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.
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.