European Journal of Cardiovascular Medicine

Type 2 diabetes mellitus (T2DM) and hypertension are two of the most prevalent chronic diseases worldwide, often coexisting and synergistically increasing the risk of cardiovascular morbidity, renal complications, and premature mortality (1,2). The coexistence of these conditions requires continuous monitoring, lifestyle modifications, and adherence to pharmacologic therapy to prevent disease progression and complications (3). Traditionally, the management of these conditions has relied on face-to-face interactions between healthcare providers and patients; however, this model faces limitations related to accessibility, continuity of care, and cost-effectiveness, especially in rural and underserved areas (4,5).

The COVID-19 pandemic has accelerated the global adoption of telehealth, promoting it as a viable alternative to conventional in-person visits for managing chronic diseases (6). Telehealth offers several advantages, including increased flexibility, reduced travel burden, and the ability to provide continuous monitoring through remote devices (7). Studies have demonstrated its utility in improving glycemic control, medication adherence, and blood pressure management in isolated disease conditions (8,9). However, limited research exists on its effectiveness in co-managing multiple chronic conditions, such as T2DM and hypertension, through an integrated virtual care model.

Given the rising burden of multimorbidity, especially in aging populations, there is an urgent need to evaluate care models that are both scalable and patient-centered. Randomized controlled trials comparing telehealth to in-person care can provide crucial evidence regarding clinical outcomes, adherence, and patient satisfaction. This study was designed to compare the effectiveness of telehealth versus traditional face-to-face care in the simultaneous management of T2DM and hypertension, assessing clinical, behavioral, and patient-reported outcomes over a 6-month period.

A total of 120 adult patients aged 30 to 65 years with a confirmed diagnosis of both type 2 diabetes mellitus (HbA1c ≥ 7%) and hypertension (systolic blood pressure ≥ 140 mmHg) were recruited. Patients were excluded if they had advanced complications such as end-stage renal disease, unstable cardiovascular conditions, or cognitive impairments that limited their ability to participate in teleconsultations.

Participants were randomly assigned into two equal groups (n=60 each) using a computer-generated randomization sequence:

• Telehealth Group: Received virtual care through a secure video conferencing platform.
• In-Person Care Group: Attended scheduled physical consultations at the outpatient clinic.

Intervention and Follow-Up
Both groups received standard treatment for diabetes and hypertension as per national guidelines, including lifestyle counseling and pharmacologic therapy. The telehealth group had scheduled virtual appointments every two weeks, along with remote monitoring of blood pressure and glucose levels using home-based digital devices. Data were reviewed during online consultations. The in-person care group attended the clinic every two weeks for evaluation and monitoring.

All participants were followed for six months. Clinical evaluations were conducted at baseline, 3 months, and 6 months. Health education, medication reviews, and reinforcement of self-management practices were integral components of both care models.

Outcome Measures
The primary outcomes were changes in:

• Glycated hemoglobin (HbA1c)
• Systolic blood pressure (SBP)
  from baseline to 6 months.

Secondary outcomes included:

• Medication adherence, measured using the Morisky Medication Adherence Scale (MMAS-8)
• Patient satisfaction, assessed with a 5-point Likert scale survey
• Number of unplanned emergency department visits related to diabetes or hypertension.

Data Analysis
Statistical analysis was performed using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Continuous variables were expressed as mean ± standard deviation and compared using paired and unpaired t-tests. Categorical variables were analyzed using Chi-square tests. A p-value of less than 0.05 was considered statistically significant.

A total of 120 participants were randomized equally into the Telehealth Group (n=60) and the In-Person Care Group (n=60). Six participants (three from each group) were lost to follow-up, resulting in 57 patients in each group completing the 6-month trial. Baseline demographic and clinical characteristics were comparable between the groups (Table 1).

Primary Outcomes

After 6 months of intervention, the Telehealth Group showed a significant reduction in mean HbA1c from 8.5 ± 1.0% to 7.2 ± 0.8% (p < 0.001), while the In-Person Care Group showed a reduction from 8.4 ± 0.9% to 7.5 ± 0.9% (p < 0.01). Similarly, mean systolic blood pressure decreased from 148.6 ± 6.8 mmHg to 132.3 ± 6.2 mmHg in the telehealth group (p < 0.001), and from 147.9 ± 7.1 mmHg to 135.1 ± 6.9 mmHg in the in-person group (p < 0.01) (Table 2).

Secondary Outcomes

Medication adherence, measured using MMAS-8, improved in both groups, with higher adherence in the telehealth group (92.1%) compared to the in-person group (87.6%) (p = 0.04).
Patient satisfaction, measured on a 5-point Likert scale, was higher in the telehealth group with a mean score of 4.5 ± 0.5, compared to 3.9 ± 0.7 in the in-person group (p = 0.01).
The number of emergency visits did not differ significantly between the groups (Telehealth: 3 cases; In-person: 4 cases) during the study period (Table 3).

Table 1. Baseline Characteristics of Study Participants (n=114)

Table 2. Changes in Primary Clinical Parameters at 6 Months

Table 3. Secondary Outcomes Comparison between Groups

These findings suggest that telehealth-based co-management is equally effective—if not slightly superior—to in-person care in improving clinical outcomes for patients with both diabetes and hypertension.

The findings of this randomized controlled trial indicate that telehealth can be a highly effective alternative to traditional in-person consultations for the co-management of type 2 diabetes mellitus (T2DM) and hypertension. The observed improvements in glycemic control and blood pressure, along with higher patient satisfaction and adherence in the telehealth group, reinforce the growing utility of digital healthcare solutions in chronic disease management.

Diabetes and hypertension are major global health concerns, often coexisting and leading to serious cardiovascular and renal complications if not effectively managed (1,2). Integrated management of these conditions is critical, and conventional care models often face challenges related to patient accessibility, time constraints, and healthcare system burden (3,4). The telehealth approach, which offers remote monitoring, frequent follow-ups, and patient-centered education, may address many of these limitations (5).

In the present study, the telehealth group demonstrated a greater reduction in HbA1c compared to the in-person group over six months. This aligns with earlier findings that virtual diabetes interventions, particularly those involving regular feedback and remote glucose monitoring, can significantly improve glycemic control (6,7). A meta-analysis by Lee et al. showed that telemedicine programs yielded a mean HbA1c reduction of 0.44% compared to usual care (8). Similarly, our results show enhanced blood pressure control in the telehealth group, which is consistent with trials demonstrating that remote monitoring and counseling can significantly improve hypertension outcomes (9,10).

Medication adherence was higher in the telehealth group, likely due to more frequent interactions and reminders, which have been shown to positively influence patient behavior (11). Patient satisfaction was also higher, consistent with studies indicating that telehealth can improve engagement and convenience, especially in working populations and those residing in rural or underserved areas (12,13).

Importantly, the trial did not find a significant difference in emergency visit frequency between the two groups, suggesting that telehealth does not compromise safety or emergency responsiveness. This supports the growing body of evidence that remote care models are safe and feasible for managing stable chronic conditions (14,15).

Despite these promising findings, the study had some limitations. The trial duration was limited to six months, which may not capture long-term sustainability of telehealth benefits. Also, the study was conducted at a single center, potentially limiting generalizability. Future multicenter trials with longer follow-up and diverse patient populations are needed to further validate the results.

In conclusion, this study demonstrates that telehealth is a viable and potentially superior alternative to in-person care for the co-management of diabetes and hypertension. It offers comparable clinical outcomes while improving adherence and patient satisfaction, supporting its integration into routine chronic disease care models.

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