Comprehensive study on telemedicine for diabetes and coronary heart disease

Patients with type 2 diabetes who also suffer from coronary heart disease have a particularly high risk of heart attacks, among other things. Those who change their lifestyle, exercise more and change their diet can demonstrably reduce such risks. A study at eleven German locations was conducted to find out whether telemedicine and training apps can help. The results have been published in the renowned journal ‘Nature Medicine’.

For the study, 502 patients (84% of whom were men) were divided into two groups. The control group received the usual medical care and was given standardised dietary recommendations and information material on physical activity. The second group also received an individualised, app-supported sports programme for at home and repeated personalised nutrition tips. In the first six months, the participants were accompanied by regular telephone calls. In a second phase, they were asked to follow the exercises independently. 

Little involvement from participants

‘After the first six months, we saw an improvement of -0.13 percentage points in long-term blood glucose in the intervention group,’ says lead author Dr Stephan Müller. Although this is a small improvement, it is statistically significant. The training had no effect on other risk factors such as blood pressure or cholesterol levels. If one only considers participants who actually followed the training and dietary guidelines, the improvement is almost -0.3 percentage points, which is also relevant from a clinical perspective. There were also statistically significant effects on body weight, waist circumference and one of the blood lipid levels, triglycerides. After the end of the second phase, there were no more benefits compared to the control group.

From the researchers' point of view, an important factor for the results of the study was the co-operation of the participants - technically known as adherence. Even in the first six months, only 41 per cent fulfilled the adherence criteria for the movement exercises, i.e. participated ‘sufficiently’. Among those who did not participate ‘sufficiently’, almost half did not achieve the goal in a single week. What's more, around a quarter of all participants did not even start training. Technology barriers may have been partly responsible for this. More than two thirds of participants - average age 68 - stated that they generally found using apps and devices ‘rather difficult’. 

‘Lots of effort for little return’

In the view of last author Martin Halle, Professor of Preventive Sports Medicine and Sports Cardiology at TUM, large studies like this are important to measure the actual success of app-based approaches. Germany is the first country in Europe in which digital services are recognised as medical services by health insurance companies. According to Halle, the shortage of doctors in this country also raises high hopes for health promotion through apps and similar services.