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Cited by 27Telemedicine and Telehealth ImplementationDiabetes Management and ResearchDiabetes Treatment and Management

Patterns of telemedicine use and glycemic outcomes of endocrinology care for patients with type 2 diabetes

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Zupa, Margaret F., Vimalananda, Varsha G., Rothenberger, Scott D., Lin, Jonathan Y., Ng, Jason M., McCoy, Rozalina G., Rosland, Ann-Marie·2023·JAMA Network Open
DOI 10.1001/jamanetworkopen.2023.46305PMC PMC10701613
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Abstract

Importance: Telemedicine can increase access to endocrinology care for people with type 2 diabetes (T2D), but patterns of use and outcomes of telemedicine specialty care for adults with T2D beyond initial uptake in 2020 are not known. Objective: To evaluate patterns of telemedicine use and their association with glycemic control among adults with varying clinical complexity receiving endocrinology care for T2D. Design, Setting, and Participants: Retrospective cohort study in a single large integrated US health system. Participants were adults who had a telemedicine endocrinology visit for T2D from May to October 2020. Data were analyzed from June 2022 to October 2023. Exposure: Patients were followed up through May 2022 and assigned to telemedicine-only, in-person, or mixed care (both telemedicine and in-person) cohorts according to visit modality. Main Outcomes and Measures: Multivariable regression models were used to estimate hemoglobin A 1c (HbA 1c) change at 12 months within each cohort and the association of factors indicating clinical complexity (insulin regimen and cardiovascular and psychological comorbidities) with HbA 1c change across cohorts. Subgroup analysis was performed for patients with baseline HbA 1c of 8% or higher. Results: Of 11 498 potentially eligible patients, 3778 were included in the final cohort (81 Asian participants [2%], 300 Black participants [8%], and 3332 White participants [88%]); 1182 used telemedicine only (mean [SD] age 57.4 [12.9] years; 743 female participants [63%]), 1049 used in-person care (mean [SD] age 63.0 [12.2] years; 577 female participants [55%]), and 1547 used mixed care (mean [SD] age 60.7 [12.5] years; 881 female participants [57%]). Among telemedicine-only patients, there was no significant change in adjusted HbA 1c at 12 months (−0.06%; 95% CI, −0.26% to 0.14%; P = .55) while in-person and mixed cohorts had improvements of 0.37% (95% CI, 0.15% to 0.59%; P < .001) and 0.22% (95% CI, 0.07% to 0.38%; P = .004), respectively. Patients with a baseline HbA 1c of 8% or higher had a similar pattern of glycemic outcomes. For patients prescribed multiple daily injections vs no insulin, the 12-month estimated change in HbA 1c was 0.25% higher (95% CI, 0.02% to 0.47%; P = .03) for telemedicine vs in-person care. Comorbidities were not associated with HbA 1c change in any cohort. Conclusions and Relevance: In this cohort study of adults with T2D receiving endocrinology care, patients using telemedicine alone had inferior glycemic outcomes compared with patients who used in-person or mixed care. Additional strategies may be needed to support adults with T2D who rely on telemedicine alone to access endocrinology care, especially for those with complex treatment or elevated HbA 1c.

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  • Telemedicine, used as the sole approach to T2DM treatment, is less effective than combined use with an in-person visit or in-person visit alone for glycaemic control, especially in patients with worse metabolic control and complex treatment.

    “Telemedicine, used as the sole approach to T2DM treatment, is less effective than combined use with an in-person visit or in-person visit alone for glycaemic control, especially in those patients with a worse metabolic control and a complex treatment (36).”

    From Impact of digital health on Type 2 diabetes management: a randomised controlled trial of the ‘TreC Diabete’ platform (TELEMECHRON Study) (2025) · cites this paper as [36]

    The Results (Glycemic Outcomes by Care Modality; Subgroup Analysis: Baseline HbA1c of 8% or Higher) report less HbA1c improvement with telemedicine-only endocrinology care than with in-person or mixed follow-up, including among patients with higher baseline HbA1c. The Discussion says patients using insulin or with HbA1c above goal may not be well served by telemedicine alone. But this retrospective study establishes an association in endocrinology care, not that telemedicine is inherently less effective as a T2DM treatment approach; it also found no significant HbA1c change at 24 months across the full care-modality groups. (LLM, conf=0.86)

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Research works printed but not linked: 1

  1. [2]Doximity. State of telemedicine report, second edition. 2022. Accessed December 8, 2022. https://c8y.doxcdn.com/image/upload/Press%20Blog/Research%20Reports/Doximity-Telemedicine-Report-2022.pdf

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Authors
Zupa, M. F., Vimalananda, V. G., Rothenberger, S. D., Lin, J. Y., Ng, J. M., McCoy, R. G., & Rosland, A.-M.
Affiliations
  • University of Pittsburgh (US)
  • Boston University (US)
  • University of Maryland, Baltimore (US)
Corresponding author
Zupa, Margaret F.
ORCID
Venue
JAMA Network Open
Publisher
American Medical Association (AMA)
Published
2023-12-06
Volume
6
Issue
12
Pages
e2346305
ISSN
2574-3805 (ISSN-L)
DOI
10.1001/jamanetworkopen.2023.46305
PMC
PMC10701613
OpenAlex
W4389377198
Cited by
27
References
55
Citations by year
2026: 8 · 2025: 12 · 2024: 7
FWCI
6.29
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Network Open (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (UL1TR001857, KL2TR001856)
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092926, T32DK007052)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
telemedicine, type 2 diabetes, endocrinology care, glycemic control, HbA1c, telehealth adoption, clinical complexity, insulin regimens, cardiovascular comorbidity, psychological comorbidity, integrated health system, racial disparities, access to specialist care, health equity
MeSH terms
Adult, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Insulin, Middle Aged, Retrospective Studies, Cohort Studies, Telemedicine, Insulin, Regular, Human

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