decreased in the intervention group, with significant differences between groups (p = 0.028 and p = 0.002, respectively). No safety issues potentially related to the intervention were identified during the study. Conclusion: In conclusion, remote insulin dose adjustment based on interstitial glucose monitoring ameliorates glucose control in nursing home residents with T2D on basal-bolus insulin therapy.