Diabetes Telehealth Intervention For Transitions in Care: A Pilot Study

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 839-872-Diabetes & Obesity Management
Clinical
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-862
Tannaz Moin*1, Jane Lee2, Diane Myung Kyung Suh2, Nancy Lee2, Rose Healy2, Dorothy Santos Martinez2, Hassan Ghasemzadeh2, Majid Sarrafzadeh2 and Sheila Ahmadi2
1VA Greater Los Angeles, Los Angeles, CA, 2UCLA, Los Angeles, CA
Introduction

Telehealth, or home telemonitoring, has been increasingly applied to many chronic diseases, but not yet reached widespread use for patients with diabetes. Studies examining telehealth applications in diabetes have shown favorable results in a variety of outpatient settings but little information is available on the impact of such technology during transitions of care.

Materials & Methods:

Patients hospitalized at a tertiary care center between June 2011 and June 2012 with a diagnosis of T2DM and HbA1c > 7.5% were eligible for recruitment. Participants in the telehealth intervention transmitted (blood glucose) BG readings in real time over a maximum of 3 months. Clinicians viewed these BG readings with a web-based application and made at least weekly telephone calls for case and/or medication management. Participants in the control group did not transmit BG readings but did receive at least one telephone call for follow-up. All patients received diabetes education counseling prior to hospital discharge and follow-up care with their usual providers in the outpatient setting. Follow-up HbA1c was obtained between 3-12 months.

Results

A total 54 participants were enrolled (40 male, average age 55 years) and randomized to either intervention (n=29) or control (n=25). Baseline HbA1c was similar in both groups (mean HbA1c=9.6% intervention vs. 9.7% control; p=0.75). Follow-up HbA1c obtained in 48%(n=26) of participants thus far has been lower in the intervention compared to control group, although not statistically significant (mean HbA1c=7.4% intervention vs.7.8% control; p=0.46). Clinicians were also able to detect and manage 155 hypoglycemic readings (defined as BG <70 mg/dL) among the intervention participants.

Conclusion

The diabetes telehealth intervention resulted in net improvements in HbA1c after hospital discharge. The key feature was real time evaluation of BG with active medication management. The intervention also made early detection and management of hypoglycemia possible. Thus, telehealth may be one way to enhance the current standard of diabetes care while minimally impacting healthcare costs. It must be noted, however, that telehealth is not a one size fits all solution. Patients with multiple co-morbidities, difficult to manage blood sugars, and at risk for hypoglycemia are most likely to benefit.  Patients with poor compliance, reluctance to monitor BG, and/or aversion to technology are least likely to benefit. Larger studies are needed to confirm the findings of this pilot study.

Nothing to Disclose: TM, JL, DMKS, NL, RH, DSM, HG, MS, SA

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: Tannaz Moin was an endocrinology fellow in the UCLA Department of Medicine,Division of Endocrinology, Diabetes, and Hypertension at study initiation but completed study activities and data analysis as a health services research fellow supported by VA Office of Academic Affiliations, Health Services Research & Development (HSR&D) through the Health Services Fellowship Training Program (TPM65-010), VA Greater Los Angeles.  This study was also supported by NIH/National Library of Medicine Medical Informatics Training Program Grant T15 LM07356.