Comprehensive Telehealth Approach Improves Outcomes Among Diabetes Patients

A study published in JAMA Internal Medicine showed that a comprehensive telehealth approach, which included various types of support in addition to telemonitoring, significantly benefits patients with persistently poorly controlled type 2 diabetes (PPDM).

Although standard telehealth methods can provide various benefits for these patients, in this study, researchers aimed to determine how comprehensive telehealth interventions compared with usual practices.

Researchers conducted a randomized clinical trial at two Veterans Affairs healthcare systems.

Following an assessment involving 1,128 patients, researchers included 200 in the final sample. Patients were divided into two study groups, one receiving care through a simple telehealth intervention (99) and the other through a comprehensive telehealth approach (101). The former received only telemonitoring and care coordination services, while the latter received telemonitoring, self-management support, diet/activity support, medication management, and depression support.

The primary measure of PPDM was the integrity of hemoglobin A1C, specifically, if it remained at 8.5 percent or higher for at least one year.

According to the Centers for Disease Control and Prevention (CDC), hemoglobin A1C can help indicate blood sugar levels, and measuring it involves a blood test that assesses blood sugar levels over three months. The CDC also states that high levels of hemoglobin A1C indicate diabetes troubles; thus, maintaining a healthy hemoglobin A1C number is critical. 

Of the 200 study participants, the average age was 57 years. Additionally, 72 percent were Black, and 22.5 percent were women.

Among those in the comprehensive telehealth group, hemoglobin A1C levels dropped by 1.59 percent to 8.58 percent, while those in the standard care group experienced a decline of 0.98 percent to 9.19 percent. Those receiving care through the comprehensive telehealth service also experienced improved overall outcomes, including in terms of distress related to diabetes and self-care.

Though the cost of care via the comprehensive telehealth approach exceeded standard telehealth by $1,519, the benefits it provides show that it is a reasonable investment, researchers concluded.

But researchers also noted various limitations within the study. These included potential generalizability difficulties, lack of clarity when differentiating between the effectiveness of multiple factors, and limited analysis of all that leads to PPDM.

During the expansion of telehealth in recent years, research shows that people with diabetes benefit significantly from virtual care.

A study published in June concluded that telehealth and continuous glucose monitors (CGMs) helped to limit the adverse effects of the COVID-19 pandemic on patients with type 1 diabetes. The positive impacts of the implementation of these virtual care services included lower hospitalization levels, improved glycemic control, and lower depression incidence.

More research published in March found that telehealth also led to positive pediatric type 1 diabetes care results. Researchers observed that following the implementation of telehealth and CGMs, parental oversight increased, leading to more consistent care and decreased hospitalizations.