**3.2 The Utah Remote Monitoring Project**

The Utah Remote Monitoring Project was a nonrandomized prospective observational pre- and post-intervention study [34]. The included patients were patients with uncontrolled type 2 diabetes and/or arterial hypertension. They have been enrolled from four rural and two urban primary care clinics and one urban stroke center participated in a telemonitoring program (n = 109). The primary clinical outcome measures were changes in HbA1c and BP. Other outcomes included fasting lipids, weight, patient engagement, diabetes knowledge, arterial hypertension knowledge, medication adherence, and patient perceptions of the usefulness of the telemonitoring program. The patients were randomized in two groups on telemonitoring delivery methods [34]. The first was a remote monitoring device for BP and heart rate. Patients used their own glucose meters to measure BG and were provided with an electronic digital scale to measure their weight. The device was programmed to sound an alarm at a pre-specified patient-referred time to prompt the patient to initiate a telemonitoring session. Patients were asked to enter data several times during the week. The device was programmed to ask how patients were feeling that day and whether they had taken their medications and then receive a prompt to take the measures. After, the patient received a series of education messages, focused on teaching patients about their diseases (diabetes, arterial

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**Figure 2.**

*State of Art of Telemonitoring in Patients with Diabetes Mellitus, with a Focus on Elderly Patients*

hypertension) and associated comorbidities. The second telemonitoring delivery method is the use of an interactive voice response (IVR) system. Patients were provided with a BP monitor and electronic digital scales, but they used their own BG meter. The patients have to use the same process described above, but received a call from the telemonitoring IVR service at a pre-specified. Medical providers were contacted either via a note in the electronic medical record (or immediately if there was a concern, in person or by telephone) if there was an out-of-range value (decided by individual providers or clinics as a value that was high or low). In this study, the mean HbA1c (principal criterion) decreased: 9.73% at baseline vs.

*Results of DiaTel study (n = 150 diabetic elderly patients) (adapted from [32]).*

*DOI: http://dx.doi.org/10.5772/intechopen.83384*

*State of Art of Telemonitoring in Patients with Diabetes Mellitus, with a Focus on Elderly Patients DOI: http://dx.doi.org/10.5772/intechopen.83384*

**Figure 2.**

*Geriatric Medicine and Gerontology*

hygiene, and physical activity

• Tools for therapeutic and hygiene observance

telephone support centers, tablets, and Websites

each), with most improvement occurring by 3 months (**Figure 2**).

The Utah Remote Monitoring Project was a nonrandomized prospective observational pre- and post-intervention study [34]. The included patients were patients with uncontrolled type 2 diabetes and/or arterial hypertension. They have been enrolled from four rural and two urban primary care clinics and one urban stroke center participated in a telemonitoring program (n = 109). The primary clinical outcome measures were changes in HbA1c and BP. Other outcomes included fasting lipids, weight, patient engagement, diabetes knowledge, arterial hypertension knowledge, medication adherence, and patient perceptions of the usefulness of the telemonitoring program. The patients were randomized in two groups on telemonitoring delivery methods [34]. The first was a remote monitoring device for BP and heart rate. Patients used their own glucose meters to measure BG and were provided with an electronic digital scale to measure their weight. The device was programmed to sound an alarm at a pre-specified patient-referred time to prompt the patient to initiate a telemonitoring session. Patients were asked to enter data several times during the week. The device was programmed to ask how patients were feeling that day and whether they had taken their medications and then receive a prompt to take the measures. After, the patient received a series of education messages, focused on teaching patients about their diseases (diabetes, arterial

**3.2 The Utah Remote Monitoring Project**

• Tools for patient motivation

dyslipidemia)

**3.1 The DiaTel study**

• Tools for medical education, particularly disease self-appropriation, food

• Tool to remote comorbidities (e.g., arterial hypertension, obesity,

• Tools for interaction between the patient and healthcare professionals like

The DiaTel study compared the short-term efficacy of home telemonitoring coupled with active medication management by a nurse practitioner with a monthly care coordination telephone call on glycemic control in veterans with type 2 diabetes [32]. The included patients were taking oral hypoglycemic agents and/or insulin for ≥1 year and had HbA1c ≥ 7.5%). Approximately one-third of the participants in both groups were aged 65 years. At enrollment, the patients were randomly assigned to either active care management (AMC) with home telemonitoring (HT) (ACM + HT group, n = 73) or a monthly care coordination telephone call (CC group, n = 77) [32]. Both groups received monthly calls for DM education and self-management review. ACM + HT group participants transmitted BG, blood pressure (BP), and weight to a nurse practitioner; the nurse practitioner adjusted medications for glucose, BP, and lipid control based on established ADA targets. Baseline characteristics of the patients in the DiaTel study were similar in both groups, with mean HbA1c of 9.4% in the CC group vs. 9.6% in ACM + HT group [32, 33]. Compared with the CC group, the ACM + HT group demonstrated significantly larger decreases in HbA1c (principal criterion) at 3 months (1.7 vs. 0.7%) and 6 months (1.7 vs. 0.8%; *p* < 0.001 for

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*Results of DiaTel study (n = 150 diabetic elderly patients) (adapted from [32]).*

hypertension) and associated comorbidities. The second telemonitoring delivery method is the use of an interactive voice response (IVR) system. Patients were provided with a BP monitor and electronic digital scales, but they used their own BG meter. The patients have to use the same process described above, but received a call from the telemonitoring IVR service at a pre-specified. Medical providers were contacted either via a note in the electronic medical record (or immediately if there was a concern, in person or by telephone) if there was an out-of-range value (decided by individual providers or clinics as a value that was high or low). In this study, the mean HbA1c (principal criterion) decreased: 9.73% at baseline vs. 7.81% at the end of the program (*p* < 0.0001) [34]. Systolic BP (principal criterion) also declined significantly: 130.7 mmHg at baseline vs. 122.9 mmHg at the end (*p* = 0.0001). Low-density lipoprotein content decreased significantly: 103.9 mg/dL at baseline vs. 93.7 mg/dL at the end (*p* = 0.0263). Knowledge of diabetes and arterial hypertension increased significantly (*p* < 0.001 for both). Patient engagement and medication adherence also improved, but not significantly. Per questionnaires at study end, patients felt the telemonitoring program was useful.
