Telemonitoring improved HbA1c more than usual care. The adjusted mean difference at 9 months was 5.60 mmol/mol, or 0.51%, in favor of the intervention.

Ambulatory systolic blood pressure was modestly lower with telemonitoring than with usual care at follow-up. The adjusted mean difference was 3.06 mmHg in favor of the intervention.

Ambulatory diastolic blood pressure was also modestly lower in the telemonitoring group. The adjusted mean difference was 2.17 mmHg in favor of the intervention.

Body weight did not clearly differ between groups at follow-up. The small numeric difference was not enough to show a meaningful intervention effect.

A telemonitoring program combining home blood glucose, blood pressure, and weight measurements with Bluetooth transmission to a secure server, weekly review by primary care clinicians, and follow-up advice or treatment adjustment when needed.

Positive: 3; Negative: 0; No effect: 1; Mixed: 0

Extracted 4 outcome signals across the study

The intervention improved HbA1c and blood pressure, while weight showed no clear difference and prescribing patterns were largely similar between groups.

Mostly intermediate or surrogate outcomes

Adjusted mean HbA1c was 5.60 mmol/mol lower in the telemonitoring group at 9 months.

Ambulatory systolic and diastolic blood pressure were both lower with telemonitoring than with usual care.

Weight, prescribing patterns, and most health service use measures were not clearly different between groups.

Wild SH, Hanley J, Lewis SC, et al. Supported Telemonitoring and Glycemic Control in People with Type 2 Diabetes: The Telescot Diabetes Pragmatic Multicenter Randomized Controlled Trial. PLoS Med. 2016;13(7):e1002098. doi:10.1371/journal.pmed.1002098

Participants and clinicians could not be fully blinded to group assignment.

Only a minority of invited eligible patients joined the trial, so participants may not represent all patients with poorly controlled diabetes.

The study did not show how long the benefit lasts after the 9-month intervention ends.

The exact mechanism of benefit was unclear because medication changes and self-management behavior may both have contributed.

In adults with poorly controlled type 2 diabetes in UK family practice, supported telemonitoring lowered HbA1c and ambulatory blood pressure more than usual care over 9 months, without changing weight.

Diastolic blood pressure ↓ by 2.17 mmHg

Body weight ↔ with no clear between-group difference

This consensus report explains how clinicians should intensify treatment and support self-management when adults with type 2 diabetes remain above glycemic targets.

Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

The ADA standards provide current guidance on glucose targets, self-monitoring, treatment adjustment, and blood pressure management in adults with type 2 diabetes.

This NIDDK resource gives trusted background on diabetes self-management, including home monitoring, healthy routines, and ongoing partnership with health professionals.

Annual ADA clinical practice guideline issue covering broad diabetes management.

NICE clinical guideline for adult type 2 diabetes management.

American Diabetes Association resource matched by keyword relevance (type 2 diabetes)

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<h4>Background</h4>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.<h4>Objective</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.

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

<h4>Context</h4>Type 2 diabetes (T2D) is one of the fastest-growing global health emergencies of the 21st century. However, high antioxidant capacity of supplementation of vitamin C and/or E was inversely associated with insulin resistance. However, each antioxidant possesses a distinct biological function that may be influenced by both dosage and duration of supplementation, potentially resulting in significantly different effects.<h4>Objective</h4>This meta-analysis aimed to evaluate whether vitamin C, vitamin E, or their combination is more effective in improving glycemic control, blood lipids, and blood pressure in individuals with T2D.<h4>Data sources and data extraction</h4>A systematic search was conducted in PubMed, Scopus, and Web of Science databases for randomized clinical trials, identifying 52 studies (n = 1425 participants).<h4>Data analysis</h4>Random-effects models were used to assess the effects of vitamin C and/or E supplementation on glycemic control, blood lipid levels, and blood pressure. These findings indicate that supplementation with vitamin C, vitamin E, or their combination has a comparable effect on glycemic index values, systolic blood pressure, and blood lipid profiles. However, a significant reduction in systolic blood pressure was observed only with vitamin C and combined vitamin C + E supplementation. Additionally, a significant increase in high-density-lipoprotein (HDL) levels was noted exclusively with the combined vitamin C + E supplementation.<h4>Conclusion</h4>Consequently, supplementation with vitamin C, vitamin E, and their combination (C + E) exhibited differing effects on HDL levels and systolic blood pressure. However, their effects on glycemic control, diastolic blood pressure, and blood lipids other than HDL were comparable.<h4>Systematic review registration</h4>PROSPERO registration no. CRD42023399366.

Effects of Vitamin C and/or E Supplementation on Glycemic Control and Cardiovascular Risk Factors in Type 2 Diabetes: A Systematic Review and Subgroup Meta-analysis.

<h4>Introduction</h4>Within the cardiovascular-kidney-metabolic syndrome (CKM) framework, semaglutide has demonstrated benefits beyond glycemic control and weight loss in clinical trials. However, most real-world studies in type 2 diabetes (T2D) have limited assessment of broader cardiometabolic and renal outcomes. We evaluated CKM-relevant outcomes among individuals with T2D who achieved substantial hemoglobin A1c (HbA1c) and weight improvements after initiating semaglutide in real-world settings.<h4>Methods</h4>This observational pre-post study used Optum's de-identified Market Clarity Data from January 1, 2007, to June 30, 2024. The primary cohort comprised individuals with T2D who achieved glycemic control (HbA1c < 7%) and weight loss (≥ 5%) goals after semaglutide initiation. We compared baseline (1 year before initiation) with 1st-year and 2nd-year follow-up for cardiometabolic endpoints (3-point and 5-point major adverse cardiovascular events [MACE]), cardiometabolic risk factors, and renal outcomes. Sensitivity analysis was performed in an exploratory cohort of patients in the top tertile of Hb1Ac reduction and weight loss.<h4>Results</h4>We identified 413 patients in the primary cohort (mean age 59.6 years and balanced sex distribution). Significant reductions were observed in low-density lipoprotein cholesterol (LDL-C), very-low-density lipoprotein cholesterol (VLDL-C), total cholesterol, triglycerides, systolic blood pressure, and diastolic blood pressure and high-density lipoprotein cholesterol (HDL-C) increased at both 1 and 2 years after semaglutide initiation (all p < 0.001). Fewer than 1% of patients experienced a ≥ 40% decline in estimated glomerular filtration rate (eGFR) during follow-up. Mean change in urine albumin-to-creatinine ratio (UACR) were - 20.13 mg/g in the 1st year (p < 0.001) and - 54.03 mg/g in the 2nd year (p < 0.001). The event rate of 3-point MACE decreased from 26.82 per 1000 person-years (PY) during baseline to 22.31 per 1000 PY in the 2nd year. The sensitivity analysis showed consistent results.<h4>Conclusion</h4>In this real-world study, semaglutide users who achieved glycemic and weight goals exhibited marked improvements in cardiometabolic and renal outcomes over 2 years.

Cardiometabolic and Renal Outcomes in Semaglutide Users with Type 2 Diabetes Achieving Glycemic and Weight Goals: An Observational Cohort Study.

<h4>Introduction</h4>The pathophysiology of chronic kidney disease (CKD) and type 2 diabetes (T2D) is multifactorial and associated with a plethora of underlying conditions and complications. Their link is reciprocal and understanding its nature, particularly over time, could improve the health of many.<h4>Methods</h4>A prospective study was conducted to examine the development of the two main components of CKD (urine albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR)) over 24 years (2001-2024) in a sample of 718 individuals with a diagnosis of T2D. Longitudinal modelling was conducted to examine the rate of change of ACR and eGFR over the 24 years, as well as whether sex, smoking status, glycated haemoglobin (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI) influenced that rate of change in both our total sample and three sub-groups (no CKD, CKD with increased ACR and preserved eGFR, and CKD with increased ACR and reduced eGFR).<h4>Results</h4>At baseline, 428 (59.6%) patients were male while 290 (40.4%) were female. Mean age at baseline was 56.6 ± 12.4 years. Mean follow-up period was 16.4 ± 2.1 years. 451 (62.8%) patients had a normal ACR and eGFR ≥60 mL/min/1.73 m<sup>2</sup>, no CKD. At 24-year follow-up, 196 (43%) of these patients had progressed to an ACR >3 mg/mmol and/or eGFR<60 mL/min/1.73 m<sup>2</sup>, developing CKD. At final follow-up, 282 patients were still alive. In the whole cohort, 10 (1.4%) patients progressed to end-stage kidney disease eGFR<15 mL/min/1.73 m<sup>2</sup>. For the whole cohort ACR increased exponentially, while eGFR decreased linearly by 1.02 mL/min/1.73 m<sup>2</sup> per year. For ACR: SBP (β = 0.36, 95% CI [0.24, 0.48]) and DBP (β = 0.40, 95% CI [0.16, 0.64]) were the only significant independent predictors of ACR progression particularly in the sub-group with increased ACR and preserved eGFR. For eGFR: Female sex (β = -3.79, 95% CI [1.96, 5.63]), SBP (β = -0.12, 95% CI [-0.17, -0.06]), DBP (β = -0.19, 95% CI [-0.08, -0.31]), HbA1c (β = -1.17, 95% CI [-0.63, -1.71]), baseline cholesterol (β = 0.86, 95% CI [0.29, 1.43]) and smoking (β = -2.05, 95% CI [-3.80, -1.30]) were significant independent predictors of eGFR progression, but only in the non-CKD at baseline sub-group. At the end of follow-up 436 (60%) of people had died including 219 (48.6%) of the patients with no CKD at baseline, compared to 158 (76.7%) of people with increased urine ACR/preserved eGFR and 59 (96.7%) of those with increased urine ACR and reduced eGFR, with 10 year mortality rates of 6.6%, 14.5% and 26.6%, respectively. In the whole cohort only 10 (1.4%) patients progressed to end-stage kidney disease (eGFR<15 mL/min/1.73 m<sup>2</sup>).<h4>Conclusion</h4>This study revealed several factors that are associated with accelerated progression of CKD over 20 + years, including female sex and current/previous smoking. At baseline, the group with ACR >3 mg/mmol exhibited the highest rate of ACR increase. Multiple factors influenced eGFR decrease in those with baseline eGFR ≥60 mL/min/1.73 m<sup>2</sup>. Mortality rate was profoundly influenced by historical CKD status.

Progression of albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) over 24 years in people with type 2 diabetes. Drivers, potential protectors and associated mortality.

<h4>Background</h4>Multimorbidity is linked to systemic low-grade inflammation, poor glycaemic control, dyslipidaemia, and hypertension, yet evidence on effective interventions is limited. We evaluated the impact of a 12-week personalised exercise therapy and self-management support programme, in addition to usual care, on these outcomes in individuals with multimorbidity.<h4>Methods</h4>This was a pre-planned secondary analysis of the MOBILIZE multicentre randomised controlled trial (NCT04645732). Participants (n = 228) had at least two of the following conditions: knee/hip osteoarthritis, chronic obstructive pulmonary disease, heart disease, hypertension, type 2 diabetes, or depression. The intervention included 24 supervised 60-minute group-based exercise sessions and 24 self-management sessions over 12 weeks. Outcomes were assessed at baseline and 4 months, including interleukin-1 receptor antagonist (IL-1ra), high-sensitivity C-reactive protein (hs-CRP), tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), glycated Hemoglobin (HbA1c), fasting glucose, insulin, High-Density Lipoprotein (HDL), Low-Density Lipoprotein (LDL), triglycerides, and blood pressure.<h4>Results</h4>Compared to usual care, the intervention group shows a statistically significant reduction in systolic blood pressure (mean difference: -4.7 mmHg, 95% CI: -8.8 to -0.6). No significant between-group differences are observed for other biomarkers, although favouring the intervention. Sensitivity analyses-excluding participants with low adherence, those receiving supervised exercise in the control group, or undergoing surgery-support the primary findings.<h4>Conclusions</h4>A 12-week personalised exercise and self-management programme reduces systolic blood pressure in people with multimorbidity. These findings support incorporating exercise therapy into multimorbidity care guidelines as a non-pharmacological adjunct.

Effect of exercise therapy and self-management support on multimorbidity: Secondary analysis of the MOBILIZE trial.

Includes self-reported outcomes (moderate): Self-reported outcomes used

Limited safety reporting (moderate): Safety reporting depth: limited

No post-intervention follow-up (moderate): 0 weeks of follow-up after treatment ended

Relies on surrogate outcomes (moderate): No hard clinical outcomes reported

Supported telemonitoring improved HbA1c and blood pressure in type 2 diabetes

This UK trial tested home telemonitoring with clinician review in 321 adults with poorly controlled type 2 diabetes. Over 9 months, people in the telemonitoring group had better HbA1c and lower ambulatory blood pressure than those receiving usual care, while body weight stayed similar between groups.

This was a structured telemonitoring program, not simple unsupported self-monitoring. Participants transmitted readings, and clinicians reviewed results regularly and contacted patients when needed. The benefits may depend on that support model, patient engagement, and the local health system’s ability to respond to incoming data. It is also not yet clear whether the improvement lasts after monitoring stops.

Whether supported telemonitoring improves diabetes and blood pressure control in primary care

These findings apply most directly to adults with type 2 diabetes in primary care who have poor glycemic control, can use home monitoring equipment, and have access to remote clinician follow-up. The results are especially relevant to UK-style family practice settings, but may also inform similar telehealth programs elsewhere.

Supported telemonitoring improved HbA1c and blood pressure in type 2 diabetes

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