The Lancet Regional Health. Americas (Nov 2024)

Teleconsultation on patients with type 2 diabetes in the Brazilian public health system: a randomised, pragmatic, open-label, phase 2, non-inferiority trial (TELECONSULTA diabetes trial)Research in context

  • Daniela Laranja Gomes Rodrigues,
  • Gisele Silvestre Belber,
  • Frederica Valle de Queiroz Padilha,
  • Lucas Bassolli de Oliveira Alves,
  • Álvaro Avezum,
  • Marcos Aurélio Maeyama,
  • Alexsandra Vitti,
  • Greta Barriquel Pompermaier,
  • Tanise Balvedi Damas,
  • Mariana Selbach Selbach Otero,
  • Raquel Souza de Aguiar,
  • Renata Almeida de Andrade,
  • Ligia Fonseca Spinel,
  • Ana Paula Neves Marques Pinho,
  • Haliton Alves de Oliveira Junior

Journal volume & issue
Vol. 39
p. 100923

Abstract

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Summary: Background: This study addresses the rising burden of type 2 diabetes mellitus, and explores the potential of teleconsultation, as an alternative for diabetes management. The primary objective was to test the hypothesis that teleconsultation is non-inferior to face-to-face consultation in terms of glycaemic control measured as glycated haemoglobin (HbA1c) (non-inferiority margin for the upper confidence interval for the difference between groups of 0,5% in HbA1c) for type 2 diabetes mellitus patients referred from Primary Healthcare to Specialized Care within the SUS. Methods: TELECONSULTA, is a randomized, pragmatic, phase 2, single-centre, open-label, non-inferiority trial conducted in Joinville, Brazil. A total of 278 participants diagnosed with type 2 diabetes were randomized through mandatory teleconsulting services from primary care health units. The randomization was 1:1 to teleconsultation or face to face consultation. The study was registered at the Brazilian Clinical Trial Register—REBEC, under the code RBR-8gpgyd. Study status is “Completed”. Findings: This study included 278 participants in the intention-to-treat (ITT) analysis. The median age was 61 (54–68) years, 167 (60%) were women. The between-groups comparative average reduction in HbA1c was −0.6% (90% CI −1.0; −0.1) at 3-months and −0.5% (90% CI −0.9; 0.0) at 6-months in Modified Intention-to-Treat (mITT) population with imputed data, showing the non-inferiority of teleconsultation. Results with no missing data imputation and in the per protocol population were similar. The frequency of hypoglycaemia and other adverse events was well balanced between groups. Interpretation: The results underscore the transformative potential of telemedicine in addressing the complexities of diabetes management within the framework of a universal healthcare system, contributing with valuable insights for healthcare policymakers and practitioners seeking innovative solutions to tackle the growing diabetes epidemic. Funding: This study was funded by the Brazilian Ministry of Health, through the Unified Health System–Institutional Development Support Program (PROADI-SUS).

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