Among older diabetics, improvements in HbA1c levels with telemedicine are related to more frequent glucose checks

A telemedicine intervention in older adults with diabetes improved hemoglobin (Hb) A_1c levels, and this improvement in HbA_1c was associated with more frequent uploading of glucose values, found Ruth Weinstock, MD, PhD, addressing a gathering at the 70th Scientific Sessions of the American Diabetes Association meeting in Orlando, Florida.

Weinstock and her colleagues conducted a Medicare demonstration project to ascertain whether older adults living in underserved areas could better manage their diabetes through telemedicine.

Medicare beneficiaries who lived in New York State, had diabetes, and lived in federally designated underserved areas were enrolled. The study population consisted of 265 ethnically diverse persons older than 70 years; approximately half were non-Hispanic white; 35% were Hispanic, and 15% were non-Hispanic black. They were randomized to receive a home telemedicine intervention or usual care.

"The intervention group was given a home telemedicine unit that allowed them to videoconference with a nurse or dietitian at a diabetes center every 4 to 6 weeks, at which time they could also download and upload their blood glucose and blood pressure levels," said Weinstock, professor of medicine and division chief, Endocrinology, Diabetes, and Metabolism at the State University of New York, Syracuse. "They would discuss diabetes management issues and also blood glucose and blood pressure levels with a nurse case manager and dietitian. They remained within the care of their primary care physicians. We sent recommendations to primary care physicians to change pharmacologic therapy if we thought it was indicated."

As reported previously, after 5 years, HbA_1c levels, blood pressure levels, and low-density lipoprotein cholesterol levels were significantly improved in the participants in the telemedicine group compared to the usual-care group.

At baseline, the Hispanic participants had the highest HbA_1c levels, and the non-Hispanic whites had the lowest HbA_1c values. "The Hispanics had the greatest fall in HbA_1cs, but they still didn’t end up quite as low as the non-Hispanic white participants," said Weinstock.

In another presentation at the Orlando meetings, the same authors found that telemedicine participants had smaller declines in physical activity over time and a lower rate of physical impairment than the usual-care group.

"The concept should work wherever there’s a need," Weinstock said. "We found that physicians in upstate New York don’t have access to dietitians, so they found this very valuable to be able to provide education to their patients."