medwireNews: A randomized trial shows that comprehensive care resulting in improved glycemic control among people with persistently poorly controlled type 2 diabetes can be delivered via telehealth.
“Because this comprehensive telehealth intervention was delivered by clinical staff using existing resources, it may warrant clinical implementation in systems with appropriate infrastructure,” write Matthew Crowley (Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Transformation, North Carolina, USA) and co-researchers in JAMA Internal Medicine.
Both the comprehensive telehealth intervention and its comparator were delivered by nurses with experience in telehealth but not specifically in diabetes. The comprehensive intervention also involved a dietitian and psychiatrist and included telemonitoring; support for self-management, diet and activity; medication management; and support for depression if needed.
During the 12-month study period the 101 participants randomly assigned to the comprehensive intervention completed an average of 19.6 of 26 possible encounters and had a significant average 1.59% reduction in their glycated hemoglobin (HbA1c) level, which fell from 10.17% to 8.58% (88 to 70 mmol/mol).
The comparator intervention, received by 99 participants, involved telemonitoring of blood glucose values, automated delivery of self-management information, and care coordination. It resulted in an average HbA1c reduction of 0.98%, from 10.17% to 9.19% (88 to 77 mmol/mol), giving a significant 0.61% difference between the two groups favoring comprehensive care.
All participants had a baseline HbA1c level of at least 8.5% (69 mmol/mol), and were an average age of 57.8 years with an average BMI of 34.8 kg/m2. Most (77.5%) were men and of Black or African–American race (72.0%).
The comprehensive intervention cost US$ 2465 (€ 2453) per participant per year, whereas the comparator intervention cost $ 946 (€ 941), making the former $ 1519 (€ 1512) more expensive per person than the latter.
However, “this incremental cost is less than most branded glucose-lowering medications, and the comprehensive approach came with added benefits for diabetes distress, self-care, and self-efficacy,” say the researchers.
Average scores on the Diabetes Distress Scale improved from 1.93 to 1.43 in the comprehensive care group versus 1.93 to 1.67 in the comparator group, and average scores on the Diabetes Self-Management Questionnaire improved from an identical 6.67 in each group to a respective 8.34 and 7.83.
Self-efficacy, measured on the Perceived Competence Scale, improved from a baseline average score of 5.20 to 6.31 in the comprehensive care group and from 5.20 to 5.92 in the comparator group. All the between-group differences were statistically significant.
“These findings demonstrate that practically designed telehealth can be effective for patients whose [type 2 diabetes] remains persistently poorly controlled despite clinic-based care,” the team concludes.
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2022 Springer Healthcare Ltd, part of the Springer Nature Group
JAMA Intern Med 2022; doi:10.1001/jamainternmed.2022.2947