1065-P: Utilizing a Novel Telemedicine Clinic for Managing Patients with Type 2 Diabetes

Abstract

Objective: To examine whether a new Diabetes Telemedicine (DT) clinic can lead to improved glycemic control compared to standard of care (SoC). Design: Pilot RCT of patients with type 2 diabetes (T2D) randomized to DT clinic or SoC. DT intervention comprised of continuous glucose monitoring, “connected” insulin pens/caps, telecommunication systems (i.e. video conferencing, online messaging and telephone) and promoting physical activity (PA) by providing brief counseling and exercise physiologist consultation. SoC was managed using point of care glucometer, traditional insulin pens, in-person visits and provider counseling on PA. Primary outcome was change in HbA1c. Secondary outcomes were time in range (TIR) 70-180 mg/dl, time above range (TAR)>180 mg/dl and time below range (TBR)< 70 mg/dl. Patients also completed senior fitness test, assessed by Hedge’s g effect size. Results: A total of 18 patients (17 male) have been recruited, 11 patients were black and 7 white, all non-Hispanic. 14 completed 90 days in the trial. Non statistically significant differences were seen. DT had an 1.6% (mean SE 0.60) HbA1c reduction vs 0.4 (0.69) in SoC [difference -1.2% (0.92), p=0.19]. TIR 70-180 mg/dl increased 8.5% (13.6) (DT) vs 4.4% (15.8) (SoC) [difference +4.1% (20.8), p=0.84]. DT had a decrease in TAR>180 mg/dl of 8.7% (13.7) compared to 4.4% (15.8) in SoC [difference -4.3% (21.0), p=0.85] and TBR<70 mg/dl 0.16% (0.60) (DT) vs 0.13% (0.69) (SoC) [difference of 0.03% (0.92), p=0.97]. DT had improved aerobic capacity (6-minute walk test 402±62 to 418±69m, g=0.53) and strength in the lower- (30-second chair stand 9.0±2.6 to 11.5±2.6 stands, g=0.91) and upper-body (30-second weighted arm curl 17.4±5.3 to 21.0±6.3 curls, g=0.72). SoC had no meaningful changes in aerobic capacity or lower/upper-body strength (g=-0.05 to 0.18). Conclusion: Patients with T2D managed with DT had a non-statistically significant improvement of glucose control and improved physical fitness performance compared to patients in SoC. Disclosure F.Sotomayor: None. I.Spanakis: Research Support; Dexcom, Inc. C.Gothong: None. R.Hernandez: None. G.I.Ash: None. W.H.Scott: None. L.Pinault: None. F.Gomez-peralta: Advisory Panel; Abbott Diabetes, Insulcloud S.L., Speaker's Bureau; A. Menarini Diagnostics, Boehringer Ingelheim and Eli Lilly Alliance, Lilly Diabetes, Novartis, Novo Nordisk. L.G.Singh: None. J.D.Sorkin: None.