The Durham VA Medical Center’s www.durham.va.gov program called “Advanced Comprehensive Diabetes Care” (ACDC) is testing 50 veterans with persistently poor diabetes control in a pilot study. The veterans taking part in the study are predominately male and the majority are African-Americans with the average age to be 60.
Half of the veterans in the study received routine care without any special interventions plus they received educational materials. The other half of the veterans in the study took part in a telehealth program.
The telehealth approach required the patients to check their blood sugar before each meal and at bedtimes. They would receive a daily automated reminder call and were then instructed to use an interactive voice system to transmit their readings to the clinic.
Every two weeks, a nurse checked in with each patient by phone. During most calls, the nurse delivered an education module on checking blood sugar along with information on the warning signs of diabetes complications.
The doctors review each patient’s case every two weeks to see if any medication tweaks are needed based on data forwarded by the nurses. The study team also checks for depression and calls in a psychiatrist for an in-person evaluation as needed.
The ACDC group reported lower blood pressure after six months. They also did better than the usual care group on an overall measure of diabetes self-care, although their self-reported medication adherence remained the same as those veterans taking part in the usual care group.
Lead researcher Dr. Matthew J. Crowley reports that since the ACDC program doesn’t require staffing or equipment beyond what the VA medical centers already have in place, it can potentially be scaled up nationwide.
Crowley and his team want to do a new study across several sites that would have up to 300 patients participating. He said, “Since the VA has built a unique nationwide telemedicine infrastructure, we see major potential for implementing this approach to control diabetes at centers across the country.”