Structured telemonitoring reduces HbA1c and emergency visits in insulin-treated type 2 diabetes: a controlled cohort study in Ecuador’s public hospital

Background 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. Methods A prospective, controlled cohort study was conducted over a six-month period. Adults with insulin-treated T2DM and baseline HbA1c >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’s Exact Test and Firth’s logistic regression. Results 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’s 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. Conclusion 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.