Leslie A Eiland1, Andjela Drincic1. 1. Division of Diabetes, Endocrinology & Metabolism, University of Nebraska Medical Center, Omaha, NE, USA.
Abstract
INTRODUCTION: Despite advances in and increased adoption of technology, glycemic outcomes for individuals with type 1 diabetes (T1D) have not improved. Access to care is limited for many, in part due to a shortage of endocrinologists and their concentration in urban areas. Managing T1D via telehealth has potential to improve glycemic outcomes, as the barriers of travel-related time and cost are mitigated. METHODS: Our endocrine telehealth program started in 2013 and currently provides care to nine rural community hospitals in Nebraska and Iowa. A retrospective cohort study was performed to evaluate glycemic outcomes in people with T1D who received care at these telehealth clinics from 2013-2019. Data were collected on age, race, gender, prior diabetes provider, use of diabetes technology, and A1c values over time. RESULTS: One hundred thirty-nine individuals were followed for an average duration of 32 months (range 4-69 months). Sixty-six percent of people were previously under the care of an endocrinologist. The most common therapeutic action, in addition to insulin adjustment, was addition of a CGM (52%). Each year in telemedicine care was associated with a decline of 0.13% in A1c (95% CI: -0.20, -0.06). There was no association between A1c and age or gender. When stratifying by previous diabetes provider, all groups had a statistically significant decline in A1c, even those with a previous endocrine provider. There was no statistically significant decline in A1c based on addition of technology. CONCLUSION: We have shown that traditional telehealth visits are an effective way to provide care for people with T1D long-term and may provide distinct advantages to home telehealth visits.
INTRODUCTION: Despite advances in and increased adoption of technology, glycemic outcomes for individuals with type 1 diabetes (T1D) have not improved. Access to care is limited for many, in part due to a shortage of endocrinologists and their concentration in urban areas. Managing T1D via telehealth has potential to improve glycemic outcomes, as the barriers of travel-related time and cost are mitigated. METHODS: Our endocrine telehealth program started in 2013 and currently provides care to nine rural community hospitals in Nebraska and Iowa. A retrospective cohort study was performed to evaluate glycemic outcomes in people with T1D who received care at these telehealth clinics from 2013-2019. Data were collected on age, race, gender, prior diabetes provider, use of diabetes technology, and A1c values over time. RESULTS: One hundred thirty-nine individuals were followed for an average duration of 32 months (range 4-69 months). Sixty-six percent of people were previously under the care of an endocrinologist. The most common therapeutic action, in addition to insulin adjustment, was addition of a CGM (52%). Each year in telemedicine care was associated with a decline of 0.13% in A1c (95% CI: -0.20, -0.06). There was no association between A1c and age or gender. When stratifying by previous diabetes provider, all groups had a statistically significant decline in A1c, even those with a previous endocrine provider. There was no statistically significant decline in A1c based on addition of technology. CONCLUSION: We have shown that traditional telehealth visits are an effective way to provide care for people with T1D long-term and may provide distinct advantages to home telehealth visits.
Entities:
Keywords:
Diabetes; Type 1 diabetes; rural health; technology; telehealth; telemedicine
Authors: Nicole C Foster; Roy W Beck; Kellee M Miller; Mark A Clements; Michael R Rickels; Linda A DiMeglio; David M Maahs; William V Tamborlane; Richard Bergenstal; Elizabeth Smith; Beth A Olson; Satish K Garg Journal: Diabetes Technol Ther Date: 2019-01-18 Impact factor: 6.118
Authors: Ashby F Walker; Korey K Hood; Matthew J Gurka; Stephanie L Filipp; Claudia Anez-Zabala; Nicolas Cuttriss; Michael J Haller; Xanadu Roque; Diana Naranjo; Gina Aulisio; Ananta Addala; Jason Konopack; Sarah Westen; Katarina Yabut; Elvira Mercado; Sydney Look; Brian Fitzgerald; Jennifer Maizel; David M Maahs Journal: Diabetes Care Date: 2021-05-17 Impact factor: 19.112