Telehealth Helps Rural Patients With Diabetes Control Their Blood Sugar

By Megan Brooks

June 17, 2020

NEW YORK (Reuters Health) - Adults with poorly controlled type 2 diabetes living in rural areas saw their blood sugar levels improve after participating in a comprehensive telehealth program, according to new research.

The telehealth intervention - known as Advanced Comprehensive Diabetes Care (ACDC) - leverages existing Veterans Health Administration home telehealth infrastructure, with modifications to support use in rural areas. It has been shown to reduce hemoglobin (Hb)A1c in a previous randomized trial, according to an abstract presented at the American Diabetes Association (ADA) virtual 2020 scientific sessions.

"Compared with their urban counterparts with diabetes, rural populations are more likely to experience poor glycemic control, are less likely to receive recommended diabetes healthcare measures and are more likely to lack access to specialty care and intensive self-management programs," Elizabeth Kobe, study investigator and MD candidate at Duke University Medical School in Durham, North Carolina, noted in her presentation.

"All of this perpetuates poor diabetes outcomes in rural areas and this is where telehealth may be able to help. Telehealth represents a potential strategy for extending specialized diabetes care to rural areas," said Kobe.

The ACDC program consists of telemonitoring, self-management support and clinician-guided medication management.

The first two elements, Kobe explained, are delivered by the existing VA network of home telehealth nurses during 30-minute phone calls every two weeks. During these calls, the nurses review blood sugar data (transmitted by participants daily using provided equipment), discuss medications and adherence, and provide eight self-management modules. For the third element, medication managers work with the nurses to review individual patient data and decide on medication changes.

Kobe reported that among 125 participants across five sites, HbA1c levels fell by an average of 1.36 percentage points, from a starting point of 9.25% to 7.89% at six months. HbA1c levels remained reduced at 12 and 18 months after the intervention, by an average of 1.22 percentage points and 1.07 percentage points below baseline levels, respectively.

"All of these changes from baseline were statistically significant," Kobe said in her presentation.

Qualitative interviews with patients and staff suggest that ACDC "enhanced patient engagement and awareness of glycemic control, while moderately increasing workload for providers," Kobe said.

"Despite the drastic changes that COVID-19 has forced healthcare systems to make, ACDC delivery has continued unabated. ACDC has truly made a substantial difference for rural patients with diabetes, and it's well positioned for further dissemination," Kobe said.

The study had no commercial funding and the authors disclosed no relevant conflicts of interest.

SOURCE: American Diabetes Association (ADA) 2020 Virtual Scientific Sessions.