Advanced Telemedicine Training and Clinical Outcomes in Type II Diabetes: A Pilot Study

Abstract

Background: COVID-19 caused a dramatic increase in the scope and utilization of telemedicine. However, the sustainability of the permanent integration of telemedicine in the management of chronic disease beyond the pandemic is still enigmatic. The purpose of this retrospective chart review was to analyze the effect of advanced training in telemedicine on clinical outcomes in type II diabetes mellitus (T2DM) in the United States. Methods: A retrospective chart review was conducted in 104 deidentified patients with diabetes from 28 specialized telemedicine agency physicians who had received specialized telemedicine training. After establishing exclusion criteria, the charts of 59 T2DM patients were evaluated. Glycated hemoglobin (HbA1c) percentage and body mass index (BMI) were used as quantitative endpoints. Visit consistency, mediation data, and compliance data were also studied. Results: The mean change in HbA1c for the 42 patients who met the inclusion criteria for evaluating HbA1c (n = 42) was -0.429%. The largest decrease in HbA1c was 5.4%, and the most significant increase was 3.9%. The mean change in BMI for the 16 patients who met the inclusion criteria for evaluating BMI (n = 16) was -2.175 kg/m². The largest decrease in BMI was 9.5 kg/m² and the largest increase was +0.7 kg/m². The average number of visits for patients with a decrease in HbA1c was 3.45. The average number of visits for patients with an increase in HbA1c was 2.62. Conclusions: Outcomes of telemedicine providers with training are comparable with the standard of care. Advanced telemedicine training and its effect on clinical outcomes in the management of chronic disease warrant further investigation. For telemedicine to become a mainstay in U.S. medicine, a standard of best practices should be evaluated and available for providers who wish to continue telehealth care delivery.

Keywords: subspecialization; telehealth; telemedicine; type II diabetes.

FIG. 1.

Therapeutic aims for nonpregnant adults with diagnosed T2DM. GLP-1, glucagon-like peptide 1; HbA1c, glycated hemoglobin; T2DM, type II diabetes mellitus.

FIG. 2.

Flowchart of the initial patient inclusion and exclusion criteria.

FIG. 3.

Flowchart of the final inclusion criteria for substudies of HbA1c and BMI. BMI, body mass index.

FIG. 4.

Change in glycated hemoglobin percentage over the duration of telemedicine delivery for 42 T2DM patients seen by physicians with advanced training in telemedicine best practices.

FIG. 5.

Change in BMI over the duration of telemedicine delivery for 16 T2DM patients seen by physicians with advanced training in telemedicine best practices.