Z.W.J.KOH1, S.Z.SIM1, E.S.LEE1, K.W.J.LEW2
NHG Polyclinics1, National Healthcare Group HQ2
With the COVID-19 pandemic, telemedicine has been increasingly deployed for the management of chronic diseases in polyclinics. However, its effectiveness is not well studied. We aim to show that one-off telephone consultation was non-inferior to face-to-face consultation in patients with sub-optimally controlled type 2 diabetes.
A retrospective propensity score matched non-inferiority cohort study was performed on diabetic patients aged 21 to 80 years old, with polyclinic visits between 9 April and 30 November 2020 and baseline glycated haemoglobin (HbA1c) ≥ 7.0%. The variables matched included age, gender and presence of hyperlipidaemia, hypertension, macro and microvascular diabetic complications. These patients were followed up at 3-4months and the mean HbA1c change (ΔHbA1c) from baseline was measured as the primary outcome. The pre-specified non-inferiority margin was set at 0.5%.
A total of 644 patients were matched into the telephone and face-to-face consultation groups. Over four months, the mean ΔHbA1c were -0.17% (95% CI: -0.26 to -0.08) and +0.05% (95% CI: -0.07 to 0.18) for face-to-face and telephone consultation groups, respectively. The upper limit of the two-sided 95% confidence interval was less than the non-inferiority margin of 0.5%, which met the criterion for declaring non-inferiority of telephone to face-to-face consultations for glycaemic control.
For patients with sub-optimally 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. Telephone consultations can be considered as an alternative mode for diabetes review. However, more studies are required to investigate the long-term effects of telephone consultations.