No HbA1c improvements for adults with type 2 diabetes exclusively using telemedicine
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Key takeaways:
- Of adults with type 2 diabetes, 31% attended only telemedicine visits from 2020 to 2022.
- HbA1c decreased for adults attending in-person or in-person plus telemedicine visits, but not telemedicine alone.
A group of adults with type 2 diabetes who used only telemedicine for endocrinology care did not have improvements in HbA1c over 2 years of follow-up, according to findings published in JAMA Network Open.
“Patients who used only telemedicine to access endocrinology care had worse glycemic outcomes compared to patients who used in-person or mixed care over the follow-up period,” Margaret Zupa, MD, MS, assistant professor of medicine in the division of endocrinology and metabolism at University of Pittsburgh School of Medicine, told Healio. “This was true across different types of patients, including those who had HbA1c above goal at baseline and who use multiple daily injections of insulin. Thus, as endocrinology clinicians, we may need to provide additional support for patients with type 2 diabetes who rely on telemedicine alone to access care in order to ensure that patients who face barriers to in-person care, such as those living in rural areas or those who have limited transportation or mobility, can still achieve their treatment goals.”
Zupa and colleagues conducted a retrospective cohort study of 3,778 adults with type 2 diabetes who had an initial or follow-up visit via telemedicine from May to October 2020 (mean age, 60.3 years; 58% women; 88% white). Adults aged 18 years and older with at least two HbA1c measurements through May 1, 2022, were included. Participants were placed into one of three groups: telemedicine only for adults attending synchronous telemedicine visits with either audio-visual or audio-only communications; in-person only for those attending in-person follow-up visits; or mixed for those who had telemedicine and in-person visits during follow-up. HbA1c values were collected at least 10 weeks apart through May 1, 2022. Sociodemographic data, insulin prescription information and comorbidities were collected from electronic medical records.
Telemedicine does not improve HbA1c
Of the study group, 41% attended in-person and telemedicine visits, 31% only used telemedicine and 28% attended only in-person visits. The percentage of visits conducted through telehealth was highest from May to October 2020 at 84% and dropped during the study to a low of 41% from November 2021 to May 2022. The telemedicine-only group had a mean 2.1 visits per year compared with 2.5 visits for the in-person only group and 2.9 visits for the mixed group.
No change in HbA1c was observed among those using telemedicine alone from baseline to 1 year, whereas the in-person group had a 0.37% HbA1c reduction and the mixed group had HbA1c decline of 0.22%. No change in HbA1c was observed for any group from baseline to 2 years.
Adults prescribed basal insulin had worse HbA1c changes at 12 months compared with those not using insulin in all three treatment modality groups. A similar trend was observed at 24 months for adults using only telemedicine. Participants receiving multiple daily injections had worse HbA1c change at both 12 and 24 months than people not receiving insulin across all three groups. HbA1c change from baseline to 12 months for people prescribed multiple daily injections vs. no insulin was higher among the telemedicine only group compared with the in-person only group (estimated difference in HbA1c change, 0.25%; 95% CI, 0.02-0.47; P = .03).
In a subgroup analysis of adults with a baseline HbA1c of 8% or higher, those attending in-person only or mixed visits had improvements in HbA1c at 12 and 24 months, whereas no improvements were observed for those only attending telemedicine visits.
Improved telemedicine strategies needed
Zupa said several studies have examined strategies to better support people with type 2 diabetes who only attend telemedicine visits. Some of those strategies include additional follow-up of blood glucose levels between visits, medication adjustments between visits and multidisciplinary care with a greater emphasis on diabetes self-management education and support.
“The next steps in this area include identification and evaluation of strategies to improve the quality of care delivered via telemedicine to our patients with type 2 diabetes,” Zupa said. “This includes testing telemedicine strategies from clinical trials to examine their impact on real-world diabetes care and outcomes, and working with patients and multidisciplinary clinicians to develop and test new approaches to best support our patients who rely on telemedicine.”
For more information:
Margaret F. Zupa, MD, MS, can be reached at zupamf@pitt.edu.
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