Practical Telemedicine for Veterans with Persistently Poor Diabetes Control: A Randomized Pilot Trial

Matthew J. Crowley, David Edelman, Ann T. McAndrew, Susan Kistler, Susanne Danus, Jason A. Webb, Joseph Zanga, Linda L. Sanders, Cynthia J. Coffman, George L. Jackson, Hayden B. Bosworth

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

Background: Telemedicine-based diabetes management improves outcomes versus clinic care but is seldom implemented by healthcare systems. In order to advance telemedicine-based management as a practical option for veterans with persistent poorly controlled diabetes mellitus (PPDM) despite clinic-based care, we evaluated a comprehensive telemedicine intervention that we specifically designed for delivery using existing Veterans Health Administration (VHA) clinical staffing and equipment. Materials and Methods: We conducted a 6-month randomized trial among 50 veterans with PPDM; all maintained hemoglobin A1c (HbA1c) levels continuously >9.0% for >1 year despite clinic-based management. Participants received usual care or a telemedicine intervention combining telemonitoring, medication management, self-management support, and depression management; existing VHA clinical staff delivered the intervention. Using linear mixed models, we examined HbA1c, diabetes self-care (measured by the Self-Care Inventory-Revised questionnaire), depression, and blood pressure. Results: At baseline, the model-estimated common HbA1c intercept was 10.5%. By 6 months, estimated HbA1c had improved by 1.3% for intervention participants and 0.3% for usual care (estimated difference, -1.0%, 95% confidence interval [CI], -2.0%, 0.0%; p = 0.050). Intervention participants' diabetes self-care (estimated difference, 7.0; 95% CI, 0.1, 14.0; p = 0.047), systolic blood pressure (-7.7 mm Hg; 95% CI, -14.8, -0.6; p = 0.035), and diastolic blood pressure (-5.6 mm Hg; 95% CI, -9.9, -1.2; p = 0.013) were improved versus usual care by 6 months. Depressive symptoms were similar between groups. Conclusions: A comprehensive telemedicine intervention improved outcomes among veterans with PPDM despite clinic-based care. Because we specifically designed this intervention with scalability in mind, it may represent a practical, real-world strategy to reduce the burden of poor diabetes control among veterans.

Original languageEnglish (US)
Pages (from-to)376-384
Number of pages9
JournalTelemedicine and e-Health
Volume22
Issue number5
DOIs
StatePublished - May 1 2016
Externally publishedYes

Keywords

  • e-health
  • home health monitoring
  • telehealth
  • telemedicine

ASJC Scopus subject areas

  • Health Informatics
  • Health Information Management

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