Glycemic Control Shows Improvement With Telehealth Intervention


Managing diabetes in rural areas is difficult due to limited access to specialty care and self-management programs.

Researchers have demonstrated that the use of a telehealth program may lead to improved glycemic control.1

In a recent study, rural patients with poorly-controlled type 2 diabetes who participated in a comprehensive telehealth program showed a 1.36% reduction in HbA1c levels after 6 months of care. Data also indicated that patients participating in the study maintained the improved HbA1c levels up to 18 months after beginning the program.1

Results of the research project, “Implementation of Intensive Telehealth Intervention for Rural Patients with Uncontrolled Diabetes,” were presented Friday during the American Diabetes Association’s (ADA’s) 80th Virtual Scientific Sessions,1 by study investigator Elizabeth Kobe, MD candidate at Duke University Medical School.2

Managing diabetes in rural areas is difficult due to limited access to specialty care and self-management programs. According to the investigators, specialists set out to address these challenges in a clinically feasible manner.1,2

Under an award from the VA Office of Rural Health Veterans Rural Health Resource Center- Iowa City, the researchers designed an intensive diabetes management intervention, Advanced Comprehensive Diabetes Care (ACDC), that was built for delivery using the existing Veterans Health Administration’s Home Telehealth (VHA HT) infrastructure and clinical staff.1

“When telehealth interventions are designed to leverage existing resources, they can greatly improve diabetes care in underserved rural populations. We also believe this design-minded approach can extend to other chronic diseases,” Kobe said in a prepared statement.1

ACDC is a 6-month telehealth intervention that combines telemonitoring with module-based self-management support and medication management. Clinical staff with VHA HT delivered ACDC through bi-monthly half-hour calls.1

An earlier randomized trial demonstrated that implementation of ACDC improved HbA1c, blood pressure and diabetes self-care in the initial 50 veterans who participated. Since 2017, ACDC has been implemented in clinical practice at 7 VHA sites around the country that serve rural veterans.1

The most recent analysis, conducted 2017-2019, examined 125 patients receiving ACDC at 5 sites.1,2 During this study, researchers implemented and evaluated ACDC with guidance from the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework.2 Across all locations, the patients’ average HbA1c levels improved from 9.25% at baseline to 7.89% at 6 months, a benefit that largely persisted 18 months after the start of the study. On qualitative analyses, ACDC enhanced patient engagement and awareness of diabetes control.1

“We are pleased to see that the intervention was well-suited for delivery in clinical practice and that it remained effective in real-world settings,” Kobe said.1


  • Intensive Use of Telehealth Improves Glycemic Control Among Rural Patients with Type 2 Diabetes [news release]. Chicago, IL; June 12, 2020: ADA website. Accessed June 12, 2020.
  • Kobe E, Lewinski A, Danus S, et al. Implementation of an Intensive Telehealth Intervention for Rural Patients with Uncontrolled Diabetes. Presented at: American Diabetes Association’s® (ADA’s) 80th Virtual Scientific Sessions; June 12-16, 2020. Accessed June 12, 2020.

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