Video diabetes consultations offer HbA1c declines, quicker care to veterans

By Dave Muoio

Veterans with Type 2 diabetes who received remote consultations via telehealth achieved glycemic control that was similar to, but not quite on par with, those attending face-to-face visits. On the flip side, these patients were able to complete their diabetes consultations an average 27 days earlier, offering a potential model for those unable to conveniently receive in-person specialty care, according to data recently presented at the Endocrine Society’s annual meeting in Chicago.

"Without incurring any travel, our electronic consultation program provides equally efficacious diabetes care with significantly expedited access," Dr. Archana Bandi, clinical director of telehealth services for the Veterans Affairs Pittsburgh Healthcare System, said in a statement. "This type of e-consult is a viable alternative to traditional face-to-face care delivery, especially in remote areas with a shortage of endocrinologists.”

From 2010 to 2015, Bandi and colleagues collected data from more than 800 veterans with Type 2 diabetes, 407 of whom requested and received face-to-face consultations and 442 of whom engaged with the system’s “telediabetes program” to varying degrees. Along with demographic information, the researchers examined the dates at which a consult was requested and completed, as well as HBA1c levels, systolic blood pressure, and lipid profile at consult and a various benchmarks following consult completion.

According to Bandi, a remote consult consisted of an endocrine provider reviewing a patient’s medical records and conducting a phone interview with the patient and their family. The provider then shares their recommendations with the referring physician, while a nurse on the diabetes care team monitors the patient via phone calls over the coming months.

Bandi and her team reported significant declines in HbA1c over the course of the study across all study groups and subgroups. From a baseline of 10 percent, HbA1c in the remote consultation group dropped to 8.98 percent at three to six months and 8.8 percent at 12 months, while the face-to-face group recorded levels of 8.75 percent and 8.57 percent at the same intervals. While this difference in decline between the two study groups was statistically significant, the researchers also found that patients receiving digital consultations completed their telehealth consultations an average of 27 days earlier. There were no significant decreases in systolic blood pressure or lipid profile values in either cohort throughout the study period.

Of note, Bandi said in a statement that HbA1c declines among the remote consultation group varied based on each veteran’s level of engagement in self-care, with those who were most engaged recording an 8.6 percent level at one year. With this and the observed timeliness of care in mind, this technology-driven approach is viable for veterans who live far from care centers or have other limitations.

"Given the obesity and diabetes epidemic along with the current shortage of endocrinologists in the US, the care delivery for patients with diabetes needs a complete change in its paradigm," Bandi said. "An example is our innovative model of care delivery that brings quality care to the patient's doorstep in an expedient fashion."