Telehealth-Only Care Fails to Improve Type 2 Diabetes Outcomes

December 13, 2023 - Type 2 diabetes patients who received endocrinology care through telehealth alone had poor glycemic outcomes compared with those who received in-person or hybrid care, which contrasts with prior research findings, according to a new study.

Published in JAMA Network Open, the study aimed to assess patterns of telehealth use and their impact on glycemic control among adults receiving endocrinology care for type 2 diabetes.

Previous research has shown that telehealth is effective in improving glycemic control, but there has not been enough data on utilization and outcomes linked to routine telehealth care for type 2 diabetes since 2020, especially in the endocrinology setting, the researchers wrote. Thus, they conducted a retrospective cohort study that included adults with type 2 diabetes who had an initial or follow-up visit via telehealth between May 1 and October 31, 2020, in the endocrinology division of a large health system.

The researchers conducted follow-ups with patients through May 2022, assigning them to telehealth-only, in-person, or hybrid care cohorts. They estimated hemoglobin A1c (HbA1c) change at 12 months within each cohort and the association of factors indicating clinical complexity, such as insulin regimen and cardiovascular and psychological comorbidities, with HbA1c change across cohorts.

Of 11,498 potential type 2 diabetes patients, 3,778 were included in the final cohort. Of the final sample, 1,182 received care via telehealth, 1,049 received in-person care, and 1,547 received hybrid care, that is, both telehealth and in-person care.

Patients in the telehealth-only cohort were younger and more likely to be women and Black than patients in the in-person and hybrid follow-up groups. Further, the telehealth-only group had fewer mean appointments and fewer follow-up HbA1c measurements per year than those in the in-person and hybrid follow-up groups.

There was no significant change in adjusted HbA1c at 12 months among patients in the telehealth-only group, compared with the in-person group, which experienced an HbA1c improvement of 0.37 percent, and the hybrid group, which experienced an improvement of 0.22 percent.

In addition, the researchers observed that patients prescribed basal insulin across all three cohorts had worse adjusted HbA1c changes at 12 months than those not prescribed insulin. However, the estimated difference in HbA1c change between patients prescribed basal insulin and those not prescribed insulin was significant only for the telehealth group at 24 months.

Further, telehealth-only patients with a baseline HbA1c of 8 percent or higher had no significant change in adjusted HbA1c at 12 or 24 months, but patients receiving in-person or hybrid follow-up had significant improvement in adjusted HbA1c at both 12 and 24 months.

“Patients with T2D [type 2 diabetes] who receive endocrinology care and have more complex care needs, including those who use insulin or have HbA1c above goal, may not be well served by telemedicine care alone as currently implemented,” the researchers concluded.

One reason may be that the strategies to support glycemic improvement deployed during in-person appointments, like self-management education and sharing home blood glucose data, have not been consistently translated to telehealth.

“Implementation of approaches to overcome these differences, such as team-based virtual care and technological tools to automate blood glucose data sharing, are needed to ensure all patients receive high-quality diabetes care regardless of care modality,” they wrote.

These study findings contrast with previous research, including a study published in early 2022 that revealed that telehealth maintained quality of care and led to better health outcomes for patients with type 2 diabetes during the COVID-19 pandemic.

The study included 16,588 with type 2 diabetes who received care before or during the pandemic, with 7,581 having a telehealth visit with either a primary care physician or an endocrinologist.

Patients who only received in-person care saw a decline in quality outcomes during the pandemic, but patients receiving care via telehealth achieved similar quality outcomes during the pandemic as they did before.