Telemedicine in the Management of Type 1 Diabetes

Abstract

BackgroundVeterans with type 1 diabetes who live in rural Alabama and Georgia face barriers to receiving specialty diabetes care because of a lack of endocrinologists in the Central Alabama Veterans Health Care System. Telemedicine is a promising solution to help increase access to needed health care. We evaluated telemedicine’s effectiveness in delivering endocrinology care from Atlanta-based endocrinologists.MethodsWe conducted a retrospective chart review of patients who were enrolled in the Atlanta VAMC Endocrinology Telehealth Clinic from June 2014 to October 2016. Outcomes of interest were hemoglobin A1c levels, changes in glycemic control, time savings for patients, cost savings for the US Veterans Health Administration, appointment adherence rates, and patient satisfaction with telehealth.ResultsThirty-two patients with type 1 diabetes received telehealth care and in general received the recommended processes of diabetes care. Patients trended toward a decrease in mean hemoglobin A1c and glucose variability and a nonsignificant increase in hypoglycemic episodes. Patients saved 78 minutes of travel time (one way), and the VA saved $72.94 in travel reimbursements per patient visit. Patients adhered to 88% of scheduled telehealth appointments on average, and 100% of surveyed patients stated they would recommend telehealth to other veterans.ConclusionsSpecialty diabetes care delivered via telemedicine was safe and was associated with time savings, cost savings, high appointment adherence rates, and high patient satisfaction. Our findings support growing evidence that telemedicine is an effective alternative method of health care delivery.

A Web-Based Survey Assessing the Attitudes of Health Care Professionals in Germany Toward the Use of Telemedicine in Pregnancy Monitoring: Cross-Sectional Study

“…This is contrasted by a growing demand for Web-based pregnancy apps among patients [ 22 ] and a general interest in health care apps [ 5 , 15 , 36 ]. It is also surprising because other countries and specialties, such as internal medicine or neurology, have already adopted telemedicine in patient care [ 37 - 39 ].…”

Patient-Driven Diabetes Care of the Future in the Technology Era

“…More recently, several meta-analyses examining published diabetes telemedicine programs determined that patients participating in telemedicine interventions in fact had greater reduction in HbA1c on average when compared with patients in non-telemedicine groups (Faruque et al, 2017;Heitkemper et al, 2017;Lee et al, 2017;Marcolino et al, 2013;Su et al, 2016a). Alongside these encouraging results, patients reported travel time savings and high satisfaction rates with telemedicine programs, and total clinician time spent was reduced by as much as 40% (Xu, 2018;Izquierdo et al, 2003;Bashshur et al, 2015;Leichter et al, 2013). Collectively, these findings affirm that telemedicine diabetes care models may produce similar or better health outcomes than in-person care models with greater time-and cost-efficiency.…”

Attitudes towards telemedicine in pregnancy monitoring: A questionnaire survey among health care professionals in Germany (Preprint)

“…This is contrasted by a growing demand for Web-based pregnancy applications from patients [22]. It is also surprising, because other countries and other specialties such as internal medicine or neurology have adopted telemedicine in patient care already [35][36][37]. Our survey suggests that especially non-physicians are still not convinced of the benefits and potential of telemedicine for pregnancy monitoring.…”