Summary: In this multicentre open-label randomised controlled trial of 128 older adults (aged 65 years and over) with arterial hypertension and type 2 diabetes in Slovenia, 12 months of mHealth home telemonitoring produced a significant between-group reduction versus standard care in systolic blood pressure of 6.9 mmHg (95% CI 2.7 to 11; P=.001) and in HbA1c of 0.5 percentage points (95% CI 0.2 to 0.8; P=.002). No significant between-group differences were observed in any secondary outcome.
PICO Summary
| Element | Detail |
|---|---|
| Population | 128 community-dwelling adults aged 65 years and over with arterial hypertension and type 2 diabetes (117, or 91.4%, completed 12 months); mean age 71.3 years; mean baseline systolic blood pressure 136.7 mmHg and HbA1c 7.2%; multicentre, open-label, 1:1 randomised controlled trial in primary care, Slovenia. |
| Intervention | mHealth home telemonitoring added to standard care for 12 months (blood pressure twice weekly, blood glucose monthly; abnormal readings triggered extended profiling or teleconsultation with a general practitioner). |
| Comparison | Standard care alone, based on integrated care protocols at community health centres (no telemonitoring). |
| Outcome | Co-primary outcomes, between-group difference at 12 months: systolic blood pressure 6.9 mmHg lower with telemonitoring (95% CI 2.7 to 11; P=.001) and HbA1c 0.5 percentage points lower (95% CI 0.2 to 0.8; P=.002). Within the telemonitoring arm, systolic blood pressure fell by 9.7 mmHg (95% CI 6.8 to 12.6; P<.001) and HbA1c by 0.5% (95% CI 0.3 to 0.8; P<.001), whereas control-arm changes were non-significant. No significant between-group differences were seen in any secondary outcome (diastolic blood pressure, fasting blood glucose, lipid profile, body mass index, appraisal of diabetes, or behavioural risk factors). No absolute risk reduction or number needed to treat is applicable, as outcomes were continuous surrogate measures rather than clinical events. |
Home telemonitoring in older adults with hypertension and type 2 diabetes
RCT · hypertension + T2D, age 65+ · 12 months
Twelve months of home telemonitoring modestly lowered systolic blood pressure and HbA1c versus standard care in older multimorbid adults. No secondary outcome differed, and the open-label design and small size temper the result.
Expert Commentary
This trial offers cautiously encouraging evidence that structured home telemonitoring can tighten control of two surrogate markers in an older, multimorbid population that is often hard to manage. The between-group reductions in systolic blood pressure and HbA1c reached statistical significance and the effect sizes are clinically plausible rather than implausibly large, which lends them credibility. The verdict, however, is measured: benefit was confined to the two co-primary surrogates, and not a single secondary outcome (including diastolic pressure, lipids, body mass index, or diabetes-related quality of life) differed between arms. The most important limitation is the open-label design, in which neither participants nor treating clinicians were blinded; performance bias, with the telemonitoring arm attracting closer attention and more frequent contact, could plausibly account for part of the effect, and the modest sample of 128 limits precision and any subgroup inference. Can I use this with my patients? Potentially yes, for a selected older patient with hypertension and type 2 diabetes who is digitally capable, motivated, and supported, where a one-percentage-point fall in surrogate control may be worthwhile. It is not yet proof of reduced cardiovascular events. Larger, longer, event-driven trials are needed before telemonitoring is offered routinely, and the authors are right to flag that complex interventions may burden frail patients more than they help.
References
Mihevc M, Mori Lukančič M, Zavrnik Č, Virtič Potočnik T, Ružić Gorenjec N, Petek Šter M, et al. Impact of 12-month mHealth home telemonitoring on clinical outcomes in older individuals with hypertension and type 2 diabetes: multicenter randomized controlled trial. JMIR Mhealth Uhealth. 2025;13:e59733. doi:10.2196/59733