Comprehensive telehealth approach improved HbA1c in type 2 diabetes

Compared with a simpler approach of telemonitoring and care coordination, an intervention that added self-management and diet/activity support, medication management, and depression care improved outcomes in veterans with poorly controlled type 2 diabetes, a trial found.

A comprehensive telehealth intervention improved HbA1c level and other outcomes in patients with persistently poorly controlled type 2 diabetes more than a simpler approach, a recent trial found.

Researchers conducted the active-comparator, parallel-arm, randomized trial in 200 adults at two Veterans Health Administration (VHA) health care systems. All had an HbA1c level of 8.5% or higher for one year or longer despite engagement with clinic-based primary care and/or diabetes specialty care. Participants were randomized to receive comprehensive telehealth (n=101), which included telemonitoring, self-management support, diet/activity support, medication management, and depression support or a simpler approach of telemonitoring and care coordination (n=99). Nurses delivered each 12-month intervention. The primary outcome was HbA1c level, and secondary outcomes were diabetes distress, diabetes self-care, self-efficacy, body mass index, and depression symptoms, assessed in intent-to-treat analyses. Results were published July 25 by JAMA Internal Medicine.

Patients' mean age was 57.8 years, 22.5% were women, and 72.0% were Black. From baseline to 12 months, change in HbA1c level was −1.59% (10.17% to 8.58%) in the comprehensive telehealth group and −0.98% (10.17% to 9.19%) in the telemonitoring/care coordination group, for an estimated mean difference of −0.61% (95% CI, −1.12 to −0.11%; P=0.02). Results were similar in sensitivity analyses. At 12 months, patients receiving comprehensive telehealth had significantly greater improvements in diabetes distress, diabetes self-care, and self-efficacy; there were no differences in body mass index or depression. Adverse events were similar between groups. Comprehensive telehealth cost an additional $1,519 per patient per year to deliver.

The population demographics may limit generalizability of the results, the study authors noted. They added that the studied interventions were designed for the VHA, potentially limiting the applicability to systems lacking capacity for nurse-delivered telehealth, integrated mental health, and dietitian services.

“Because this comprehensive telehealth intervention was delivered by clinical staff using existing resources, it may warrant clinical implementation in systems with appropriate infrastructure,” the authors wrote. “More broadly, this study provides valuable comparative evidence that may help systems maximize the value of telehealth during the COVID-19 pandemic and beyond.”