Impact of point-of-care testing and telemedicine on diabetes management in primary care unit settings in rural Thailand

The objective of this study was to compare waiting time, travel expense, hemoglobin A_1c (HbA_1c) and point-of-care fasting blood glucose observations for 29 diabetic patients who used telemedicine at primary care units versus 68 patients who were managed conventionally in the associated community hospital in Ao Luk District, Krabi Province, southern Thailand. Data were compared using the Mann-Whitney test and Student t test. In telemedicine versus hospital patients, median waiting time was 5.0 versus 150.0 minutes, travel expense was US $0.3 versus $2.9, fasting blood glucose difference (before vs after visit treatment) was 44.0 versus 29.5 mg/dL, and HbA_1c was 6.9% versus 8.4%, respectively. Rank analysis for waiting time, travel expense, fasting blood glucose difference, and HbA_1c was significant (P < 0.001). Based on these results in the period of this study, diabetic patients who were managed by telemedicine at primary care units saved time and travel cost versus patients who were managed conventionally at the community hospital. Hemoglobin A_1c results suggested better diabetes control in the telemedicine group. Monitoring diabetes control by using HbA _1c is becoming the standard of care in diabetic patients in Thailand, and hence, this measurement could be offered at the point of care in primary care units, whether they have telemedicine services.