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

• DOI: 10.1210/js.2019-mon-lb002
• Publication Date: 2019-05-10T01:50:52Z
• Authors: Archana Bandi; Meg Larson; Janice Beattie; Ashley Summerville; Brandi Lumley; Stacey Lutz-McCain; Monique B-Kelly
• Keywords: Discontinuation; Telehealth; Veterans Affairs

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