MON-LB002 Diabetes Care Network: A Telehealth Based Collaborative Approach to Scale Endocrine Expertise

Abstract

Background: Diabetes Care Network (DCN) is a collaborative care pathway that uses a team approach via telehealth to modernize diabetes care delivery and scale the endocrine expertise for complex diabetic patients. Methods: We studied the efficacy and sustainability of our approach to improving diabetes care over 12 months among 101 Veterans with poorly controlled Type 2 Diabetes (T2DM) (A1c>9%) identified from the electronic database. Among all enrolled Veterans, 87 (86.1%) were followed for 12 months. We assessed consultation completion via E-consult and protocol-based continuity care collaboration with primary care liaisons. Means (SD), frequencies, and percentages are presented, and Spearman correlations were assessed. Statistical significance set at p<0.05. Results: The cohort (N=87) was 97.7% male, 90.8% white, had a mean age 67.2 (8.9), and an average of 3.3 comorbidities, 0.7 macro-, and 1.3 microvascular complications. Initial care delivered via E-consult within 2.6(1.7) days with weekly follow-up telephonic team meetings. Collaborative care in the study cohort (N=87) allowed for therapy optimization and/or escalation with the initiation of metformin in 9 (10.3%), SGLT-2-I in 6 (6.8%), DPP-4I in 8 (9.1%), insulin U500 in 8 (9.1%), GLP-1A agents in 25 (28.7%), any insulin in 12 (13.7%), discontinuation of metformin in 9 (10.3%) and oral sulfonylurea in 17 (19.5%) Veterans. Of the 24 (27%) non-insulin users at enrollment, 12 Veterans initiated insulin therapy by 12 months. A1C declined significantly from the baseline A1C of 10.2% (1.4), to 8.1% (0.99) at 3 months, 7.6% (0.96) at 6 months, and 7.5 % (0.86) at 12 months (all p<.0001). At 3, 6, 12 months, number of patients who achieved HBA1c <8 % were 38 (43.6%), 56 (64%), and 56 (64%), and number of patients who achieved HBA1c <7% were 10 (11.4%), 21 (24.1%), and 23 (26.4%), respectively. Non-statistically significant improvements were noted in Weight {229.3lbs (48.1) to 228.4lbs (46.9)}, LDL {89.0mg/dl (36.4) to 79.5mg/dl (32.5)}, systolic BP {130.5mmHg (16.1) to 123.9mmHg (17.5)}, and triglycerides {226.9 mg/dl (195.3) to 159.3 (97.4)}. Compared to the 12 months pre-enrollment period, no difference in healthcare utilization (ER visits or admissions) was noted in the post-enrollment period. From baseline to completion, only nonsignificant improvements were noted in secondary preventative therapy for the use of antiplatelet agents, ACE-I/ARB, moderate to high-intensity statins and, the frequency of urine microalbumin tests, and annual foot/ retinal exams. Conclusions: With the DCN approach, we show that using telehealth technologies and collaborative partnerships, endocrine expertise can successfully be scaled to address the shortage of endocrinologists and help attain improved diabetes control. Such pathways will alleviate the large burden on primary care and address primary care inertia with timely therapy optimizations. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.