Use of Telemedicine to Improve Glycemic Management in a Skilled Nursing Facility: A Pilot Study

Abstract

The objective of this study was to evaluate the feasibility of using telemedicine to improve glycemic control (reduce episodes of hypoglycemia and severe hyperglycemia) for residents with diabetes in a skilled nursing facility. This randomized pilot study enrolled residents with diabetes (n=23; mean age, 83 years; 91% insulin-treated) and compared usual care (control; n=11) with usual care plus weekly/biweekly teleconsultations with an endocrinologist (n=12) for up to 6 months. A nurse and dietitian from the skilled nursing facility were at all televisits. Residents who were able and willing attended the televisits. Family members were also invited and occasionally were present. The endocrinologist reviewed glucose levels from point-of-care glucose meter downloads, dietary intake, medications, and medical status and recommended changes in glycemic therapy as needed. Measurements included glucose levels from point-of-care glucose meter downloads, hemoglobin A1c (A1c) levels, and a nurse satisfaction survey. Results showed that 7 of 10 insulin-treated intervention subjects had basal doses reduced (18-69%) compared with 2 of 11 control subjects (reduced 10% and 25%, respectively). There was a decrease in percentage of intervention participants with episodes of hypoglycemia (<80 mg/dL) over the previous month from baseline (42%) to end of study (22%) versus a rise in the control group (from 36% to 45%) and less hyperglycemia (>400 mg/dL) (intervention, from 33% to 22%; control, from 22% to 55%). There were no end-of-study A1c values >8.0% in the intervention group versus 44% in controls. Nursing staff at the skilled nursing facility expressed high satisfaction. Results suggest that telemedicine diabetes consultations to skilled nursing facilities can improve glycemic management.

Effectiveness of Ambulatory Telemedicine Care in Older Adults: A Systematic Review

“…The majority of the included RCTs were based in the United States (n = 6), with Europe and South Korea consisting of five and four studies, respectively, (Table 2, Appendix S3). Only four studies focused in whole or in part on rural participants . The majority of studies were funded by governmental or public agencies.…”

“…While our focus was not hospital based, only two RCTs were in nursing facilities. 53,79 Observational studies exist 80,81 ; yet, the lack of rigorous studies in older adults has considerable implications as they are sicker and require increased medical assessment and acuity, 77 ultimately leading to increased utilization. Research to evaluate TMed interventions in such facilities is needed.…”

“…Only four studies focused in whole or in part on rural participants. [52][53][54][55] The majority of studies were funded by governmental or public agencies. Computers of all types (desktop, tablet, laptop) were used and included studies focused on effectiveness and participant perception of TMed usage.…”

Management of Diabetes in the Elderly

“…80,81 In addition, we have shown in a pilot study in a long-term care facility that review of glucose values and medications by an endocrinologist using telemedicine has the potential to improve glycemia, including reduction of hypoglycemia. 82 Additional investigation in this area is needed.…”

Tele-diabetology to Screen for Diabetes and Associated Complications in Rural India

“…In addition, teleconsultation for diabetes is also now being used worldwide. [21][22][23] Tele-diabetology may be beneficial in improving access, care, and outcome in diabetic patients. In Native Hawaiian and Alaskan population, 24 the use of telemedicine in chronic disease management such as diabetes, was found to have potential to improve patient care in remote indigenous populations and may supplement patient-provider relationships.…”