Objective:
to examine the effects of the Informatics for Diabetes Education and Telemedicine (IDEATel) telemedicine intervention and pedometer use on physical activity (PA) and impairment in older adults with diabetes.
Design:
randomised clinical trial.
Subjects
ethnically diverse medically underserved Medicare beneficiaries with diabetes (n = 1,650).
Methods:
participants received home videovisits with a diabetes educator every 4–6 weeks or usual care. All received a pedometer. Annual measurements included hemoglobin A1c, Comprehensive Assessment and Referral Evaluation Activities of Daily Living, Diabetes Self-Care Activities, Charlson Comorbidity Index, Luben Social Support and pedometer use. Mixed model analyses were performed using random effects to adjust for clustering within primary care physicians.
Results:
in the telemedicine group compared with the usual care group, the rate of decline in PA (P = 0.0128) and physical impairment (PI) (P = 0.0370) was significantly less over time. Significant mean endpoint differences were observed for PA (P = 0.003). Pedometer use was significantly associated with PA (P = 0.0006) and PI (P < 0.0001). Baseline characteristics associated with greater PA included having fewer comorbid conditions (P = 0.0054), less depression (P < 0.0001), more social networking (P < 0.0001), lower BMI (P < 0.0001), male gender (P < 0.0001) and lower hemoglobin A1c level (P = 0.0045). Similar predictors were observed for PI, except duration of diabetes also predicted increased impairment (P < 0.0001). Significant indirect effects were observed through use of the pedometer on reduced decline in PA (P = 0.0024, 0.0013) and PI (P = 0.0024, P < 0.0001).
Conclusions:
this telemedicine intervention reduced rates of decline in PA and impairment in older adults with diabetes. Pedometers may be a helpful inexpensive adjunct to diabetes initiatives delivered remotely with emerging technologies.
Abstract
Weinstock, Ruth S.; Brooks, Gary; Palmas, Walter; Morin, Philip C.; Teresi, Jeanne A.; Eimicke, Joseph P.; Silver, Stephanie; Izquierdo, Roberto; Goland, Robin; Shea, Steven, Age and Ageing, Online first, DOI: 10.1093/ageing/afq147
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