medwireNews: A rural telehealth program designed to fit with existing staff and equipment delivers large benefits for people with poorly controlled type 2 diabetes, researchers report.
The intervention had previously resulted in an average 1.0% improvement in glycated hemoglobin (HbA1c) levels in a randomized trial with 50 participants, rising to 2.0% among those who achieved at least half of the scheduled healthcare provider contacts.
Speaking at the virtual ADA 80th Scientific Sessions, Elizabeth Kobe (Duke University School of Medicine, Durham, North Carolina, USA) reported the implementation of the project within the Veterans Affairs (VA) health service.
The telehealth intervention – known as ACDC (Advanced Comprehensive Diabetes Care) – consists of three elements: telemonitoring; self-management support; and medication management. The first two elements were delivered by the existing VA network of home telehealth nurses during 30-minute phone calls every 2 weeks, during which they reviewed blood glucose data (transmitted by participants daily using provided equipment), discussed medications and adherence, and delivered eight self-management modules.
For the third element, medication managers work with the nurses to review regular reports and decide on medication changes, which are enacted by the nurses. “There is no direct contact between the medication manager and the patient,” Kobe stressed.
She reported that the study “successfully engaged” 125 people with type 2 diabetes across five sites between 2017 and 2019, representing 30–100% of eligible people. During the 6-month intervention period, HbA1c fell by a significant average of 1.36%, from a starting point of 9.25%.
The majority (61.6%) of study participants came from rural areas, with 9.6% being from highly rural and 28.8% from urban areas.
Kobe noted that people from rural areas have higher diabetes prevalence than urban people, along with poorer glycemic control, a lower likelihood of receiving recommended treatments, and poorer access to specialty healthcare.
Matthew Crowley discusses the successful implementation of the ACDC
Because the study participants wished to retain the telehealth support after the 6-month period, the team introduced a maintenance protocol of calls every 4 weeks. HbA1c remained significantly reduced at both 12 and 18 months after the main intervention period, by an average of 1.22% and 1.07% below baseline levels, respectively.
In qualitative interviews, participants with type 2 diabetes cited many positive aspects to the telehealth intervention; however, healthcare providers reported that it “moderately” increased their workload, despite being designed to fit with existing telehealth staff and equipment.
Kobe noted that ACDC continues to be rolled out to more VA sites and concluded that it “has made a substantial difference for rural patients with diabetes and is well-positioned for further dissemination.”
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ADA Scientific Sessions; 12–16 June 2020