Electronic Consults (EC) offer enhanced access to endocrinologists for patients with type 2 diabetes mellitus (T2DM). The effects of EC on costs of care and glycemic control compared to Face-to-Face (F2F) visits are unknown. A retrospective chart review was conducted for Veterans who received EC (n=440) or F2F (n=397) care for T2DM through the VA Pittsburgh Healthcare System (VAPHS) from 2010 to 2015. Data on demographics, rurality, days to consult completion, and percent (%) A1C at baseline and post-consult at 3-6, and 12 months were collected. A web-based tool calculated the average round-trip distance in miles and travel time in hours from patient’s residential zip code to VAPHS. Annual travel costs for recommended 3 visits per year were estimated at a reimbursement rate of $0.415 per mile. Continuous measures (mean ± standard deviation) were compared using Wilcoxon rank-sum tests. Categorical measures (sex, rurality) were presented as percentages and compared between groups by time point using chi-square tests. Veterans who received EC were predominantly male (98.4%), younger (64.2±8.5 years) and rural (15.8%) than those who received F2F care (95.3% male, p=0.01; 68.1±8.7 years, p<0.0001; 3.7% rural, p<0.0001). The EC cohort had shorter consult completion time than the F2F cohort (EC: 10±10 days, F2F: 37±33; p<0.0001). Mean annual travel-related savings per Veteran in the EC cohort were 431±297 miles, 9.4±7 hours, and $179±123. Mean annual travel burden per Veteran in the F2F cohort were 159±171 miles, 3.5±4 hours and $66±71. EC and F2F cohorts had similar baseline A1C values (10%±1.6). Both cohorts had decline in baseline percent A1C to 3- 6 months (EC: 8.98%±1.54, F2F: 8.75%±1.77, p=0.03) and from baseline percent A1C to 12 months (EC: 8.80%±1.61, F2F: 8.57%±1.72, p=0.002). Electronic consults deliver effective and expedient care by saving money and travel time, and offer long-term, sustainable glycemic control comparable to F2F care for patients in remote areas with T2DM. Disclosure N. Karajgikar: None. K.B. Detoya: None. J.N. Beattie: None. S.J. Lutz-McCain: None. M.Y. Boudreaux-Kelly: None. A. Bandi: None.

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 ...

Veterans are three times more likely to have diabetes than the general population. Diabetes self-management education and support (DSMES) is a critical component of diabetes care that galvanizes more informed and engaged patients. Many Veterans are disabled or reside in rural areas and have limited access to comprehensive DSMES. Clinical Video Telehealth (CVT) extends access to specialty services from regional Veterans Affairs (VA) Healthcare Centers to Community-Based Outpatient Clinics where many Veterans receive healthcare. The purpose of this study was to examine and compare proximal (3-6 month) and distal (12 and 18 month) metabolic outcomes (A1C, lipids, BMI and blood pressure) of Veterans who received comprehensive group DSMES via CVT vs. in-person . Veterans who received DSMES from 2012 to 2017 by CVT (n=197) and in-person (n=359) were identified in the VA computerized medical record. The CVT group was similar to those that attended in-person, but were less racially diverse. A linear mixed model was used to compare changes in metabolic outcomes within and between groups over time. A1C improved at 3 months and was sustained for 12-18 months in both groups. Neither group showed changes in lipids, BMI, or blood pressure. In conclusion, CVT is an effective means of improving A1C by expanding DSMES access to Veterans who receive community care. Disclosure M. DiNardo: None. A.O. Youk: None. N. Beyer: None. J.N. Beattie: None. D. Obrosky: None.

Purpose: The purpose of the study was to examine the impact of a novel approach to provide diabetes specialty team care to rural patients with type 2 diabetes (T2DM) on clinical outcomes and processes of care. Methods: Diabetes Care Network (DCN) provides Veterans with T2DM and elevated A1C an initial 6-week period of remote self-management education and support and medication management by a centrally located team of diabetes specialists. Participants are then comanaged by remote liaisons embedded in rural primary care facilities for the remainder of the 12-month intervention. In this pre-post intervention study, 87 Veterans enrolled in DCN from 2 different clinical sites had baseline and 12-month postenrollment A1C, systolic blood pressure, weight, and LDL cholesterol levels collected and compared using paired t tests. Results: Participants were mostly male and White with elevated baseline A1C. Participants from both sites had significant improvement in A1C over the 12-month intervention period compared to an increase in the 12 months prior to enrollment. There were also significant improvements in LDL and systolic blood pressure at 1 site, with no significant change in weight at either site. Conclusions: DCN participants had significant improvement in A1C after not meeting similar goals previously in a robust primary care setting. A technology-enabled collaborative partnership between centrally located diabetes care teams and local liaisons is a feasible approach to enhance access to diabetes specialty care for rural populations.