IDF21-0043 Technology Trio: Continuous Glucose Monitoring, Telehealth, and Electronic Messaging for Insulin-Treated Patients

Abstract

Background: The recent accelerated super-imposition of telemedicine on advances in continuous glucose monitoring (CGM) and electronic patient portal communication has brought about major changes in the delivery of diabetes care. Aim: We evaluated the impact of clinic-monitored proactive CGM, frequent virtual video visits, and an electronic patient-nurse-physician messaging system on glycemic parameters in patients on intensive insulin therapy. Method: In a newly-established academic endocrinology practice consisting of a diabetes specialist and a nurse clinician, CGM data was downloaded proactively every 2 weeks from computer cloud-based device accounts (LibreView for Freestyle Libre and Clarity for Dexcom G6) in 146 patients with diabetes on multiple (2-5) daily insulin injections or insulin pump therapy. The diabetes specialist interpreted the ambulatory glucose profile and individually advised patients of modifications in diet, behavior, and components of the insulin regimen by electronic portal communication linked to email, and during telehealth and in-person office visits. Results: The average time-in-range (TIR) increased from 63% to 69% (p<0.05), while the average hemoglobin A1c decreased from an inpatient value of 9.46% to 7.36% (p<0.05) over a mean period of 12 months. The CGM adherence rate was close to 100%. Discussion: Improved glucose control is seen in insulin-treated outpatients when CGM data analysis by remote upload capabilities is employed in a routine clinician-initiated and proactive fashion and coupled with convenient interactive technology like telehealth and electronic messaging. Impact on hypoglycemia rates and patient satisfaction levels remain to be determined.