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Submitted on July 22, 2005
Accepted on September 21, 2005
Affiliation of the authors: 1 Department of Medicine, Columbia University, New York, NY; Department of Epidemiology, Joseph Mailman School of Public Health, Columbia University, New York, NY; Department of Biomedical Informatics, Columbia University, New York, NY; 2 Joslin Diabetes Center and Division of Endocrinology, Diabetes and Metabolism, SUNY Upstate Medical University, Syracuse, NY; Department of Veterans Affairs, VA Medical Center, Syracuse, NY; 3 Department of Biomedical Informatics, Columbia University, New York, NY; Department of Radiology, Columbia University, New York, NY; 4 Research Division of the Hebrew Home for the Aged at Riverdale, Bronx, NY; Stroud Center, Columbia University, New York, NY; New York State Psychiatric Institute, New York, NY; 5 Department of Medicine, Columbia University, New York, NY; 6 Joslin Diabetes Center and Division of Endocrinology, Diabetes and Metabolism, SUNY Upstate Medical University, Syracuse, NY; 7 Department of Medicine, Columbia University, New York, NY; Naomi Berrie Diabetes Center, Columbia University, New York, NY; 8 Department of Family Medicine, SUNY Upstate Medical University, Syracuse, NY; 9 Department of Biomedical Informatics, Columbia University, New York, NY; 10 Research Division of the Hebrew Home for the Aged at Riverdale, Bronx, NY; 11 Department of Biostatistics, Joseph Mailman School of Public Health, Columbia University, New York, NY; 12 Department of Medicine, Harlem Hospital Center, New York, NY
* To whom correspondence should be addressed.
Background Telemedicine is a promising but largely unproven technology for providing case management services to patients with chronic conditions who experience barriers to access to care or a high burden of illness.
Methods We conducted a randomized controlled trial comparing telemedicine case management to usual care, with blinding of those obtaining outcome data, in 1,665 Medicare recipients with diabetes, aged 55 years or greater, and living in federally designated medically underserved areas of New York State. The primary endpoints were HgbA1c, blood pressure, and low density lipoprotein (LDL) cholesterol levels.
Results
In the intervention group (N=844), mean HgbA1c improved over 1 year from 7.35% to 6.97%, and from 8.35% to 7.42% in the subgroup with baseline HgbA1c 
7% (N=353). In the usual care group (N=821), mean HgbA1c improved over 1 year from 7.42% to 7.17%. Adjusted net reductions (1-year minus baseline mean values in each group, compared between groups) favoring the intervention were as follows: HgbA1c, 0.18% (p=0.006), systolic and diastolic blood pressure, 3.4 (p=0.001) and 1.9 mmHg (p<0.001), and LDL cholesterol, 9.5 mg/dl (p<0.001). In the subgroup with baseline HgbA1c 7%, net adjusted reduction in HgbA1c favoring the intervention group was 0.32% (p=0.002). Mean LDL cholesterol level in the intervention group at one year was 95.7 mg/dl. The intervention effects were similar in magnitude in the subgroups living in New York City and upstate New York.
Conclusions Telemedicine case management improved glycemic control, blood pressure levels, and total and LDL-cholesterol levels at 1 year of follow-up.
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