{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T07:10:49Z","timestamp":1792221049627,"version":"4.4.0"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Clin. Diabetes Healthc."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Remote patient monitoring (RPM) has demonstrated potential to improve glycemic control in type 2 diabetes mellitus (T2DM), yet evidence from middle-income public health systems remains limited. This study evaluated the clinical impact of structured telemonitoring in insulin-treated T2DM patients at a public hospital in Ecuador.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective, controlled cohort study was conducted over a six-month period. Adults with insulin-treated T2DM and baseline HbA1c &amp;gt;8% were assigned to structured telemonitoring or standard care. The intervention included Bluetooth-enabled glucometers linked to the mySugr app, automated data uploads, and weekly clinical review. The primary outcome was the change in HbA1c; secondary outcomes included emergency visits and hospitalizations. Repeated measures ANOVA assessed HbA1c trajectories. Emergency visits were analyzed using Fisher\u2019s Exact Test and Firth\u2019s logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 100 patients (50 per group), mean HbA1c decreased by 2.67% in the intervention group compared to 1.38% in the control group (p = 0.006). Emergency visits occurred in eight control patients and none in the intervention group (p = 0.006). Firth\u2019s regression showed a non-significant odds ratio. No hospitalizations were reported. Direct cost savings totaled USD 9,660 over six months for the studied population and USD 174,000 annually, based on a 10% adoption rate (450 patients) over one year, using 2024 data from HGDC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Structured telemonitoring was associated with improved glycemic control and reduced utilization of acute care services. These findings support RPM feasibility in middle-income public health settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcdhc.2026.1734589","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T05:22:12Z","timestamp":1770614532000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Structured telemonitoring reduces HbA1c and emergency visits in insulin-treated type 2 diabetes: a controlled cohort study in Ecuador\u2019s public hospital"],"prefix":"10.3389","volume":"7","author":[{"given":"Angel","family":"Santill\u00e1n","sequence":"first","affiliation":[{"name":"Hospital General Docente de Calderon (HGDC), Ministry of Health of Ecuador","place":["Quito, Ecuador"]},{"name":"Doctorando en Ciencias Biom\u00e9dicas del Instituto Universitario Italiano de Rosario (IUNIR)","place":["Rosario, Argentina"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin Ivan","family":"Travez Proa\u00f1o","sequence":"additional","affiliation":[{"name":"Hospital General Docente de Calderon (HGDC), Ministry of Health of Ecuador","place":["Quito, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivanna Noem\u00ed","family":"Jaramillo Encalada","sequence":"additional","affiliation":[{"name":"Hospital General Docente de Calderon (HGDC), Ministry of Health of Ecuador","place":["Quito, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricio Alejando","family":"Abril L\u00f3pez","sequence":"additional","affiliation":[{"name":"Hospital General Docente de Calderon (HGDC), Ministry of Health of Ecuador","place":["Quito, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Tricallotis","sequence":"additional","affiliation":[{"name":"Health Sciences Faculty, Universidad Internacional SEK (UISEK)","place":["Quito, Ecuador"]},{"name":"School of Medicine, Pontificia Universidad Cat\u00f3lica del Ecuador","place":["Quito, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime David","family":"Acosta-Espa\u00f1a","sequence":"additional","affiliation":[{"name":"Health Sciences Faculty, Universidad Internacional SEK (UISEK)","place":["Quito, Ecuador"]},{"name":"School of Medicine, Pontificia Universidad Cat\u00f3lica del Ecuador","place":["Quito, Ecuador"]},{"name":"Centro de Investigaci\u00f3n para la Salud en Am\u00e9rica Latina (CISeAL), Pontificia Universidad Cat\u00f3lica del Ecuador","place":["Quito, Ecuador"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1038\/NRENDO.2017.151","article-title":"Global aetiology and epidemiology of type 2 diabetes mellitus and its complications","volume":"14","author":"Zheng","year":"2018","journal-title":"Nat Rev Endocrinol"},{"key":"B2","unstructured":"Diabetes Atlas, Global Diabetes Data & Statistics\n          \n          \n          \n          2025"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e002097","DOI":"10.1136\/BMJDRC-2020-002097","article-title":"Cost-effectiveness of a self-management and comprehensive training intervention in patients with type 2 diabetes up to 5 years of diagnosis in a specialized hospital in Mexico City","volume":"9","author":"Hern\u00e1ndez-Jim\u00e9nez","year":"2021","journal-title":"BMJ Open Diabetes Res Care"},{"key":"B4","doi-asserted-by":"publisher","first-page":"3","DOI":"10.31243\/mdc.uta.v2i4.132.2018","article-title":"Diabetes mellitus tipo 2 en el Ecuador: revisi\u00f3n epidemiol\u00f3gica","volume":"2","author":"Calahorrano","year":"2018","journal-title":"Med UTA"},{"key":"B5","unstructured":"National Health and Nutrition Survey ENSANUT 2022"},{"key":"B6","article-title":"Vital Statistics, General Death Statistics Registry for 2023. 24AD","year":"2023"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.7189\/JOGH.07.020410","article-title":"The cost of diabetes in Latin America and the Caribbean in 2015: Evidence for decision and policy makers","volume":"7","author":"Barcelo","year":"2017","journal-title":"J Glob Health"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.2337\/DC25-S009","article-title":"9. Pharmacologic approaches to glycemic treatment: standards of care in diabetes\u20142025","volume":"48","author":"Committee","year":"2025","journal-title":"Diabetes Care"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.2337\/DC25-S012","article-title":"12. Retinopathy, neuropathy, and foot care: standards of care in diabetes\u20142025","volume":"48","author":"Committee","year":"2025","journal-title":"Diabetes Care"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/J.HPOPEN.2021.100030","article-title":"Hospitalization for ambulatory care sensitive conditions: What conditions make inter-country comparisons possible","volume":"2","author":"Rocha","year":"2021","journal-title":"Health Policy Open"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.2196\/JMIR.2600","article-title":"Mobile health applications for the most prevalent conditions by the world health organization: Review and analysis","volume":"15","author":"Mart\u00ednez-P\u00e9rez","year":"2013","journal-title":"J Med Internet Res"},{"key":"B12","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1016\/J.POP.2022.04.002","article-title":"The state of telehealth before and after the COVID-19 pandemic","volume":"49","author":"Shaver","year":"2022","journal-title":"Prim Care"},{"key":"B13","doi-asserted-by":"publisher","first-page":"86","DOI":"10.4103\/IJEM.IJEM_153_21","article-title":"Digital Health Services among Patients with Diabetes during the COVID-19 Pandemic: A Scoping Review","volume":"25","author":"Purnamayanti","year":"2021","journal-title":"Indian J Endocrinol Metab"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.23736\/S2724-6507.23.04096-4","article-title":"Telemedicine for type 2 diabetes during COVID-19 pandemic: experience from a tertiary diabetes center","volume":"50","author":"Angelino","year":"2025","journal-title":"Minerva Endocrinol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.2196\/MHEALTH.8873","article-title":"The impact of mHealth interventions: Systematic review of systematic reviews","volume":"6","author":"Marcolino","year":"2018","journal-title":"JMIR Mhealth Uhealth"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1177\/1932296817713506","article-title":"A systematic review of reviews evaluating technology-enabled diabetes self-management education and support","volume":"11","author":"Greenwood","year":"2017","journal-title":"J Diabetes Sci Technol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/J.IJNSA.2023.100169","article-title":"Effectiveness of telehealth on the glycemic control of patients with type 2 diabetes mellitus during the COVID-19 pandemic: A systematic review and meta-analysis of randomised controlled trials","volume":"6","author":"Chiaranai","year":"2024","journal-title":"Int J Nurs Stud Adv"},{"key":"B18","doi-asserted-by":"publisher","first-page":"S2","DOI":"10.1089\/DIA.2019.0019","article-title":"Real-world assessments of mySugr mobile health app","volume":"21","author":"Debong","year":"2019","journal-title":"Diabetes Technol Ther"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1186\/S12913-018-3274-8","article-title":"The impact of telehealth remote patient monitoring on glycemic control in type 2 diabetes: A systematic review and meta-analysis of systematic reviews of randomised controlled trials","volume":"18","author":"Lee","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"B20","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1007\/BF03320906","article-title":"RETRACTED ARTICLE: Validaci\u00f3n del cuestionario \u201cDiabetes treatment satisfaction questionnaire\u201d (DTSQ) en la poblaci\u00f3n espa\u00f1ola","volume":"3","author":"Gomis","year":"2013","journal-title":"PharmacoEcon Spanish Res Art"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.2337\/DS21-0023","article-title":"Home telemonitoring of patients with type 2 diabetes: A meta-analysis and systematic review","volume":"35","author":"Zhu","year":"2022","journal-title":"Diabetes Spectr"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3390\/IJERPH19074173","article-title":"A meta-analysis of the effectiveness of telemedicine in glycemic management among patients with type 2 diabetes in primary care","volume":"19","author":"Zhang","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.3390\/ELECTRONICS9040678","article-title":"A smart glucose monitoring system for diabetic patient","volume":"9","author":"Rghioui","year":"2020","journal-title":"Electronics"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.2337\/DC25-S007","article-title":"7. Diabetes technology: standards of care in diabetes\u20142025","volume":"48","author":"Committee","year":"2025","journal-title":"Diabetes Care"}],"container-title":["Frontiers in Clinical Diabetes and Healthcare"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcdhc.2026.1734589\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T05:22:13Z","timestamp":1770614533000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcdhc.2026.1734589\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,9]]},"references-count":24,"alternative-id":["10.3389\/fcdhc.2026.1734589"],"URL":"https:\/\/doi.org\/10.3389\/fcdhc.2026.1734589","relation":{},"ISSN":["2673-6616"],"issn-type":[{"value":"2673-6616","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,9]]},"article-number":"1734589"}}