Life-long Tele-monitoring of Patients With Type 2 Diabetes Mellitus in Central Greece (RHCluster2GR)

• Health related quality of life of the patients measured by the SF-36 version 2 questionnaire [ Time Frame: 12 months minimum- at the entry point of the intervention and the end. ] [ Designated as safety issue: No ]
• HbA1c levels [ Time Frame: 12 months minimum - at the entry point and every 3 months. ] [ Designated as safety issue: No ]
  Glycated hemoglobin (HbA1c) levels at the entry point and every 3 months (for a period of 12 months minimum)

• Health related quality of life of the patients as measured by the SF-36 version 2 questionnaire [ Time Frame: 12 months minimum- at the entry point of the intervention and the end. ] [ Designated as safety issue: No ]
• HbA1c levels [ Time Frame: 12 months minimum - at the entry point and every 3 months. ] [ Designated as safety issue: No ]
  Glycated hemoglobin (HbA1c) levels at the entry point and every 3 months (for a period of 12 months minimum)

• Emotional functioning in diabetes assessed by the "Problem areas in diabetes questionnaire - PAID © 1999 Joslin Diabetes Center" [ Time Frame: 12 months minimum- at the entry point of the intervention and the end. ] [ Designated as safety issue: No ]
• Physical activity measured by the "International Physical Activity Questionnaire" (IPAQ) [ Time Frame: 12 months minimum- at the entry point of the intervention and the end. ] [ Designated as safety issue: No ]
• Nutrition habits assessed by validated questionnaire. [ Time Frame: 12 months minimum- at the entry point of the intervention and the end. ] [ Designated as safety issue: No ]
• Patients' Acceptance-Satisfaction measured by the WSD Questionnaire [ Time Frame: at 2nd and at 12th month ] [ Designated as safety issue: No ]
• Economic Evaluation (Cost-Effective Analysis- Cost Utility Analysis) [ Time Frame: 12 months minimum ] [ Designated as safety issue: No ]

• Emotional functioning in diabetes as assessed by the "Problem areas in diabetes questionnaire - PAID © 1999 Joslin Diabetes Center" [ Time Frame: 12 months minimum- at the entry point of the intervention and the end. ] [ Designated as safety issue: No ]
• Physical activity as measured by the "International Physical Activity Questionnaire" (IPAQ) [ Time Frame: 12 months minimum- at the entry point of the intervention and the end. ] [ Designated as safety issue: No ]
• Nutrition habits as assessed by prevalidated questionnaire. [ Time Frame: 12 months minimum- at the entry point of the intervention and the end. ] [ Designated as safety issue: No ]
• Patients' Acceptance-Satisfaction measured by the WSD Questionnaire [ Time Frame: at 2nd and at 12th month ] [ Designated as safety issue: No ]
• Economic Evaluation (Cost-Effective Analysis- Cost Utility Analysis) [ Time Frame: 12 months minimum ] [ Designated as safety issue: No ]

To evaluate whether patients with type 2 diabetes mellitus can be followed by simplified, centralized and large scale tele-monitoring of blood glucose levels and blood pressure, and whether this intervention produces health and economic benefits when introduced without major changes to the existing organization of a large tertiary care center.

The present study aims to examine the clinical and financial effects and the patients' perception and satisfaction of home telemedicine support system for diabetes management versus standard (usual) care. In the intervention group the patients will be provided with a blood glucose meter and a mobile phone and their data will be transferred via the mobile to the regional database and will be assessed by the allocated care team. Appropriate counseling on treatment and symptoms or problems related to diabetes will also be provided.

Measurements of HbA1c will be taken to assess glycaemic control while the dietary and the exercise habits will be assessed by the use of questionnaires. In addition the patients' satisfaction from the use of the telemedicine service will be studied. A Cost-Effective Analysis and Cost Utility Analysis will be applied to evaluate the tele-health service compared with the usual care from the health and social perspective. The effect of the tele-health service in the organization structure of the outpatient hospital department will be evaluated with a qualitative study.

• Diabetes Mellitus, Type 2
• Telemedicine

• No Intervention: Usual care
  Participants in the control group receive usual care. Usual care consists of regular visits to the specialist when required. In the occasion of the visit, HbA1c and glucose measurements are performed and the current oral or insulin therapy is modified if necessary. Patients also receive basic education in the management of diabetes.
• Experimental: Telemonitoring of diabetes 2 patients
  Patients will have one educational visit to set up the system and explain how it works. Patients will download their measurements from their tele-glucose meter to their mobile phone and the data will be transferred to the regional database. The care team (a nurse specially trained and the allocated physician) will regularly access the patient's home diary, and will provide the appropriate counselling and medication changes as frequently as necessary. In addition to blood glucose measurements, routine questions about symptoms and eventual difficulties related to diabetes as well as diabetic management will be routinely captured and reported.
  Intervention: Procedure: Telemonitoring of patients with diabetes type 2

• Polisena J, Tran K, Cimon K, Hutton B, McGill S, Palmer K. Home telehealth for diabetes management: a systematic review and meta-analysis. Diabetes Obes Metab. 2009 Oct;11(10):913-30. Epub 2009 Jun 16. Review.
• Klonoff DC. Diabetes and telemedicine: is the technology sound, effective, cost-effective, and practical? Diabetes Care. 2003 May;26(5):1626-8. Review. No abstract available.
• Jaana M, Paré G. Home telemonitoring of patients with diabetes: a systematic assessment of observed effects. J Eval Clin Pract. 2007 Apr;13(2):242-53. Review.

Inclusion Criteria:

• Diagnosis of type 2 Diabetes
• HbA1c > 53 mmol/mol (7.0 % according to NGSP)
• Capability to use the devices provided
• Being cognitively able to participate
• Capability of filling in questionnaires in german or greek language
• Absence of severe comorbidity prevalent on diabetes with life expectancy < 12 months

Exclusion Criteria:

• Pregnancy

• Ministry of Health and Social Welfare, Greece
• Municipality of Trikala, Greece
• e-trikala SA, Trikala, Greece
• Cities Net SA, Trikala, Greece
• Biomedical Research & Technology (BIOMED, Larissa, Greece
• Institute of Communications and Computer Systems (ICCS), Athens, Greece
• Technological Educational Institute of Thessaloniki, Greece
• University of Macedonia, Thessaloniki, Greece
• University of Thessaly