TeleHealth improves diabetes self-management in an underserved community: diabetes TeleCare

Richard M Davis, Angela D Hitch, Muhammad M Salaam, William H Herman, Ingrid E Zimmer-Galler, Elizabeth J Mayer-Davis, Richard M Davis, Angela D Hitch, Muhammad M Salaam, William H Herman, Ingrid E Zimmer-Galler, Elizabeth J Mayer-Davis

Abstract

Objective: To conduct a 1-year randomized clinical trial to evaluate a remote comprehensive diabetes self-management education (DSME) intervention, Diabetes TeleCare, administered by a dietitian and nurse/certified diabetes educator (CDE) in the setting of a federally qualified health center (FQHC) in rural South Carolina.

Research design and methods: Participants were recruited from three member health centers of an FQHC and were randomized to either Diabetes TeleCare, a 12-month, 13-session curriculum delivered using telehealth strategies, or usual care.

Results: Mixed linear regression model results for repeated measures showed a significant reduction in glycated hemoglobin (GHb) in the Diabetes TeleCare group from baseline to 6 and 12 months (9.4 +/- 0.3, 8.3 +/- 0.3, and 8.2 +/- 0.4, respectively) compared with usual care (8.8 +/- 0.3, 8.6 +/- 0.3, and 8.6 +/- 0.3, respectively). LDL cholesterol was reduced at 12 months in the Diabetes TeleCare group compared with usual care. Although not part of the original study design, GHb was reduced from baseline to 12 and 24 months in the Diabetes TeleCare group (9.2 +/- 0.4, 7.4 +/- 0.5, and 7.6 +/- 0.5, respectively) compared with usual care (8.7 +/- 0.4, 8.1 +/- 0.4, and 8.1 +/- 0.5, respectively) in a post hoc analysis of a subset of the randomized sample who completed a 24-month follow-up visit.

Conclusions: Telehealth effectively created access to successfully conduct a 1-year remote DSME by a nurse CDE and dietitian that improved metabolic control and reduced cardiovascular risk in an ethnically diverse and rural population.

Figures

Figure 1
Figure 1
Comparison of GHb in intervention and control groups.

References

    1. UK Prospective Diabetes Study Group Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352:854–865
    1. UK Prospective Diabetes Study Group Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352:837–853
    1. American Diabetes Association Standards of medical care for patients with diabetes: 2009. Diabetes Care 2009;32(Suppl. 1)1:S13–S61
    1. Shojania KG, Ranji SR, McDonald KM, Grimshaw JM, Sundaram V, Rushakoff RJ, Owens DK. Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis. JAMA 2006;296:427–440
    1. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention National Diabetes Fact Sheet [article online], 2007. Available at Accessed 17 November 2008
    1. Meigs JB, Cagliero E, Dubey A, Murphy-Sheehy P, Gildesgame C, Chueh H, Barry MJ, Singer DE, Nathan DM. A controlled trial of web-based diabetes disease management: the MGH diabetes primary care improvement project. Diabetes Care 2003;26:750–757
    1. Montori VM, Dinneen SF, Gorman CA, Zimmerman BR, Rizza RA, Bjornsen SS, Green EM, Bryant SC, Smith SAthe Translation Project Investigator Group The impact of planned care and a diabetes electronic management system on community-based diabetes care: the Mayo Health System Diabetes Translation Project. Diabetes Care 2002;25:1952–1957
    1. Izquierdo RE, Knudson PE, Meyer S, Kearns J, Ploutz-Snyder R, Weinstock RS. A comparison of diabetes education administered through telemedicine versus in person. Diabetes Care 2003;26:1002–1007
    1. Shea S, Weinstock RS, Teresi JA, Palmas W, Starren J, Cimino JJ, Lai AM, Field L, Morin PC, Goland R, Izquierdo RE, Ebner S, Silver S, Petkova E, Kong J, Eimicke JPthe IDEATEL Consortium A randomized trial comparing telemedicine case management with usual care in older, ethnically diverse, medically underserved patients with diabetes mellitus: 5 year results of the IDEATel study. J Am Med Inform Assoc 2009;16:446–456
    1. Rural Assistance Center Federally Qualified Health Centers Information Guide [article online], 2007. Available at Accessed 16 August 2007
    1. Davis RM, Hitch AD, Nichols M, Rizvi A, Salaam M, Mayer-Davis EJ. A collaborative approach to the recruitment and retention of minority patients with diabetes in rural community health centers. Contemp Clinical Trials 2009;30:63–70
    1. Hurley AC. The Health Belief Model: evaluation of a diabetes scale. Diabetes Educ 1990;16:44–48
    1. Zimmerman GL, Olsen CG, Bosworth MF. A “stage of change” approach to helping patients change behavior. Am Fam Phys 2000;61:1409–1416
    1. Mayer-Davis EJ, D'Antonio AM, Smith SS, Kirkner G, Levin S, Parra-Medina D, Schulz R. Pounds Off With Empowerment (POWER): a clinical trial of weight management strategies for African American and White persons with type 2 diabetes in rural, medically under-served communities. Am J Public Health 2004;94:1736–1742
    1. The Diabetes Prevention Program Research Group The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care 25: 2165–2171
    1. American Diabetes Association Clinical practice recommendations 2008. Diabetes Care 2008;31(Suppl. 1):S3–S4
    1. Michigan Diabetes and Research Training Center Life with Diabetes: A Series of Teaching Outlines 3rd ed, American Diabetes Association, Alexandria, VA
    1. Parra-Medina D, D'Antonio AM, Smith SM, Levin S, Kirkner G, Mayer-Davis EJ. Successful recruitment and retention strategies for a randomized weight management trial for persons with diabetes living in rural, medically underserved counties of South Carolina: the POWER study. J Am Diet Assoc 2004;104:70–75
    1. American Diabetes Association Standards of medical care in diabetes: 2009. Diabetes Care 2009;32(Suppl. 1):S13–S61
    1. Moreno L, Dale SB, Chen AY, Magee CA. Costs to Medicare of the Informatics for Diabetes Education and Telemedicine (IDEATEL) home telemedicine demonstration: findings from an independent evaluation. Diabetes Care 2009;32:1202–1204

Source: PubMed

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