1087-P: Managing Diabetes in the Delta—Effect of Access to Endocrinology Services in an Underserved Area

Abstract

Background: The Mississippi Delta has one of the highest rates of diabetes in the nation, but patients in these rural, minority-majority counties have lower access to specialty care. At the start of a hybrid diabetes management program at two rural health clinics in the Delta, 53.1% of patients with diabetes had uncontrolled HbA1c levels. We analyze the specific effect of integrating endocrinology specialists into this intervention. Patients could access this care via telemedicine or in-person. Methods: We conducted a quasi-experimental study with clinical data from electronic health records for patients diagnosed with diabetes or prediabetes (aged ≥ 18). We followed two cohorts of the same patients over time for the first 18 months of the program, each matched on elevated HbA1c levels (≥8% at baseline). The treatment group comprised program participants; the control group comprised general clinic patients at-risk of diabetes. We also followed patients in the treatment group who received endocrine services in addition to other program benefits. Results: Among the control group, HbA1c increased an average of 0.04 points; the treatment group saw an average decrease of 0.42 points. The treatment group's endocrinology subset saw an even greater decrease of 0.85 points. The average HbA1c score for this group went down three points in a two-year period (7/20-7/22). Conclusions: The study results indicate that receiving coordinated endocrinology services has been especially effective in reducing HbA1c levels among program participants. As care continuity is associated with better glycemic control for diabetic patients, sustained program participation will likely help the patient population best manage their diabetes and avoid further adverse health outcomes. Additionally, as this diabetes program takes place in a rural, low-income minority area with low access to specialty care, the results demonstrate promising practices for strengthening the rural health care system. Disclosure C.Brindley: None. W.James: None. J.R.Bennett: None. K.F.Matthews: None. Funding Health Resources and Services Administration, Federal Office of Rural Health Policy (HRSA-20-025, D06RH37500)