Smith-Strøm H, Igland J, Østbye T, Tell GS, Hausken MF, Graue M, Skeie S, Cooper JG, Iversen MM, et al.
Diabetes care. Date of publication 2018 Jan 1;volume 41(1):96-103.
1. Diabetes Care. 2018 Jan;41(1):96-103. doi: 10.2337/dc17-1025. Epub 2017 Nov 29.
The Effect of Telemedicine Follow-up Care on Diabetes-Related Foot Ulcers: A
Cluster-Randomized Controlled Noninferiority Trial.
Smith-Strøm H(1)(2), Igland J(1)(2), Østbye T(2)(3), Tell GS(2), Hausken MF(4),
Graue M(1)(2), Skeie S(5), Cooper JG(4), Iversen MM(6)(2)(4).
Author information:
(1)Department of Health and Social Science, Centre for Evidence-Based Practice,
Western Norway University of Applied Sciences, Bergen, Norway.
(2)Department of Global Public Health and Primary Care, University of Bergen,
Bergen, Norway.
(3)Duke Global Health Institute, Duke University, Durham, NC.
(4)Section of Endocrinology, Department of Medicine, Stavanger University
Hospital, Stavanger, Norway.
(5)Department of Research, Stavanger University Hospital, Stavanger, Norway.
(6)Department of Health and Social Science, Centre for Evidence-Based Practice,
Western Norway University of Applied Sciences, Bergen, Norway miv@hvl.no.
OBJECTIVE: To evaluate whether telemedicine (TM) follow-up of patients with
diabetes-related foot ulcers (DFUs) in primary health care in collaboration with
specialist health care was noninferior to standard outpatient care (SOC) for
ulcer healing time. Further, we sought to evaluate whether the proportion of
amputations, deaths, number of consultations per month, and patient satisfaction
differed between the two groups.
RESEARCH DESIGN AND METHODS: Patients with DFUs were recruited from three
clinical sites in western Norway (2012-2016). The cluster-randomized controlled
noninferiority trial included 182 adults (94/88 in the TM/SOC groups) in 42
municipalities/districts. The intervention group received TM follow-up care in
the community; the control group received SOC. The primary end point was healing
time. Secondary end points were amputation, death, number of consultations per
month, and patient satisfaction.
RESULTS: Using mixed-effects regression analysis, we found that TM was
noninferior to SOC regarding healing time (mean difference -0.43 months, 95% CI
-1.50, 0.65). When competing risk from death and amputation were taken into
account, there was no significant difference in healing time between the groups
(subhazard ratio 1.16, 95% CI 0.85, 1.59). The TM group had a significantly lower
proportion of amputations (mean difference -8.3%, 95% CI -16.3%, -0.5%), and
there were no significant differences in the proportion of deaths, number of
consultations, or patient satisfaction between groups, although the direction of
the effect estimates for these clinical outcomes favored the TM group.
CONCLUSIONS: The results suggest that use of TM technology can be a relevant
alternative and supplement to usual care, at least for patients with more
superficial ulcers.
© 2017 by the American Diabetes Association.
DOI: 10.2337/dc17-1025
PMID: 29187423 [Indexed for MEDLINE]
