Turning the Tide on Diabetes Using TelehealthBy: Caregility Team
Telehealth has proven to be an effective tool that helps patients and their health care providers effectively manage chronic diseases – including diabetes. “Diabetes is an ideal medical condition for telehealth utilization because it relies heavily on patient self-management and use for home medical devices that both generate and capture data,” wrote the authors of a 2020 article in Diabetes Technology & Therapeutics.
Health care providers have been piloting diabetes-focused telehealth initiatives since the 1990s to improve patient outcomes and to help rural and underserved populations have access to high-quality diabetes care. Technological advances in videoconferencing, remote patient monitoring devices, and mobile device apps have sped the adoption of telehealth in diabetes care in recent years. Research has shown those efforts are bearing fruit. For example: A widely cited 2019 article published in Telemedicine and e-health examined data from more than 40 studies encompassing more than 6,000 patients with Type 1 and Type 2 diabetes. The studies compared outcomes for patients enrolled in telehealth interventions with those who received only in-person care. The results: “The mean reduction in HbA1c was significantly higher in the telemedicine groups” versus the in-person groups.
This post will outline some of benefits of telehealth for diabetes care, how telehealth can increase patient access to diabetes care, and steps physicians can take to incorporate telehealth into their diabetes care plans.
Benefits of Telehealth for Diabetes Care
“In the diabetes world, where data from meter, pump, and sensor downloads are critical to management, telemedicine is an ideal way to interact with patients,” stated Mark H. Schutta, medical director of the Penn Rodebaugh Diabetes Center at the University of Pennsylvania in an article for Endocrinology Advisor. “Diabetes experts can manage the majority of patients using the HbA1C test and other data the patient has recorded and downloaded to a website.”
Incorporating telehealth, therefore, can introduce several efficiencies in care planning that can promote better patient outcomes, such as:
- Medication adherence: Text message reminders or app notifications can nudge patients to take medications in the correct dose and frequency. These communications can also ensure patients fill their prescriptions in a timely manner.
- Quicker response times from care teams: Telehealth allows patients to easily report daily blood glucose readings directly to their care teams. Armed with that data, physicians or nurses can quickly identify any problems and address them—for example, through a medication adjustment—before they become emergencies.
- Reduced transportation burdens for patients: Because physicians can provide a clinical assessment and order lab tests via video consultation, patients don’t have to visit multiple facilities to receive care, which means less time away from home or work and lower transportation costs.
And the benefits aren’t limited to patients. Research has shown reduced costs for health care systems: A 2018 study published in Preventing Chronic Disease showed that “the use of telemedicine in 7 rural hospital emergency departments in Mississippi decreased the hospitals’ expenditures from $7.6 million to $1.1 million during a five-year period, with no apparent effect on clinical outcomes.”
Telehealth Increases Access to Diabetes Care
Patients who live in rural areas and other chronically underserved communities face a double-edged sword when it comes to diabetes. These populations typically have higher rates of diabetes than urban and higher-income areas while lacking access to health care—particularly diabetes subspecialists—near their homes.
Several studies have illustrated how telehealth programs have helped rural patients better manage chronic conditions, including diabetes. In one example, the Veterans Health Administration’s (VHA) Advanced Comprehensive Diabetes Care program engaged patients in telemonitoring, a module-based self-management support program, and twice-monthly phone calls with VHA staff. An analysis of 125 patients enrolled in the program showed that participants’ HbA1c levels improved from 9.25% at baseline to 7.89% after six months. The program’s administrators also reported that ACDC improved “patient engagement and awareness of diabetes control.”
“Telehealth interventions and innovative technologies can be adapted to the needs of these individuals and their local communities,” the article said. “Patients may better understand their health conditions and use their health care resources to develop optimal diabetes self-management behaviors to this lifelong condition.”
Integrating Telehealth into Diabetes Care
Because telehealth has been piloted by many diabetes care providers over the past three decades, advice for how physicians can best incorporate technology into their care plans is plentiful. A few recommendations include:
- Incorporating telehealth only after an in-person relationship has been established with a diabetes patient. In the previously mentioned Endocrinology Advisor article, Schutta says he sees his patients at least once per year in person but uses telehealth to address acute problems and medication changes.
- Preparing patients for diabetes telehealth appointments. Ensure your patients understand the technical requirements of telehealth—from the devices they need to use to the level of internet service they need to have—as well as the fact that they may need to have more frequent virtual visits for their diabetes care.
- Setting physicians up to succeed in diabetes telehealth care. “Learning a new care model can be anxiety-provoking and overwhelming for providers,” note the authors of the aforementioned Diabetes Technology and Therapeutics article. They recommend “building supportive practices,” including enhanced onboarding practices, simulated telehealth visits, and scheduling fewer patients for physicians new to telehealth until they’re confident with the modality.
- Using discretion about when using telehealth for diabetes care. Just because you can see a patient via telehealth doesn’t mean you should for every appointment. For example, the Diabetes Technology and Therapeutics authors write, a telehealth appointment may be appropriate for introducing a new exercise plan for a patient, but not for explaining a difficult diagnosis or a complicated treatment plan.
The Future of Telehealth in Diabetes Care
Although the benefits of using telehealth in diabetes care are clear, the future of the modality is blurrier. For physicians to continue deploying telehealth to supplement diabetes care plans, insurance plans will need to continue to compensate them at a rate comparable to in-person visits as they have throughout the COVID-19 pandemic. And the barriers keeping rural and underserved populations from accessing telehealth care – foremost among them the availability of broadband internet – must be addressed. But early indications are that the Biden Administration, Congress, and leaders in both political parties have an interest in making the policy changes that drove the pandemic’s telehealth expansion permanent. And that’s great news for diabetes patients and the physicians who care for them.
Contact Caregility today to learn how our telehealth solutions can help elevate diabetes care in your practice.