Telemedicine Home-based Management in Patients With CHF and Type 2 Diabetes

NCT ID: NCT05633784

Last Updated: 2024-11-01

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

163 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-08-18

Study Completion Date

2024-09-30

Brief Summary

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The progressive ageing of the population of industrialized countries is accompanied by a dramatic increase in the prevalence of chronic multi-pathologies. In the general population, HF is associated with a higher prevalence of T2DM compared with patients without HF and with marked regional differences observed in Europe and the rest of the world. In clinical trials of chronic HF patients, the prevalence of T2DM is approximately 30% in patients with reduced or preserved ejection fraction and rises to as much as 45% in hospitalized patient registries. A complex drug regimen is often associated with low adherence in patients with HF and T2DM and poor adherence is associated with adverse clinical events. Similarly, adherence to recommendations regarding lifestyle changes, such as increasing physical activity, is often limited despite these changes' favourable effects on the patient. Therefore, interventions are needed to improve all these factors and optimize adherence. The inclusion of telemedicine (telenursing, telerehabilitation, mHealth) focused on health and correct behaviour can create opportunities to implement customized and scalable solutions in populations at risk. The project will aim to evaluate for patients with chronic diseases with a complex phenotype (heart failure and type II diabetes mellitus) the effectiveness of a remote surveillance program with particular attention to lifestyle changes.

Detailed Description

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Conditions

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Chronic Heart Failure Diabetes Mellitus

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
Consenting eligible patients were randomized to either an Intervention or a Control group (1:1).

A computer (www.randomization.com) generated tables to allocate patients in fixed blocks of four. In order to prevent selection bias, the list of randomization will be managed by personnel not directly involved in the enrolment of the patient. Due to the nature of the intervention, neither the patients nor the physicians were blinded to patients' group allocation. However, outcome assessors and data analysts will be blinded to the allocation.

Study Groups

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Intervention group

At the beginning and at the end of the 6-month study period, patients of the Intervention group will perform outpatient cardiological visits. During the 6-month they will be followed through a home remote teleassistance program, designed to provide multidisciplinary support.

Group Type EXPERIMENTAL

Teleassistance

Intervention Type OTHER

Support the nursing case manager through a structured teleconsultation program (telephone and videoconference support at least once a week)

Teleconsultation

Intervention Type OTHER

Cardiological and Diabetological teleconsultation at the beginning of the program and in case of need during the program.

Telerehabilitation

Intervention Type OTHER

Support from a physiotherapist (if needed)

Telemonitoring

Intervention Type OTHER

Telemonitoring of patient vital signs (eg single electrocardiographic trace) and delay steps

mHealth

Intervention Type OTHER

The support of an App for recording and monitoring parameters: delay treatment, clinical parameters such as glycemia, blood pressure, HR, symptoms, etc.

telepsycology

Intervention Type OTHER

Psychological support (if necessary)

Quality of life

Intervention Type OTHER

Minnesota LIVING WITH HEART FAILURE® Questionnaire (MLHFQ), Short Form Survey (SF-12) Questionnaire and Diabetes Quality of Life (DQoL) questionnaire

Biochemistry evaluation

Intervention Type OTHER

Glycemia, glycated haemoglobin, total cholesterol, HDL and LDL, triglycerides, creatinine, BUN, creatinine clearance, BNP

Clinical evaluation

Intervention Type OTHER

6-minute-walking test, IMC, NYHA class, Ejection fraction

State of health of the patient

Intervention Type OTHER

Severity Index and Comordbidity index

Control group

At the beginning and at the end of the 6-month study period, patients of the Control group will perform outpatient cardiological visits. During the 6-month at home, patients will be followed in the usual care model by GP.

Group Type ACTIVE_COMPARATOR

Quality of life

Intervention Type OTHER

Minnesota LIVING WITH HEART FAILURE® Questionnaire (MLHFQ), Short Form Survey (SF-12) Questionnaire and Diabetes Quality of Life (DQoL) questionnaire

Biochemistry evaluation

Intervention Type OTHER

Glycemia, glycated haemoglobin, total cholesterol, HDL and LDL, triglycerides, creatinine, BUN, creatinine clearance, BNP

Clinical evaluation

Intervention Type OTHER

6-minute-walking test, IMC, NYHA class, Ejection fraction

State of health of the patient

Intervention Type OTHER

Severity Index and Comordbidity index

Interventions

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Teleassistance

Support the nursing case manager through a structured teleconsultation program (telephone and videoconference support at least once a week)

Intervention Type OTHER

Teleconsultation

Cardiological and Diabetological teleconsultation at the beginning of the program and in case of need during the program.

Intervention Type OTHER

Telerehabilitation

Support from a physiotherapist (if needed)

Intervention Type OTHER

Telemonitoring

Telemonitoring of patient vital signs (eg single electrocardiographic trace) and delay steps

Intervention Type OTHER

mHealth

The support of an App for recording and monitoring parameters: delay treatment, clinical parameters such as glycemia, blood pressure, HR, symptoms, etc.

Intervention Type OTHER

telepsycology

Psychological support (if necessary)

Intervention Type OTHER

Quality of life

Minnesota LIVING WITH HEART FAILURE® Questionnaire (MLHFQ), Short Form Survey (SF-12) Questionnaire and Diabetes Quality of Life (DQoL) questionnaire

Intervention Type OTHER

Biochemistry evaluation

Glycemia, glycated haemoglobin, total cholesterol, HDL and LDL, triglycerides, creatinine, BUN, creatinine clearance, BNP

Intervention Type OTHER

Clinical evaluation

6-minute-walking test, IMC, NYHA class, Ejection fraction

Intervention Type OTHER

State of health of the patient

Severity Index and Comordbidity index

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Inform consent
* Age ≥ 18 years
* Documented diagnosis of heart failure, NYHA class II-III (reduced or preserved Ejection fraction without hospitalization in the last 3 months
* Diagnosis of Diabetes Mellitus Type II in pharmacological treatment from at least one month
* Ability to walk without assistive devices
* Consent to using a device (independently or with the support of a caregiver) for recording the single electrocardiographic trace at home
* Consent to using the App

Exclusion Criteria

* Subjects with poor collaboration
* No possibility of using mobile technology
* Life expectancy of fewer than 6 months
* Medical issues that preclude participation in the program
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Azienda Ospedaliera Bolognini di Seriate Bergamo

OTHER

Sponsor Role collaborator

Papa Giovanni XXIII Hospital

OTHER

Sponsor Role collaborator

Istituti Clinici Scientifici Maugeri SpA

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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SIMONETTA SCALVINI, MD

Role: STUDY_CHAIR

ICS MAUGERI

Locations

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Azienda Ospedaliera Bolognini di Seriate Bergamo

Seriate, Bergamo, Italy

Site Status

Istituti Clinici Scientifici Maugeri

Lumezzane, Brescia, Italy

Site Status

Papa Giovanni XXIII Hospital

Bergamo, , Italy

Site Status

Countries

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Italy

References

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Seferovic PM, Petrie MC, Filippatos GS, Anker SD, Rosano G, Bauersachs J, Paulus WJ, Komajda M, Cosentino F, de Boer RA, Farmakis D, Doehner W, Lambrinou E, Lopatin Y, Piepoli MF, Theodorakis MJ, Wiggers H, Lekakis J, Mebazaa A, Mamas MA, Tschope C, Hoes AW, Seferovic JP, Logue J, McDonagh T, Riley JP, Milinkovic I, Polovina M, van Veldhuisen DJ, Lainscak M, Maggioni AP, Ruschitzka F, McMurray JJV. Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018 May;20(5):853-872. doi: 10.1002/ejhf.1170. Epub 2018 Mar 8.

Reference Type BACKGROUND
PMID: 29520964 (View on PubMed)

Thrainsdottir IS, Aspelund T, Thorgeirsson G, Gudnason V, Hardarson T, Malmberg K, Sigurdsson G, Ryden L. The association between glucose abnormalities and heart failure in the population-based Reykjavik study. Diabetes Care. 2005 Mar;28(3):612-6. doi: 10.2337/diacare.28.3.612.

Reference Type BACKGROUND
PMID: 15735197 (View on PubMed)

Sharma A, Mentz RJ, Granger BB, Heitner JF, Cooper LB, Banerjee D, Green CL, Majumdar MD, Eapen Z, Hudson L, Felker GM. Utilizing mobile technologies to improve physical activity and medication adherence in patients with heart failure and diabetes mellitus: Rationale and design of the TARGET-HF-DM Trial. Am Heart J. 2019 May;211:22-33. doi: 10.1016/j.ahj.2019.01.007. Epub 2019 Jan 31.

Reference Type BACKGROUND
PMID: 30831331 (View on PubMed)

Scalvini S, Bernocchi P, Zanelli E, Comini L, Vitacca M; Maugeri Centre for Telehealth and Telecare (MCTT). Maugeri Centre for Telehealth and Telecare: A real-life integrated experience in chronic patients. J Telemed Telecare. 2018 Aug;24(7):500-507. doi: 10.1177/1357633X17710827. Epub 2017 May 24.

Reference Type BACKGROUND
PMID: 28537509 (View on PubMed)

Bernocchi P, Giudici V, Borghi G, Bertolaia P, D'Isa S, Trevisan R, Scalvini S. Telemedicine home-based management in patients with chronic heart failure and diabetes type II: study protocol for a randomized controlled trial. Trials. 2024 May 21;25(1):333. doi: 10.1186/s13063-024-08171-0.

Reference Type BACKGROUND
PMID: 38773662 (View on PubMed)

Other Identifiers

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NET-2018-12367206-WP3

Identifier Type: OTHER

Identifier Source: secondary_id

ICS Maugeri CE2338

Identifier Type: -

Identifier Source: org_study_id

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