Abstract
Background
According to the Global Diabetes Plan, a unified health system with preventive and educational strategies is essential to proper diabetes care and primary settings should be the main site of care. In Brazil, there is limited access to outpatient hospital diabetes services, while primary-care diabetes support is underutilized. Telemedicine can be a useful adjunct to support discharge of stable patients with type 2 diabetes to the primary care setting. In this paper, we present a randomized controlled trial (RCT) protocol designed to evaluate the effects of telehealth support for stable type 2 diabetes patients discharged from hospital outpatient diabetes clinics.
Methods
We designed a RCT. Patients with stable type 2 diabetes (glycated hemoglobin < 8%) considered eligible for discharge from specialized to primary care will be included. Those with uncontrolled ischemic heart disease, severe neuropathy, and stage IV/V nephropathy will be excluded. Enrolled patients will be randomized into two groups: follow-up supported by periodic phone calls by a nurse (intervention group) plus primary care or routine primary care only (control group). The intervention group will receive regular telephone calls (every three months for one year) and will have a toll-free number to call in case of questions about disease management. The main outcome measure is a comparison of glycemic control between groups (assessed by glycated hemoglobin) at one-year follow-up.
Discussion
We plan to evaluate the effectiveness of a telephone-based intervention on glycemic control in patients with type 2 diabetes followed by primary care teams. Telemedicine can be an important adjunct in type 2 diabetes management, improving patient education and knowledge about the disease. Furthermore, it can help the healthcare system by alleviating overload in specialized care settings and supporting the stewardship role of primary care.
Trial registration
Clinical Trials, NCT02768480. Registered on 29 April 2016.
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Details
1 Federal University of Rio Grande do Sul (UFRGS), Post Graduate Program in Medical Sciences – Division of Endocrinology, Porto Alegre, Brazil (GRID:grid.8532.c) (ISNI:0000 0001 2200 7498); Serviço de Endocrinologia do Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil (GRID:grid.414449.8) (ISNI:0000 0001 0125 3761)
2 Federal University of Rio Grande do Sul (UFRGS), Post Graduate Program in Medical Sciences – Division of Endocrinology, Porto Alegre, Brazil (GRID:grid.8532.c) (ISNI:0000 0001 2200 7498)
3 Federal University of Rio Grande do Sul (UFRGS), Post Graduate Program in Medical Sciences – Division of Endocrinology, Porto Alegre, Brazil (GRID:grid.8532.c) (ISNI:0000 0001 2200 7498); Federal University of Rio Grande do Sul, Division of Epidemiology, Porto Alegre, Brazil (GRID:grid.8532.c) (ISNI:0000 0001 2200 7498)
4 Federal University of Rio Grande do Sul, Division of Epidemiology, Porto Alegre, Brazil (GRID:grid.8532.c) (ISNI:0000 0001 2200 7498)