ADA: Nurse Telehealth Intervention Lowers HbA1c Levels by 2 Points

The virtual program, which included no face-to-face contact with patients, is economically feasible and could be implemented almost anywhere, say researchers. 

Susan Lehrer (New York City Health and Hospitals), the nurse leading the project stated that, "The program was initiated when we noticed the home-care programs were not affecting HbA_1c levels." "Also, the episodes of home care are very short and getting shorter with managed care, but they can have an effect if provided for a long enough period of time. The concept of telehealth emerged as a way for us to know what was happening in the patient's home, so we could target the interventions at a time when it was most important for the patient to get the information. We thought this way we could have more of an effect on outcomes."

Lehrer explained that 126 patients from 11 New York City hospitals were enrolled in the pilot project and given a blood glucose monitor that was connected to a landline telemonitoring system. "Red" alerts were generated when a patient's daily blood glucose levels were 20% higher than the blood glucose threshold established by their primary-care physician. When this occurred, the nurses received a text or email with the information, and this prompted a call to the patient with the notification.

Diabetic patients enrolled in the program for one year experienced HbA_1c reductions of 2% on average, a finding Lehrer said is dramatic. The average baseline HbA_1c level of patients entering the program was 8.0%, so the program is effective in getting patients down to the 7.0% range recommended by the clinical guidelines. Patients considered a "success" who were discharged from the program had an average reduction of more than 3.0%.

Lehrer stated that, "The information is available to the nurses -- I get it on my Blackberry and I get in on my computer -- all through the day, and this allows us to respond to low blood sugar or high blood sugar." "It allows us to see impending situations that would require an intervention. We make a call to the patient and record everything that's happening on the website. We're then able to create reports of the readings and send them to the doctors in preparation for their appointments."

Dr. Nancy Allen from Boston College, MA, who lead the study, pointed out that the program is designed to be practical, saying the study is an example of a telehealth program that is working. Past studies testing the effectiveness of telehealth interventions in diabetes care have been flawed, she said, noting that this program is sustainable given that it is covered by the medical insurance companies. "When you think about it, in the real world, to keep effective programs going, you have to have the economic piece of the puzzle figured out."

Allen NA, Stamp K, Lehrer S, et al. Telehealth program for Medicaid patients with type 2 diabetes lowers hemoglobin A_1c. Presented at the American Diabetes Association 2012 Scientific Sessions; June 10, 2012; Philadelphia, PA. Abstract 17-LB.