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Intensive Telehealth Program Improves A1c In Rural Patients with Type 2 Diabetes


ADA 2020. Improvement in glycemic control among US veterans was seen across 5 study sites and was sustained at 18 months after study initiation, says study reported at the ADA 80th Virtual Scientific Sessions.


A comprehensive telehealth program delivered to rural patients with poorly controlled type 2 diabetes (T2D) resulted in a reduction in A1c levels at 6 months, according to research presented at the American Diabetes Association’s 80th Virtual Scientific Sessions.

The improvement—a 1.36% reduction in A1c—was maintained up to 18 months after the program initiation.

Diabetes management in rural areas is problematic because of limited access to specialists as well as to self-management programs. Under an award form the Veterans Administration (VA) Office of Rural Health--Iowa City, researchers designed an intensive diabetes management program called the Advanced Comprehensive Diabetes Care (ACDC)

The program was specifically designed for delivery using the existing Veterans Health Administration’s Home Telehealth (VHA HT) infrastructure and clinical staff.

The 6-month telehealth intervention combines telemonitoring with module-based self-management support and medication management.

Existing clinical staff with VHA HT delivered ACDC through bi-monthly half-hour calls. In an earlier randomized trial, researchers found that ACDC improved A1c, blood pressure, and diabetes self-care in the initial 50 veterans who participated. Since 2017, ACDC has been implemented in clinical practice at 7 VHA sites around the country that serve rural veterans.

The most recent analysis examined 125 patients receiving ACDC at 5 sites. Across all locations, patients’ average A1c levels improved from 9.25% at baseline to 7.89% at 6 months, a benefit that largely persisted 18 months after the start of the study. On qualitative analyses, ACDC enhanced patient engagement and awareness of diabetes control.

“We are pleased to see that the intervention was well-suited for delivery in clinical practice and that it remained effective in real-world settings,” said Elizabeth Kobe, a study investigator and MD candidate at Duke University Medical School.

“When telehealth interventions are designed to leverage existing resources, they can greatly improve diabetes care in underserved rural populations. We also believe this design-minded approach can extend to other chronic diseases.”

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