Long-term Effects of Remote Patient Monitoring in Patients Living with Diabetes: A Retrospective Look at Participants of the Mississippi Diabetes Telehealth Network Study.

Introduction: Remote patient monitoring (RPM) has demonstrated value as a tool to aid patients in management of their chronic illness in the home. Although the Mississippi Diabetes Telehealth Network Study (MSDTNS) was successful in reducing HbgA1c levels for patients participating in RPM in the Mississippi Delta, the long-term effect of RPM on patients and how to support patients to maintain the treatment effect after discharge remain unclear. Objective: This study evaluated the long-term effectiveness of an RPM program after the intervention was withdrawn. Materials and Methods: A retrospective review of medical records of patients who completed all phases of the MSDTNS from 2014 to 2016 was performed over a period of 6 months. Data collected included HbgA1c values, demographics, and changes in social determinants of health. Results: Of the 31 participants, African Americans displayed a significant difference in HbgA1c values compared with Caucasians since the end of the MSDTNS. No significant effect of other variables, such as income, marital status, insurance coverage, or age, on the change in HbgA1c values was detected since the end of the original study. Conclusions and Relevance: This limited study implies that African Americans are at higher risk for an increase in hemoglobin A1C after the program is completed. More investigation is needed to identify ways to reduce their risk and equalize the long-term effects of RPM on clinical outcomes of patients in rural or underserved communities.

Mississippi Diabetes Telehealth Network: A Collaborative Approach to Chronic Care Management.

Background/Introduction: Ineffective management of chronic illness and lack of referral sources in underserved areas has contributed to increased health care spending and a decline in quality of life for the affected. In 2016, 15.4% of the adult population of Mississippi had diabetes. Telehealth in the home is a viable way to bring a care team to patients to assist them as they manage their illnesses. The purpose of the study was to determine the relationship between the Mississippi Diabetes Telehealth Network clinical care model and selected diabetes outcomes over time. Methods: A prospective, longitudinal cohort study design evaluated the relationship between using telehealth for chronic care management and diabetes outcomes over a 12-month period. Eligible participants were patients over 18 years old diagnosed with diabetes at a rural health clinic with an hemoglobin A1c (HbA1c) ≥7.0%. Rolling enrollment continued until the pool of eligible participants was depleted. A total of 171 were enrolled. Results: There was a significant difference in HbA1c values from baseline to 3-, 6-, 9-, and 12-month values. A significant difference was found between baseline and 12-month measures for total cholesterol, low density lipoproteins (LDL), high density lipoproteins (HDL), triglycerides, creatinine clearance, glomerular filtration rate, and potassium. There were no differences in baseline and 12-month measures for weight, blood pressure, blood urea nitrogen (BUN), and microalbumin. Discussion/Conclusions: Even with the limited sample size and design, remote patient monitoring and telehealth may be an effective tool for assisting home-based patients in the self-management of diabetes in rural areas. The maximum benefit was achieved after 3-4 months on the program and maintained over the 12-month period.