Frontiers in clinical diabetes and healthcare · 2026
Structured telemonitoring reduces HbA1c and emergency visits in insulin-treated type 2 diabetes: a controlled cohort study in Ecuador's public hospital.
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Santillán Angel, Travez Proaño Edwin Ivan, Jaramillo Encalada Ivanna Noemí, Abril López Patricio Alejando, Tricallotis Jennifer, Acosta-España Jaime David
Аннотация
BACKGROUND: Remote patient monitoring (RPM) has demonstrated potential to improve glycemic control in type 2 diabetes mellitus (T2DM), yet evidence from middle-income public health systems remains limited. This study evaluated the clinical impact of structured telemonitoring in insulin-treated T2DM patients at a public hospital in Ecuador.
METHODS: A prospective, controlled cohort study was conducted over a six-month period. Adults with insulin-treated T2DM and baseline HbA1c >8% were assigned to structured telemonitoring or standard care. The intervention included Bluetooth-enabled glucometers linked to the mySugr app, automated data uploads, and weekly clinical review. The primary outcome was the change in HbA1c; secondary outcomes included emergency visits and hospitalizations. Repeated measures ANOVA assessed HbA1c trajectories. Emergency visits were analyzed using Fisher's Exact Test and Firth's logistic regression.
RESULTS: Among 100 patients (50 per group), mean HbA1c decreased by 2.67% in the intervention group compared to 1.38% in the control group (p = 0.006). Emergency visits occurred in eight control patients and none in the intervention group (p = 0.006). Firth's regression showed a non-significant odds ratio. No hospitalizations were reported. Direct cost savings totaled USD 9,660 over six months for the studied population and USD 174,000 annually, based on a 10% adoption rate (450 patients) over one year, using 2024 data from HGDC.
CONCLUSION: Structured telemonitoring was associated with improved glycemic control and reduced utilization of acute care services. These findings support RPM feasibility in middle-income public health settings.
METHODS: A prospective, controlled cohort study was conducted over a six-month period. Adults with insulin-treated T2DM and baseline HbA1c >8% were assigned to structured telemonitoring or standard care. The intervention included Bluetooth-enabled glucometers linked to the mySugr app, automated data uploads, and weekly clinical review. The primary outcome was the change in HbA1c; secondary outcomes included emergency visits and hospitalizations. Repeated measures ANOVA assessed HbA1c trajectories. Emergency visits were analyzed using Fisher's Exact Test and Firth's logistic regression.
RESULTS: Among 100 patients (50 per group), mean HbA1c decreased by 2.67% in the intervention group compared to 1.38% in the control group (p = 0.006). Emergency visits occurred in eight control patients and none in the intervention group (p = 0.006). Firth's regression showed a non-significant odds ratio. No hospitalizations were reported. Direct cost savings totaled USD 9,660 over six months for the studied population and USD 174,000 annually, based on a 10% adoption rate (450 patients) over one year, using 2024 data from HGDC.
CONCLUSION: Structured telemonitoring was associated with improved glycemic control and reduced utilization of acute care services. These findings support RPM feasibility in middle-income public health settings.