142-LB: Comparing Two Telehealth Interventions for Patients with Clinic-Refractory Type 2 Diabetes: A Randomized Controlled Trial

Patients whose type 2 diabetes (T2D) remains persistently poorly-controlled despite receiving clinic-based care are at high risk for complications and costs. To address clinic-refractory T2D within the Veterans Health Administration, we conducted a randomized trial comparing two nurse-delivered telehealth strategies to augment clinic-based care: 1) telemonitoring and care coordination; and 2) a comprehensive intervention combining telemonitoring, self-management support, diet/activity support, medication management, and depression management. Delivery of both interventions utilized only existing clinical staff and infrastructure. Patients (n=200) with HbA1c continually ≥8.5% for ≥1 year despite receiving diabetes management from Primary Care and/or Endocrinology were randomized in a 1:1 ratio to the two 12-month intervention arms between 12/2018 and 1/2020. We analyzed our primary outcome, HbA1c collected at 0, 3, 6, 9 and 12 months, using linear mixed models. Secondary outcomes included BMI and hypoglycemia. Patients had a mean age of 58, and were mostly male (78%) and African American (72%); all patients were engaged with Primary Care prior to enrollment, and 68% with Endocrinology. Baseline characteristics were similar across arms. Estimated mean baseline HbA1c was 10.08%, which declined to an estimated 9.23% at 12 months in the telemonitoring arm and 8.67% in the comprehensive telehealth arm (estimated between-arm difference at 12 months -0.55%, 95%CI -1.06%,-0.05%, p=0.03). No difference in BMI between arms was seen. Hypoglycemia rates were low, and similar between arms. While both strategies improved HbA1c in this high-risk, clinic-refractory population, the comprehensive telehealth intervention led to a clinically and statistically significant added HbA1c benefit. Because its delivery relies solely on existing clinical resources, this comprehensive intervention may be a practical means to address clinic-refractory T2D.

Duke Scholars

Author David Edward Edelman Medicine, General Internal Medicine

Author Hayden Barry Bosworth Population Health Sciences

Author Matthew Janik Crowley Medicine, Endocrinology, Metabolism, and Nutrition