ABSTRACT
STATEMENT OF PROBLEM/QUESTION: Will a telehealth initiative improve poorly controlled type 2 diabetes mellitus (DM) and unmet social determinants of health (SDOH) needs exacerbated by the COVID-19 pandemic? DESCRIPTION OF PROGRAM/INTERVENTION: Due to COVID-19, many patients with DM faced challenges accessing healthcare, as well as exacerbations of socioeconomic disparities regarding access to food, affordable housing, and safe places to exercise. To address these challenges, we adapted an existing student-faculty collaborative practice at Beth Israel Deaconess Medical Center, Boston, MA, to a telehealth platform to provide targeted DM management, and referrals to dietitians and community resource specialists. MEASURES OF SUCCESS: We assessed clinical outcomes, such as changes in hemoglobin A1c (HbA1c), LDL, and number of medication adjustments. Measured quality indicators included frequency of HbA1c, LDL, and microalbuminuria measurements, as well as prescription of cardiovascular/diabetic medications such as ACE inhibitors, statins, and aspirin within the year prior to enrollment and within 6 months after the final visit. To measure the role and intervenability of SDOH needs, we tracked the results of SDOH screens to identify key needs, as well as the number of dietitian and community resource specialist (CRS) referrals placed. FINDINGS TO DATE: Of 998 patients with non-insulin-dependent type 2 DM, 60 were enrolled in the program, of whom 42% were white and had a median BMI of 32.0 kg/m2 (IQR 28.3-36.1). Patients endorsed high motivation (8/10) and confidence (7/10) in managing their diabetes, but reported inadequate nutrition education (56.7% of cohort), as well as difficulty maintaining a healthy diet (76.7%) and exercising (78.3%). Analysis of baseline data and for those who completed the program thus far (n = 22, >6 months since last clinic visit), showed a significant decrease in mean HbA1c (mean ±SEM) from 8.72±0.15 to 8.09±0.22 (p = 0.03). LDL levels were not significantly different before and after the program, 90.3±5.4 vs 100.9±10.6 (p = 0.42). Lab draw frequency (HbA1c, LDL) and medication prescription (ACE inhibitors, statin, aspirin) and were not significantly different. Of patients who completed the program, 8 (36.4%) had their diabetes medications adjusted. 2 (9.1%) were referred to a CRS, and 2 (9.1%) were referred to a dietitian. KEY LESSONS FOR DISSEMINATION: Our ongoing study showed that the implementation of a telehealth diabetes program with SDOH screening can be an effective way to assist patients with uncontrolled diabetes. We identified significant patient needs for additional support and clinical care. Assessing socioeconomic burdens faced by patients and understanding the impact and key features of such a collaborative telehealth program can pave the way for the implementation of a similar model of care for other chronic conditions.