Impact of 12-Month mHealth Home Telemonitoring on Clinical Outcomes in Older Individuals With Hypertension and Type 2 Diabetes: Multicenter Randomized Controlled Trial.

BACKGROUND

As the population ages, the prevalence of chronic diseases such as arterial hypertension (AH) and type 2 diabetes (T2D) is increasing, posing challenges for effective management in primary care settings. Although mobile health (mHealth) home telemonitoring offers promising support, evidence regarding its clinical impact on older patients is limited.

OBJECTIVE

The objective of this paper was to evaluate the impact of 12-month telemonitoring on clinical outcomes in older individuals with AH and T2D compared to standard care in a primary care setting.

METHODS

In a multicenter, open-label, randomized controlled trial, individuals aged 65 years and older with AH and T2D were randomly assigned in a 1:1 ratio to either a telemonitoring group or a standard care group. The telemonitoring group received mHealth support in addition to standard care. Over 12 months, participants measured blood pressure (BP) twice weekly with 2 consecutive readings each morning and evening, using the second reading as valid. Blood glucose (BG) was measured monthly, both fasting and 90 minutes after meals. Abnormal results triggered a 7-day BP or 1-day BG profile or a teleconsultation with a general practitioner. Meanwhile, the control group received routine care based on integrated care protocols at community health centers. Primary outcomes were the differences between groups in the change in systolic blood pressure (SBP) and HbA1c levels at 12 months after inclusion from baseline. Secondary outcomes included changes in diastolic blood pressure, fasting BG, lipid profile, body mass index, appraisal of diabetes, and behavioral risk factors.

RESULTS

Initially, 128 patients were enrolled, with 117 (91.4%) completing the 12-month follow-up. The mean age was 71.3 (SD 4.7) years, with a mean SBP of 136.7 (SD 14.1) mmHg and mean HbA1c of 7.2% (SD 1.0%). There were no significant sociodemographic or clinical differences between groups at baseline. At 12 months, the telemonitoring group experienced significant reductions in SBP (-9.7 mmHg, 95% CI -12.6 to -6.8; P<.001) and HbA1c (-0.5%, 95% CI -0.8 to -0.3; P<.001), whereas the control group exhibited nonsignificant changes in SBP (-2.8 mmHg, 95% CI -5.9 to 0.2; P=.07) and HbA1c (0%, 95% CI -0.3 to 1.9; P=.75). The difference between groups at 12 months was significant for both SBP (-6.9 mmHg, 95% CI -11 to -2.7; P=.001) and HbA1c (-0.5%, 95% CI -0.8 to -0.2; P=.002), with no significant differences observed in secondary outcomes.

CONCLUSIONS

Telemonitoring effectively improves AH and T2D control in older people but has no impact on other cardiovascular risk factors and diabetes-related quality of life. Future research should explore combining educational and behavioral interventions with telemonitoring to enhance overall health outcomes. However, complex interventions may pose challenges for the elderly, suggesting the need for careful patient selection to ensure that benefits outweigh potential burdens.