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Research Article: Evaluation of the clinical effectiveness of telephone consultation compared to face-to-face consultation in terms of glycaemic control among patients with suboptimally controlled type 2 diabetes: a retrospective cohort study

Date Published: 2023-05-09

Abstract:
Objective With the COVID-19 pandemic, telemedicine has been increasingly deployed in lieu of face-to-face consultations for management of diabetes in primary care. There was a need to evaluate clinical effectiveness of telephone consultations for diabetes management and this study aimed to show whether one-off telephone consultation was inferior or not to face-to-face consultation in terms of glycaemic control among patients with suboptimally controlled type 2 diabetes. Design Retrospective cohort study. Data of all patients with type 2 diabetes who had a chronic disease consultation during the period 9 April 2020–18 September 2020, and met the study’s inclusion and exclusion criteria was obtained from the electronic medical records. Setting A primary care clinic in the north-eastern region of Singapore. The clinic’s patient population was representative of Singapore’s population in terms of gender and age. Participants 644 patients with type 2 diabetes and glycated haemoglobin (HbA1c) 7.0% and above, aged 21–80 years old. Interventions Participants either underwent telephone or face-to-face consultation for diabetes management. Outcome measure Mean HbA1c change (?HbA1c) between preintervention and postintervention. Results Over 4?months, the mean ?HbA1c was ?0.16?percentage points (p.p.) (95% CI ?0.26 to –0.07) and ?0.11?p.p. (95%?CI ?0.20 to –0.02) for face-to-face and telephone consultation groups, respectively. The difference in mean ?HbA1c between the two groups was +0.05?p.p. (95%?CI ?? to 0.16), with the upper limit of the one-sided 95% CI less than the prespecified non-inferiority margin of 0.5?p.p. (p<0.05). In those with HbA1c?9%, the difference in mean ?HbA1c was +0.31?p.p. (95%?CI ?? to 0.79), which exceeded the non-inferiority margin. Conclusion For patients with suboptimally controlled type 2 diabetes, one-time telephone consultation was non-inferior to face-to-face consultation in terms of glycaemic control in the short term. However, more studies are required to investigate the long-term effects of telephone consultations and for those with HbA1c?9%.

Introduction:
Telemedicine refers to the systematic provision of healthcare services over physically separate environments via information and communications technology. 1 There are several modes of telemedicine, including mobile phone text messaging, consultations via videoconferencing and t internet-based glucose monitoring programmes. In Singapore, prior to the pandemic, telemedicine experience in primary care was mostly limited to management of simple acute conditions over video systems by private general practitioners.…

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