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Publication Briefs

Telemedicine-Based Intervention Improves Outcomes for Veterans with Poorly Controlled Diabetes

Individuals with persistent poorly-controlled diabetes mellitus (PPDM), or maintenance of HbA1c >9% for >1 year despite clinic-based diabetes care, represent a high-priority target for intervention. Telemedicine approaches that address factors underlying poor diabetes control appear superior to usual care, but healthcare systems have rarely integrated comprehensive telemedicine-based diabetes care into practice. To address this gap, investigators in this pilot trial developed the Advanced Comprehensive Diabetes Care (ACDC) intervention. ACDC bundles four evidence-based telemedicine approaches – telemonitoring, self-management support, medication management, and depression management – and is designed for practical delivery by existing VA Home Telehealth program nurses using standard VA equipment. Investigators evaluated ACDC's feasibility and effectiveness over six months (enrollment 12/2013 through 4/2014, follow-up through 12/2014) among Veterans with PPDM. Veterans were randomized to ACDC-augmented care (n=25) or usual care alone (n=25). Veterans in the usual care group received an education packet and diabetes management with existing providers. Outcomes included HbA1c, diabetes self-care, depressive symptoms, and blood pressure control.


  • The ACDC intervention significantly reduced HbA1c by 1.0% versus usual care.
  • Veterans receiving ACDC had significantly better diabetes self-care at six months versus usual care, but depressive symptoms did not differ between groups.
  • Although ACDC did not address hypertension, Veterans in the intervention group had significantly lower systolic (-7.7 mmHg) and diastolic blood pressure (-5.6 mmHg) versus usual care.


  • ACDC leverages VA's unique Home Telehealth network to facilitate practical delivery. By utilizing Home Telehealth infrastructure that is ubiquitous at VA centers nationwide, ACDC represents a potentially scalable approach to reducing the burden of diabetes within VA.


  • This was a single-site study with a relatively small cohort.

This study was funded through VA HSR&D's Quality Enhancement Research Initiative (RRP 12-458), and Dr. Crowley is supported by an HSR&D Career Development Award. Drs. Crowley and Edelman are part of HSR&D's Center for Health Services Research in Primary Care, Durham, NC.

PubMed Logo Crowley M, Edelman D, McAndrew A, et al. Practical Telemedicine for Veterans with Persistently Poor Diabetes Control: A Randomized Pilot Trial. Telemedicine and eHealth. November 5, 2015;ePub ahead of print.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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