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Literature Review

Telehealth in Managing Chronic Diseases: Diabetes and Hypertension

Gurzhii Tetyana

St. Thomas University

NUR-611

Dr. Corzo-Sanchez

July 13, 2024

Telehealth in Managing Chronic Diseases: Diabetes and Hypertension.

Telehealth is the method of healthcare delivery using communication technologies, including computers, tablets, smartphones, remote monitoring devices, and wearable technology. While the adoption of telemedicine has increased in recent years, its role in improving care provision during the coronavirus pandemic has cemented its place as an important channel to deliver vital services. Telehealth encompasses prescription management and adherence to the treatment regimen, physical examination, nutritional evaluation, and patient education. This topic is important for research as telemedicine has great potential to manage chronic diseases and, specifically, address glycemic control and weight management in youth and adults. Addressing this issue is crucial as it helps to improve the ability of patients to self-manage their conditions and provide more personalized, professional, and safe management, resulting in improved life quality. The purpose of this paper is to provide a literature review on four RCT studies investigating trends and perspectives of using telehealth to improve symptoms and manage hypertension and diabetes.

SMS-Based Home BP Telemonitoring

Purpose

The goal of research conducted by Calderón-Anyosa et al. (2023) is to determine whether an SMS-based home BP telemonitoring system is strong enough to improve symptoms of uncontrolled high BP and decrease BP in patients receiving main treatment in a primary care center.

Subjects

Authors involve 38 patients in this RCT. 68% of research subjects are females, and their mean age is 68 years (Calderón-Anyosa et al., 2023). Current study includes patients with uncontrolled hypertension; 19 persons receive follow-up control, while 19 subjects receive intervention.

Methodology

Experts apply quantitative research methodology and use RCT design. The intervention group is engaged in the telemonitoring system, while the control group is offered the usual management.

Results

Calderón-Anyosa et al. (2023) discover a significant difference in diastolic BP change (-1.2 [6.4] mmHg versus -7.2 [9.8] mmHg) for control and intervention groups. A significant reduction in diastolic BP and values is also observed in those subjects who use telemonitoring if compared to the control group. Therefore, home BP telemonitoring based on SMS delivery is effective in decreasing diastolic BP, particularly when working in collaboration with primary care facilities.

Telehealth Intervention Versus Telemonitoring and Care Coordination

Purpose

Unlike previous research that compares telemonitoring systems and usual management of BP, the study conducted by Crowley et al. (2022) investigates the effectiveness of two interventions such as (1) comprehensive telehealth and (2) a simple telehealth approach based on telemonitoring and care coordination to improve symptoms in people with persistently poorly controlled T2DM. Here, the goal is to compare comprehensive and simple telehealth interventions and highlight their effectiveness in improving health outcomes, including HbA1c levels in patients who have poorly controlled diabetes.

Subjects

Unlike previous research that includes 38 patients with uncontrolled hypertension, current research randomizes 200 adults (45 females and 155 males) with persistently poorly controlled T2DM. 101 participants are involved in comprehensive telehealth, and 99 persons are engaged in telemonitoring/care coordination. Their mean age is 57.8.

Methodology

Previous studies and current research apply quantitative research methodology with RCT design. Here, authors compare a comprehensive and simple telehealth intervention, consisting of care coordination and telemonitoring for T2DM.

Results

Current research supports findings of previous study despite the fact that authors discuss different medical conditions, they still highlight effectiveness of using telehealth intervention in chronically ill patients. Specifically, researchers reveal that changes in HbA1c constitute −1.59% (10.17% to 8.58%) in comprehensive group from baseline to 12 months. Moreover, at 12 months, those engaged in comprehensive telehealth, show greater improvements in self-effectiveness, self-care, and distress related to their diabetes diagnosis.

Telemedicine Management of T2DM in Obese Youth and Middle-Aged Patients

Purpose

The current research seeks to assess the effectiveness of telemedicine management of diabetes in obese youth and middle-aged patients with diabetes during the coronavirus crisis.

Subject

99 subjects are involved in research and complete the 6-month follow-up. 52 respondents are involved in the intervention group, and 47 individuals are involved in the control group. Their mean age is 47.

Methodology

Previous studies and current research apply quantitative research methodology with RCT design. Authors randomly assigned 52 patients to the intervention telemedicine group and 47 patients to the control group (traditional outpatient clinic appointment) (Yin et al., 2022).

Results

Unlike previous research highlighting that comprehensive telehealth show greater improvements in self-effectiveness, self-care, and distress related to diabetes diagnosis, current one states that the intervention group demonstrates a decrease in postprandial blood glucose, triglyceride, and LDL cholesterol level and significant reduction in BMI.

Home Blood Pressure Monitoring and Videoconferencing

Purpose

The research seeks to explore the safety and effectiveness of telemedicine for managing hypertension in Japanese patients.

Subject

Unlike previous research that involves obese patients with diabetes, the current study includes 99 patients with hypertension, 54% of whom have untreated conditions (Yatabe et al., 2021). 49 persons are allocated to telemedicine, and 50 subjects are allocated to usual care.

Methodology

Previous studies and current research apply quantitative research methodology with RCT design. Here, the authors compare the effectiveness of telemedicine (monitoring and videoconferencing) and usual care in improving BP control.

Results

Current research supports findings of Calderón-Anyosa et al. (2023) highlighting effectiveness of SMS-based home BP telemonitoring in decreasing diastolic BP and state that antihypertensive therapy through home BP telemonitoring and video conferencing helps to achieve better BP control.

Conclusion and Direction for Further Research

Telemonitoring is an effective patient management approach involving various information technologies for monitoring clients at a distance. Besides improving adherence to treatment, the telemonitoring system increases awareness of disease. Due to the low level of control among people with hypertension, health experts propose telemonitoring blood pressure at home, thus increasing the proportion of patients with controlled conditions. Besides hypertensive patients, diabetic patients affected during COVID-19 can improve their self-effectiveness and management ability through telehealth technology. In the future, the use of SMS-based home telemonitoring of BP will have to be expanded in rural areas, and health providers should evaluate the utilization of this technology for longer follow-ups and involve a larger sample size. As most of the reviewed studies involve small size, it is necessary to determine the advantages of telemedicine use in treating hypertension and poorly controlled diabetes on a larger scale. In addition, current studies provide a solid basis for developing individualized telemedicine management models for chronic conditions.

References

Calderón-Anyosa, R., Tincopa, J. P., Raza, M., & Cárcamo, C. P. (2023). Randomized

controlled trial of home telemonitoring of blood pressure with an adapted

tensiometer with SMS Capability. European Journal of Investigation in Health,

Psychology and Education, 13(2), 440-449. https://doi.org/10.3390/ejihpe13020033

Crowley, M. J., Tarkington, P. E., Bosworth, H. B., Jeffreys, A. S., Coffman, C. J.,

Maciejewski, M. L., ... & Edelman, D. (2022). Effect of a comprehensive telehealth intervention vs telemonitoring and care coordination in patients with persistently poor type 2 diabetes control: A randomized clinical trial. JAMA Internal Medicine, 182(9), 943-952. https://doi.org/10.1001/jamainternmed.2022.2947

Yatabe, J., Yatabe, M. S., Okada, R., & Ichihara, A. (2021). Efficacy of telemedicine in

hypertension care through home blood pressure monitoring and videoconferencing: Randomized controlled trial. JMIR Cardio, 5(2), e27347. https://doi.org/10.2196/27347

Yin, W., Liu, Y., Hu, H., Sun, J., Liu, Y., & Wang, Z. (2022). Telemedicine management of

type 2 diabetes mellitus in obese and overweight young and middle-aged patients

during COVID-19 outbreak: A single-center, prospective, randomized control study.

PLoS One, 17(9), e0275251. https://doi.org/10.1371/journal.pone.0275251

Evidence Matrix

Name: Gurzhii Tetyana Date: 07/13/2024

Author	Journal Name/ Year of Publication	Research Design	Sample Size	Outcome Variables Measured	Quality (A, B, C)	Results/Author’s Suggested Conclusion
Calderón-Anyosa et al.	European Journal of Investigation in Health, Psychology and Education/2023.	Quantitative. RCT	38	The aim of the study is to assess how SMS-based home BP telemonitoring influences hypertensive patients and their symptoms (Calderón-Anyosa et al., 2023).	B	Authors do not reveal a significant difference in systolic BP changes in control group (−7.2 [14.9] mmHg) and intervention group (−16.3 [16.7] mmHg). However, experts detect significant differences in diastolic BP changes (−1.2 [6.4] mmHg) for control group and −7.2 [9.8] mmHg for intervention group. In conclusion, experts highlight the effectiveness of SMS-based home BP telemonitoring in decreasing diastolic BP. This intervention serves as an important alternative option for controlling BP in hypertensive patients.
Crowley et al.	JAMA Internal Medicine/2022	Quantitative. RCT.	200	The aim of the study is to address gaps in clinical evidence that hinder the smooth utilization of telemedicine in poorly controlled T2DM by comparing simple and comprehensive telehealth interventions.	B	From baseline to 12 months, changes in HbA1c constitute −1.59% (10.17% to 8.58%) in the comprehensive group and −0.98% (10.17% to 9.19%) in the telemonitoring group. At 12 months, clients involved in comprehensive telehealth show greater improvements in distress, self-effectiveness, and self-care related to diabetes diagnosis. If compared to the conventional treatment approach, comprehensive telehealth improves multiple medical outcomes in patients with poorly controlled diabetes (Crowley et al., 2022). Current research supports using comprehensive telehealth for assigned medical conditions in health systems with relevant
Yatabe et al.	JMIR Cardio/2021	Quantitative. RCT.	99	The objective of research is to examine safety and effectiveness of telemedicine for managing high blood pressure in Japanese patients.	B	Baseline BP is similar in both control and intervention groups, but the level of systolic BP at the end of the first year of intervention is lower in telemedicine group (125, SD 9 mmHg versus 131, SD 12 mmHg). The rate of SBP (135 mmHg) is higher in telemedicine group (85.3% versus 70.0%) than in control group (Yatabe et al., 2021). Antihypertension intervention through web-based visits and home telemonitoring helps to better control BP control if compared to traditional care. This safe alternative treatment requires further examination to reveal how offered interventions benefit patients with other chronic conditions.
Yin et al.	PLoS One/2022.	Quantitative. RCT.	120	The objective of the research is to estimate the effects of telemedicine management on obese youth and middle-aged people with T2DM during the coronavirus pandemic.	B	On 22nd day, the level of fasting glucose in the intervention group decreased if compared to the control group (p < 0.05), and the self-rating depression scale of the control group significantly increased in comparison with the baseline value (p < 0.05). At the end of 3 months, the level of FBG and HbA1c in the intervention group decreases if compared to the control group (p < 0.01) (Yin et al., 2022). At the end of 3 and 6 months, patients in the intervention group show a lower BMI if compared to the control group (p < 0.01). Authors conclude that telemedicine is an effective strategy to regulate blood glucose, lose weight, and relieve depression in T2DM patients.