Clinicians, staff highlight strategies to enhance virtual diabetes care

Though telehealth can significantly improve diabetes care, new research shows several gaps that must be closed through strategies such as creating efficient workflows around scheduling follow-up visits and ensuring diabetes data collection ahead of telehealth visits.

Published in The Journal of Clinical Diabetes, the study identified clinic-and provider-level practices that positively and negatively affect virtual diabetes care delivery. Researchers from the University of California Davis (UC Davis) and the University of California San Francisco (UCSF) conducted the study, supported by a research award from the Children’s Miracle Network at UC Davis.

Prior research shows that virtual care modalities helped maintain care quality for diabetes patients during the pandemic. One study published in early 2022 reveals that among 16,588 type 2 diabetes patients receiving care before or during the pandemic, nearly half (7,581) had a telehealth visit with either a primary care physician or an endocrinologist. Additionally, the study found that patients who utilized in-person care alone saw a decline in quality outcomes during the pandemic, but patients who used telehealth achieved similar quality outcomes during the pandemic as they did before. Another study published in 2022 showed that endocrinologists were the top adopters of telehealth technology.

However, the UC Davis and UCSF researchers noted in the new study that evidence examining specific practices around telehealth for diabetes care is scarce. Thus, they conducted a qualitative study of clinician and staff perspectives on virtual specialty diabetes care.

The research team interviewed clinicians and staff at UC Davis, UCSF, the University of California Los Angeles, and the University of California San Diego. They interviewed 26 people, including five pediatric endocrinologists, seven adult endocrinologists, four diabetes educators, two diabetes pharmacists, and eight administrative staff members. The interviewers asked open-ended questions about the challenges of using telehealth and recommendations to improve its use.

The responses to the interviews were divided into two categories: optimizing telehealth operations for specialty diabetes care and improving the quality of virtual diabetes visits.

To optimize telehealth operations, clinicians and staff suggested reviewing patients’ diabetes data before telehealth visits and adopting strategies and workflows that maximize data collection. They also noted that provider organizations should develop workflows to ease follow-up appointment scheduling for telehealth and create protocols that support team-based care using synchronous and asynchronous telehealth.

To improve virtual diabetes visits, clinicians and staff recommended taking advantage of the ability to view the patient’s home environment to identify potential challenges in diabetes self-care and offer advice, communicating expectations for video visits to patients ahead of time, and integrating data sharing into telehealth visits.

“I hope the findings of our study will spark discussion around how we can optimize telehealth and take advantage of its unique capabilities to improve patient care, rather than trying to replicate the in-person visit,” said Sarah Haynes, PhD, lead author of the study and assistant professor in the UC Davis department of pediatrics, in a press release.

The study emphasizes telehealth’s role in complementing in-person care for diabetes, which aligns with prior research.

Published in December 2023, a study revealed that type 2 diabetes patients who received care through telehealth alone had poor glycemic outcomes compared with those who received in-person or hybrid care.

The study included 3,778 adults with type 2 diabetes who had an initial or follow-up visit via telehealth in the endocrinology division of a large health system between May 1 and October 31, 2020. Of the study sample, 1,182 received care via telehealth, 1,049 received in-person care, and 1,547 received hybrid care, that is, both telehealth and in-person care.

The researchers found no significant change in adjusted HbA1c at 12 months among patients in the telehealth-only group, compared with the in-person and hybrid groups, which experienced HbA1c improvements of 0.37 percent and 0.22 percent, respectively.