The rapid adoption of telehealth in managing chronic conditions like type 2 diabetes (T2D) has opened new avenues for patient care. A recent study published in JAMA Network Open highlights the limitations of telehealth, particularly in managing more complex cases of T2D. This retrospective cohort study, carried out on patients from May to October 2020, delves into the efficacy of telehealth in T2D management within an endocrinology setting. Contrary to earlier findings favoring telehealth, this research shows a mixed narrative, especially for patients with more complex diabetes care needs.
The study, which extended its follow-up period through May 2022, segmented 3,778 T2D patients into three groups: those receiving telehealth-only, in-person, or hybrid (both telehealth and in-person) care. The telehealth-only cohort, comprising younger, predominantly female and Black patients, had fewer follow-up appointments and hemoglobin A1c (HbA1c) measurements. The essence of the study’s findings is largely in the comparative analysis of glycemic control across these groups. Patients in the telehealth-only group showed no significant improvement in HbA1c levels at 12 months, contrasting with the in-person and hybrid groups, who demonstrated improvements. This discrepancy shows a gap in telehealth’s effectiveness, in patients with a baseline HbA1c of 8 percent or higher.
The study details the role of clinical complexity in managing T2D via telehealth. Patients on basal insulin therapy across all cohorts experienced worse HbA1c outcomes at 12 months. This negative trajectory was said to be significant in the telehealth group at 24 months. This finding is important as it draws attention to the challenges telehealth faces in adequately managing patients with care needs, such as those on insulin therapy or with elevated HbA1c levels. The study’s authors suggest that telemedicine, in its current form, may be insufficient for patients requiring more nuanced care. This revelation is highly relevant considering the growing reliance on telehealth amidst shortages of endocrinologists and barriers to in-person visits. While previous studies had shown the efficacy of telemedicine in improving glycemic outcomes, these often included intensive care components not typically present in routine telemedicine care. This study, therefore, brings to light the discrepancy between ideal clinical trial conditions and the real-world application of telehealth in managing complex T2D cases. The study also exposes the inherent limitations of telehealth in replicating the nuances of face-to-face interactions. Strategies like self-management education and sharing home blood glucose data, that are featured through in-person visits, are not well translated into the telehealth realm. This gap presents the need for innovative solutions, such as team-based virtual care and technological advancements for effective data sharing, to bridge the divide in care quality irrespective of the modality.
The study’s insights are particularly striking when analysed against earlier research, which suggested that telehealth maintained care quality and improved health outcomes for T2D patients during the COVID-19 pandemic. This earlier study included over 16,000 T2D patients, revealing that while in-person care quality declined during the pandemic, telehealth patients maintained similar quality outcomes as pre-pandemic levels. The contrast between these studies accentuates the complexity of telehealth efficacy in T2D care, suggesting that while telehealth can be effective in certain scenarios, it may not universally cater to the diverse needs of all T2D patients.The study’s implications are far-reaching, especially in guiding future telehealth strategies for T2D management. Identifying patient populations that can effectively manage their diabetes through telehealth and those requiring supplemental in-person care is important to distinguish, and the findings also emphasize the need for healthcare practitioners to consider individual patient complexities, such as insulin regimen and comorbidities, when prescribing telehealth. The study advocates for the refinement of telemedicine interventions, potentially incorporating components from clinical trials, such as remote monitoring and patient engagement, to enhance the quality of telemedicine care.
