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Main characteristics of type 1 and type 2 diabetic patients interested in the use of a telemonitoring platform

2011; Wiley; Volume: 3; Issue: 4 Linguagem: Inglês

10.1111/j.1752-9824.2011.01120.x

1752-9824

Heidi Buysse, Georges De Moor, Pascal Coorevits, Georges Van Maele, Jean‐Marc Kaufman, Johannes Ruige,

Mobile Health and mHealth Applications

Journal of Nursing and Healthcare of Chronic IllnessVolume 3, Issue 4 p. 456-468 ORIGINAL ARTICLEFree Access Main characteristics of type 1 and type 2 diabetic patients interested in the use of a telemonitoring platform Heidi Buysse MD, Heidi Buysse MDSearch for more papers by this authorGeorges De Moor MD, Georges De Moor MDSearch for more papers by this authorPascal Coorevits PhD, Pascal Coorevits PhDSearch for more papers by this authorGeorges Van Maele PhD, Georges Van Maele PhDSearch for more papers by this authorJean Kaufman MD, Jean Kaufman MDSearch for more papers by this authorJohannes Ruige PhD, MD, Johannes Ruige PhD, MDSearch for more papers by this author Heidi Buysse MD, Heidi Buysse MDSearch for more papers by this authorGeorges De Moor MD, Georges De Moor MDSearch for more papers by this authorPascal Coorevits PhD, Pascal Coorevits PhDSearch for more papers by this authorGeorges Van Maele PhD, Georges Van Maele PhDSearch for more papers by this authorJean Kaufman MD, Jean Kaufman MDSearch for more papers by this authorJohannes Ruige PhD, MD, Johannes Ruige PhD, MDSearch for more papers by this author First published: 14 November 2011 https://doi.org/10.1111/j.1752-9824.2011.01120.xCitations: 7 Heidi Buysse De Pintelaan 185 (5K3) Ghent 9000 Belgium Telephone: +32 9 3325463 E-mail: Heidi.Buysse@UGent.be AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract buysse h, de moor g, coorevits p, van maele g, kaufman j & ruige j (2011) Journal of Nursing and Healthcare of Chronic Illness 3, 456–468 Main characteristics of type 1 and type 2 diabetic patients interested in the use of a telemonitoring platform Aims and objectives. The main question addressed in this work, and to the best of our knowledge the first study focusing on this aspect, is whether diabetic patients – before they ever used a telemonitoring platform – are interested in using such a platform. In case they are interested, it is investigated whether characteristics of interested users could be distinguished. From a clinical perspective, special attention was drawn to metabolic control and to empowerment. Background. Diabetes is one of the most challenging health problems in the 21st century. The use of a telemonitoring platform could be an opportunity for persons with diabetes. However, until now, it has never been investigated if those persons are interested in using such a platform. Results. Of the 172 patients signing the informed consent, 137 (79·7%) patients filled in the questionnaires. Depending on the type of treatment, about 40–60% is interested in using a telemonitoring platform. Patients can easily be identified by the use of a computer or Internet, and interested patients log their treatment data. Most patients showing interest are on insulin treatment without having adequate metabolic control, or are on insulin and oral treatment with low empowerment scores, suggesting that implementation of a telemonitoring platform in these patients makes sense and can be used to improve metabolic control, e.g., by increasing empowerment. Conclusions. There is substantial interest in the use of a telemonitoring platform in insulin using (type 1/type 2) patients, and there is also a potential for improvement of metabolic control or empowerment in these patients. Implications for practice. Implementation of telemonitoring projects is potentially cost-effective in insulin using (type 1/type 2) patients already using a computer or the Internet. Introduction Diabetes is one of the most challenging health problems in the 21st century (Shaw et al. 2010). According to the International Diabetes Federation (2010), in Belgium, a persistent growth is predicted, from an estimated prevalence in the age group 20–79 years of 5·3% in 2010 to 6·7% in 2030. Also, there is a rise in diabetes among children. Over the last 15 years, the Belgian Diabetes Registry recorded an increase of diabetes in boys under the age of 10 of 8·2% (Belgian Diabetes Registry 2009). The earlier the onset of diabetes, the greater the risk to develop chronic complications (Belgian Diabetes Registry 2009), resulting in increased disability, reduced life expectancy and exploding healthcare costs (Hall et al. 2008, Zhang et al. 2010). Prevention or reduction of long-term complications can be reached through a reduction of the average concentration of blood glucose (The Diabetes Control and Complications Trial Research Group 1993, Nathan et al. 2005, Jaana & Pare 2007, Clark 2008, Gerstein et al. 2008, Aschner et al. 2010) by which empowerment, information and education have shown to be important aspects (Cherry et al. 2002, Celler et al. 2003, Buller 2004, Montori et al. 2004, Sigurdardottir & Jonsdottir 2008). Although patients still need support by medical doctors and diabetes educators, their role becomes a more central one (Holman & Lorig 2000). Active involvement in the process of care and treatment management and taking responsibility for collecting measurements and related information has become necessary (Lorig & Holman 2003). Patients need to participate extensively in daily and ongoing diabetes care decisions (Funnell & Anderson 2003) and thus need to be empowered (Shiu et al. 2003). Diabetes empowerment is defined by Funnell et al. (1991) as facilitating people the discovery of their own innate ability and letting them use it to gain mastery over their diabetes. Therefore, education about the illness and support in adopting self-management as a lifelong task became key factors in diabetes health care (Lorig & Holman 2003, Buller 2004, Aujoulat et al. 2007, Clark 2008). Telemonitoring could facilitate these processes (Jaana & Pare 2007). It is defined by Meystre (2005) as 'the employment of information technology with the goal of monitoring patients over distance', and it comprises – applied to diabetes –'the recording, transmission and visualisation of the main variables considered in diabetes care' (Gomez et al. 2002, Wojcicki 2005). Telemonitoring seems to have a positive impact on education, clinical outcomes as well as on empowerment (Jaana & Pare 2007, Meijer & Ragetlie 2007, Pare et al. 2010, Samoocha et al. 2010). From a clinical point of view, type 2 diabetic patients needing multiple daily insulin injections also have to adapt their dose and can with respect to treatment be included in the group of patients with type 1 diabetes. Telemonitoring could thus also be very promising for those patients. Patients on only oral treatment have – oppositely – a fixed dose prescribed by their physician. For those patients, a very close follow-up of the diabetes-related measurements is clinically not 'urgent', so possibly those patients have more benefit of other services than those offered via a telemonitoring platform. In this study, three different 'groups' of patients could be distinguished: type 1 and type 2 diabetic patients with insulin treatment, type 2 diabetic patients with a 'combined' treatment (tablets and insulin) and type 2 diabetic patients taking tablets. This is a new point of view because even though quite some studies focus on telemonitoring by diabetic patients (Polisena et al. 2009), the selection of patients is primarily based on a classical type 1/type 2 classification. The use of a telemonitoring platform could have different surplus values. Such platforms have the possibility to enhance the communication between different actors in a private and secure way (Car & Sheikh 2004, Claerhout & DeMoor 2005, Van Hoecke et al. 2007a,b), both very important issues. By using a telemonitoring platform, patients could receive timely (personalised) feedback. Another advantage of using such a platform could be that there are less transcription errors (Waldo 2003) or, a higher reliability (Wojcicki 2005) of direct transfer of blood glucose data into the system. Aim The aim of the present study was to investigate whether patients with diabetes are interested in the use of a telemonitoring platform before they ever used such a platform. It further aims at investigating whether it is possible to identify characteristics of interested users. From a clinical perspective, special attention was drawn to metabolic control (HbA1c) and to empowerment. Methods The patients included in this study were adults (aged ≥18 years at date of the study) diagnosed with type 1 or type 2 diabetes visiting their diabetologist at the Department of Endocrinology of the Ghent University Hospital during the months July till December 2008. There were no specific exclusion criteria. The diabetes educator responsible for distributing therapeutic devices asked for their participation. The researcher informed the patients willing to participate regarding the purpose of the study. Seven patients out of 179 refused to participate. All patients participating in this study (n = 172) signed the informed consent form. The study was approved by the Ethical Review Board of the Ghent University Hospital (Approval Ethics Committee: 'Project EC UZG 2008/294') and conducted according to the principles of the Declaration of Helsinki. Before the effective implementation of the study, structured interviews were held with patients (n = 9). Special attention was given to the phrasing of the question, the difficulty to answer it and its relevance. These interviews were tape-recorded and transcribed verbatim. According to Streiner and Norman (2003), the interviews were ended at the point where no new elements could be added (sampling to redundancy) (Buysse et al. 2010). Instruments For the purpose of this study, patients received two validated questionnaires. The Diabetes Empowerment Scale (DES) developed by Anderson et al. (2000) was translated and validated into Dutch; the Dutch-DES-20. It is an overall assessment of diabetes-related psychosocial self-efficacy and scored on a 5-point Likert scale. The Telemonitoring Health Effect and Readiness Questionnaire (THERQ) is a newly developed and validated questionnaire (Buysse et al. 2010). It consists of adapted and translated questions from existing questionnaires and some newly added questions. An important aspect in this questionnaire is the measurement of interest in using a telemonitoring platform. Such a platform can contain various services. In this study, it was asked for the use of rather restricted services because it is better to implement from a bottom-up approach offering a limited but fully functional system instead of implementing a wide range of functionality of beta quality (Ackaert et al. 2009). Adding other features to an existing platform is mostly, from a technical point of view and if a platform is built generic, not that difficult. Also, the interviews held before the effective implementation of the study learned that – when talking about a telemonitoring platform – all patients associated it with a computer even though this should not be the case. They also thought in terms of transferring their diabetic data to their physician via the computer and receiving feedback. However, such platforms could have a lot of other functionalities, e.g., transferring other data (pedometer-data via PDA, blood pressure, weight, etc.), video-chat in a private and secure environment, emergency call with video follow-up, online audio-diary, etc. In this questionnaire, the focus was therefore on three main aspects: (1) sending blood glucose values, (2) sending diabetic-related data or (3) asking disease-related questions to their medical doctor or diabetes educator. Further, a telemonitoring platform has, as surplus value, no limitations with respect to location or time (Mazzi & Kidd 2002). It was thus asked whether patients would like to use it from their home environment or from alternative locations which was operationalised as 'during holidays'. Sharing experience with other diabetic patients also has become easier and could thus be valuable (Hoffman-Goetz et al. 2009), so questions were inserted to ask for interest in communication with peers. Because some telemonitoring studies showed positive health effects (Jaana & Pare 2007, Meijer & Ragetlie 2007, Pare et al. 2010, Samoocha et al. 2010), some questions concerning this topic were also included. All questions could be scored on a 5-point Likert scale. The Dutch-DES-20 and the THERQ were given to 172 patients, together with a stamped envelope, a copy of the already signed informed consent form and information regarding the study. Basic clinical information was retrieved from the medical record of only those patients returning the questionnaires (n = 137). Statistical analysis All analyses were performed with spss Statistics version 18 (IBM PASW Statistics, Markham, Canada). Because the data do not fit the normal curve, nonparametric descriptive statistics were used to establish frequencies, range and median of demographic and clinical characteristics. The Kruskal–Wallis one-way anova and Mann–Whitney U-tests were performed for comparison of continuous variables, Chi-squared test for contingency tables and Fisher's Exact test where applicable. Spearman correlation coefficients were calculated between the specific 'interest in telemonitoring' questions and questions concerning (1) general data and clinical information, (2) empowerment and (3) the use of the Internet. The significance level was set at α = 0·05. Because this is, as far as the authors know, the first study analysing the results from a 'treatment-view', the analyses were also carried out from the classical type 1/type 2 classification (see extra Tables). Table Extra Table 1 . Demographic and basic clinical data of patients participating in the main study (n = 138) Type 1 (n = 70) Type 2 (n = 68) n (%) n (%) Age (years)* 18–35 29 (41·4) 2 (2·9) 36–55 22 (31·4) 18 (26·5) >55 19 (27·2) 48 (70·6) Years since diabetes diagnosis† 20 33 (47·1) 11 (16·2) HbA1c (%)‡ Optimal control ( 8·5%) 16 (22·9) 6 (9·0) No information 15 (21·4) 13 (19·4) Treatment Tablets 12 (17·7) Tablets and insulin 26 (38·2) Insulin 70 (100·0) 29 (42·6) No information 1 (1·5) Medication for diabetic-related disorders 16 (23·2) 26 (39·4) Highest educational degree No degree or primary School degree 21 (30·0) 27 (39·7) Secondary School degree 19 (27·1) 19 (27·9) High School or University degree 27 (38·6) 21 (30·9) No information 3 (4·3) 1 (1·5) Median [range]: *54 years [18–87 years]. †15 years [0–54 years]. ‡7·5% [5·8–12·1%]. Table Extra Table 2 . The frequency distribution (%) of responses on some items from the questionnaire (n = 138) Questions Type 1 Type 2 Yes Sometimes No/no info Yes Sometimes No/no info I use a computer 61·4 18·6 20·0 36·8 22·1 41·2 Currently, I keep blood glucose values on paper 38·6 17·1 44·3 64·7 14·7 20·6 Currently, I keep blood glucose values on computer 8·6 17·1 74·3 7·4 0·0 92·6 Currently, I keep other data on paper 17·1 21·4 61·4 35·3 23·5 41·2 Currently, I keep other data on computer 4·3 8·6 87·1 2·9 2·9 94·1 Yes I will No Yes I will No I can easily find diabetes information on the Internet 48·6 5·7 45·7 22·1 11·8 66·2 I use a diabetes forum 12·9 35·7 51·4 8·8 23·5 67·6 I (will) use a telemonitoring platform from the home environment to transfer blood glucose values to my diabetes professional 27·1 42·9 30·0 8·8 33·8 57·4 I (will) use a telemonitoring platform from the home environment to transfer other diabetic data to my diabetes professional 18·6 42·9 38·6 4·4 32·4 63·2 I (will) use a telemonitoring platform from the home environment to ask questions to my diabetes professional 30·0 37·1 32·9 7·4 30·9 61·8 I (will) use a telemonitoring platform during holidays to transfer blood glucose values to my diabetes professional 1·4 21·4 77·1 22·1 19·1 58·8 I (will) use a telemonitoring platform during holidays to transfer other diabetic data to my diabetes professional 1·4 18·6 80·0 1·5 20·6 77·9 I (will) use a telemonitoring platform during holidays to ask questions to my diabetes professional 4·3 20·0 75·7 2·9 20·6 76·5 I (will) use a telemonitoring platform to transfer blood glucose values to another diabetic person 0·0 12·9 87·1 0·0 16·2 83·8 I (will) use a telemonitoring platform to transfer other diabetic data to another diabetic person 2·9 14·3 82·9 0·0 13·2 86·8 I (will) use a telemonitoring platform to ask questions to another diabetic person 5·7 22·9 71·4 0·0 16·2 83·8 Table Extra Table 3 . General patient information and interest in the use of a telemonitoring platform Type 1 Type 2 Interest in using the telemonitoring platform from the home environment for communication with a diabetes professional with respect to Interest in using the telemonitoring platform from the home environment for communication with a diabetes professional with respect to Blood glucose values† Other data‡ Questions§ Blood glucose values† Other data‡ Questions§ Age (y) r S −0·31** −0·40** −0·47** −0·51** −0·41** −0·36** Highest educational degree r S 0·15 0·02 0·26* 0·48** 0·46** 0·42** HbA1c r S 0·25*** 0·33* 0·18 0·03 0·18 0·07 I keep blood glucose values on paper r S −0·04 0·01 0·13 −0·15 −0·02 0·16 I keep blood glucose values on computer r S 0·61** 0·46** 0·35** 0·49** 0·11 0·22 I keep other diabetic data on paper r S −0·02 0·17 0·02 −0·18 0·02 0·01 I keep other diabetic data on computer r S 0·15 0·17 0·03 0·28* 0·29* 0·25*** Logging my blood glucose values makes me stay healthier r S 0·32* 0·19 0·26* 0·32* 0·28* 0·34** Logging other diabetic data makes me stay healthier r S 0·07 0·22*** 0·28* 0·28* 0·42** 0·35** r S: Spearman rank correlation coefficient. *Significant at the 0·05-level; **significant at the 0·01 level; ***borderline missed significance. †Transferring daily blood glucose values. ‡Transferring other diabetic-related data, e.g., weight, diet information, etc. §Ask questions. Table Extra Table 4 . Use of the computer and the Internet and interest in the use of a telemonitoring platform Type 1 Type 2 Interest in using the telemonitoring platform from the home environment for communication with a diabetes professional with respect to Interest in using the telemonitoring platform from the home environment for communication with a diabetes professional with respect to Blood glucose values† Other data‡ Questions§ Blood glucose values† Other data‡ Questions§ In general. I use a computer r S 0·50** 0·61** 0·46** 0·62** 0·61** 0·57** I make use of a diabetes forum r S 0·33** 0·21 0·41** 0·41** 0·43** 0·45** I can easily find (in Dutch) diabetic information on the Internet r S 0·30* 0·29* 0·46** 0·48** 0·56** 0·55** Most information found on the Internet is understandable r S 0·21 0·28* 0·47** 0·23 0·21 0·23 r S: Spearman rank correlation coefficient. *Significant at the 0·05-level; **significant at the 0·01-level. †Transferring daily blood glucose values. ‡Transferring other diabetic-related data, e.g., weight, diet information, etc. §Ask questions. Table Extra Table 5 . Diabetes empowerment and interest in the use of a telemonitoring platform Type 1 Type 2 Interest in using the telemonitoring platform from the home environment for communication with a diabetes professional with respect to Interest in using the telemonitoring platform from the home environment for communication with a diabetes professional with respect to Blood glucose values† Other data‡ Questions§ Blood glucose values† Other data‡ Questions§ Diabetes Empowerment Scale r S −0·09 −0·13 −0·12 −0·30* −0·29* −0·23 Feeling able to fit diabetes into life in a positive manner†† r S −0·06 −0·05 −0·21 −0·33* −0·31* −0·30* Feeling comfortable asking questions to a professional†† r S 0·31* 0·24* 0·22** −0·20 −0·07 −0·06 Rating knowledge about diabetes and its treatment†† r S 0·23** 0·05 0·11 −0·02 0·13 0·03 Diabetes prevents one from doing normal daily activities†† r S 0·10 −0·04 −0·02 0·13 0·16 0·13 r S, Spearman rank correlation coefficient. *Significant at the 0·05-level; **borderline missed significance. †Transferring daily blood glucose values. ‡Transferring other diabetic-related data, e.g., weight, diet information, etc. §Ask questions. ††Questions related to the Diabetes Empowerment Scale. Results Of the 172 patients signing the informed consent, 137 (79·7%) filled in the questionnaire (Table 1). Half of the patients had diabetes type 1. Of the type 2 diabetic patients, 43·3% were under insulin treatment; another 38·8% had both insulin and tablets. The remainder 16·4% only took tablets and normally do not change their medication themselves. Patients' median age was 54 years (range: 18–87 years). The median time since diagnosis was 15 years (range: 0–54 years) and the median HbA1c 7·5% (range: 5·8–12·1%). Table 1. Demographic and basic clinical data of patients participating in the main study (n = 137) Insulin§ (n = 99) Combined¶ (n = 26) Tablets** (n = 12) n (%) n (%) n (%) Type of diabetes Type 1 70 (70·7) 0 (0·0) 0 (0·0) Type 2 29 (29·3) 26 (100·0) 12 (100·0) Sex Female 48 (48·5) 11 (42·3) 3 (25·0) Age (years)* 18–35 30 (30·3) 0 (0·0) 1 (8·3) 36–55 30 (30·3) 7 (26·9) 3 (25·0) >55 39 (39·4) 19 (73·1) 8 (66·7) Years since diabetes diagnosis† 20 41 (41·4) 2 (7·7) 1 (8·3) HbA1c (%)‡ Optimal control ( 8·5%) 18 (18·2) 4 (15·4) 0 (0·0) No information 22 (22·2) 2 (7·7) 3 (25·0) Medication for diabetic-related disorders 24 (24·2) 12 (46·2) 6 (50·0) Highest educational degree No degree or primary school degree 32 (32·3) 27 (39·7) 3 (25·0) Secondary school degree 27 (27·3) 19 (27·9) 4 (33·3) High school or University degree 36 (36·4) 21 (30·9) 5 (41·7) No information 4 (4·0) 1 (1·5) 0 (0·0) Median [range]: *54 years [18–87 years]; †15 years [0–54 years]; ‡7·5% [5·8–12·1%]; insulin treatment: *51 years [18–87 years]; †18 years [0–54 years]; ‡7·6% [5·8–12·1%]; combined treatment: *64 years [44–83 years]; †12 years [2–30 years]; ‡7·6% [5·8–9·9%]; only tablets: *70 years [32–72 years]; †6 years [0–24 years]; ‡7·1% [5·8–7·5%]. §Insulin: type 1 and type 2 diabetic patients on insulin only treatment. ¶Combined: type 2 diabetic patients with a combined treatment (insulin and tablets). **Tablets: type 2 diabetic patients on only oral treatment. Compared to patients taking only tablets, patients with a combined (insulin and tablets) or insulin only treatment have higher HbA1c-levels [(combined: p = 0·027), insulin: p = 0·010)]. Patients with an insulin only treatment are younger than patients with a combined treatment (p < 0·001) or than patients with only oral treatment (p = 0·036). Compared to patients with only oral treatment, patients with insulin treatment are already diagnosed for a longer period (p = 0·005). Table 2 gives an overview of how patients responded on some important questions. About 20% of patients with insulin treatment already use some form of electronic exchange of data with the diabetes educator of physician, such as e-mail. Important to note is that in all groups (insulin, combined and tablets), quite some patients are willing to use such a platform (insulin and combined: about 40%, tablets: about 30%). There is thus a potential use of about 60–40%, depending on the group. Patients in all groups seem less interested in the use of such a telemonitoring platform from other locations than home or for using it with peers. However, about 40% of patients with a combined treatment are also interested in using a telemonitoring platform from other locations. Table 2. The frequency distribution (%) of responses on some items from the questionnaire Questions Insulin* (n = 99) Combined† (n = 26) Tablets‡ (n = 12) Yes +/−§ No Yes +/−§ No Yes +/−§ No I use a computer 54·6 12·1 33·3 34·6 26·9 38·5 36·8 22·1 41·2 Currently, I keep blood glucose values on paper 46·5 15·2 38·4 80·8 15·4 3·8 64·7 14·7 20·6 Currently, I keep blood glucose values on computer 8·1 12·1 79·8 7·7 0·0 92·3 7·4 0·0 92·6 Currently, I keep other data on paper 22·2 20·2 57·6 38·5 30·8 30·8 35·3 23·5 41·2 Currently, I keep other data on computer 3·0 6·0 90·9 7·7 0·0 92·3 2·9 2·9 94·1 Yes I will No Yes I will No Yes I will No I can easily find diabetes information on the Internet 41·4 6·1 52·5 34·6 15·4 50·0 25·0 16·7 58·3 I use a diabetes forum 12·1 32·3 55·4 7·7 19·2 73·1 8·3 33·3 58·4 I (will) use a telemonitoring platform from the home environment to transfer blood glucose values to my diabetes professional 21·2 39·4 39·4 11·5 38·5 50·0 8·3 33·3 58·3 I (will) use a telemonitoring platform from the home environment to transfer other diabetic data to my diabetes professional 14·1 37·4 48·4 7·7 42·3 50·0 0·0 33·3 66·7 I (will) use a telemonitoring platform from the home environment to ask questions to my diabetes professional 22·1 32·3 45·5 11·5 46·2 42·3 8·3 25·0 66·7 I (will) use a telemonitoring platform during holidays to transfer blood glucose values to my diabetes professional 1·0 17·2 81·8 0·0 42·3 57·7 0·0 16·7 83·3 I (will) use a telemonitoring platform during holidays to transfer other diabetic data to my diabetes professional 2·0 16·2 81·8 0·0 34·6 65·4 0·0 16·7 83·3 I (will) use a telemonitoring platform during holidays to ask questions to my diabetes professional 3·0 16·2 80·8 7·7 38·5 53·8 0·0 16·7 83·3 I (will) use a telemonitoring platform to transfer blood glucose values to another diabetic person 0·0 12·1 87·9 0·0 26·9 73·1 0·0 8·3 91·7 I (will) use a telemonitoring platform to transfer other diabetic data to another diabetic person 2·0 13·1 84·9 0·0 19·2 80·8 0·0 8·3 91·7 I (will) use a telemonitoring platform to ask questions to another diabetic person 4·0 19·2 76·8 0·0 23·1 76·9 0·0 16·7 83·3 *Insulin: type 1 and type 2 diabetic patients on insulin only treatment. †Combined: type 2 diabetic patients with a combined treatment (insulin and tablets). ‡Tablets: type 2 diabetic patients on only oral treatment. §Sometimes. Patients with only insulin treatment Younger patients are more interested in the use of a telemonitoring platform (Table 3). Patients without adequate metabolic control represented by higher HbA1c-levels are also more prone to use such a platform. It was further found that if they already keep blood glucose values on computer, they are more interested in using a telemonitoring platform. Table 3. General patient information and interest in the use of a telemonitoring platform Insulin† (n = 99) Combined‡ (n = 26) Tablets§ (n = 12) Blood glucose¶ Other data†† Q‡‡ Blood glucose¶ Other data†† Q‡‡ Blood glucose¶ Other data†† Q‡‡ Age (y) r S −0·38** −0·38** −0·48** −0·70** −0·74** −0·69** −0·62 −0·17 −0·45 Highest educational degree r S 0·18 0·11 0·24* 0·72** 0·70** 0·75** 0·42 0·27 0·29 HbA1c r S 0·30* 0·39** 0·33** 0·37 0·39 0·15 0·36 0·00 0·54 I keep blood glucose values on paper r S −0·14 −0·04 0·05 −0·48* −0·39 −0·24 0·68* 0·28 0·58 I keep blood glucose values on computer r S 0·63** 0·45** 0·40** 0·35 0·29 0·14 0·60 −0·32 0·61 I keep other diabetic data on paper r S −0·01 0·20 0·09 −0·44* −0·40* −0·36 0·33 0·80 0·19 I keep other diabetic data on computer r S 0·22 0·22 0·15 0·35 0·23 0·14 0·34 0·60 0·46 Logging my blood glucose values makes me stay healthier r S 0·21* 0·15 0·19 0·47* 0·49* 0·56** 0·68* 0·28 0·58 Logging other diabetic data makes me stay healthier r S 0·05 0·20 0·23* 0·48* 0·49* 0·57** 0·11 0·51 −0·02 r S: Spearman rank correlation coefficient. *Significant at the 0·05-level; **significant at the 0·01-level. †Insulin: type 1 and type 2 diabetic patients on insulin only treatment. ‡Combined: type 2 diabetic patients with a combined treatment (insulin and tablets).