Telehealth Platform Improves HbA1c Levels For Rural Type 2 Diabetes Patients

Elizabeth Kobe, MD Candidate

Findings of a new study suggest a comprehensive telehealth program leads to improved HbA1c levels among rural patients with poorly controlled type 2 diabetes.

The findings, presented at the American Diabetes Association’s (ADA’s) 80th Virtual Scientific Sessions, highlighted a 1.36% reduction in HbA1c levels after 6 months of care.

“We are pleased to see that the intervention was well-suited for delivery in clinical practice and that it remained effective in real-world settings,” Elizabeth Kobe, an MD candidate at Duke University Medical School, said in a statement.

Kobe and a team of investigators aimed to address the challenges of managing diabetes for patients in rural areas by designing an intensive diabetes management intervention called Advanced Comprehensive Diabetes Care. The platform was built after the team received an award from the VA Office of Rural Health Veterans Rural Health Resource Center — Iowa City. The program was built using the existing Veterans Health Administration’s Home Telehealth (VHA HT) infrastructure and clinical staff.

Advanced Comprehensive Diabetes Care was a six-month telehealth intervention combining telemonitoring with module-based self-management support and medication management. Clinical staff from VHA HT delivered the intervention through bi-monthly 30-minute calls. The intervention has been implemented at 7 VHA sites around the country since 2017. The sites serve rural veterans.

The investigative team examined 125 patients receiving Advanced Comprehensive Diabetes Care at 5 sites. The patients had poor glycemic control, which varied by site, but was typically >8.5%. Patients included were predominantly male (94%), white (89%), and classified as rural or highly rural (71%).

Across all site, the patients’ average HbA1c levels improved from 9.25% at baseline to 7.89% at 6 months (-1.36; 95% CI, -1.61 to -1.11; P <.001). The improvement persisted at 12 months (-1.22; 95% CI, -1.48 to -.97; P <.001) and 18 months (-1.07, 95% CI, -1.4 to -.73; P <.001) after the start of the study.

An average of 8-10 of 12 scheduled Advanced Comprehensive Diabetes Care calls were completed. During a qualitative analysis, the intervention was found to enhance patient engagement and awareness of diabetes control.

“When telehealth interventions are designed to leverage existing resources, they can greatly improve diabetes care in underserved rural populations,” Kobe said.

The study further backed prior research sponsored by the VA Office of Research and Development. A previous randomized trial took place to evaluate the effectiveness of Advanced Comprehensive Diabetes Care, assess the implementation strategy, and generate data to refine local intervention implementation.

In total, 50 veterans were randomly assigned into intervention (n=25) or control groups (n=25). Those randomized to the intervention group were enrolled in the Home Telehealth program and received the intervention for 6 months. The investigators found the Advanced Comprehensive Diabetes Care intervention improved HbA1c levels, blood pressure, and diabetes self-care among the participants.

Kobe and the investigators believe a similar approach can be used for a variety of chronic diseases.

The study, “Implementation of an Intensive Telehealth Intervention for Rural Patients with Uncontrolled Diabetes,” was presented at ADA 2020.