In 2014, Greenville Health System spent more than double on employees with A1c greater than 7.5% compared to employees with A1c less than 7.5%. Visits with a primary care physician every three months may be inadequate to meet the needs of a patient with uncontrolled diabetes. The goal of the study was to improve care for a targeted population of employees of a large health care system with type 1 or 2 diabetes. The intervention combined diabetes education, telehealth, a wireless enabled meter, and algorithms for medication adjustments.
Methods: Fifty patients were given a wireless enabled meter that links to secure portal for the healthcare professional, the patient, and a support person. The primary objective was to achieve a 15 percent reduction in patients’ average baseline A1c. Secondary objectives included improving patient’s understanding of diabetes and self-management of diabetes, increasing adherence rates of diabetes monitoring and medication utilization, decreasing rates of hypoglycemic or hyperglycemic events, and reduce overall cost of healthcare. Patients were contacted by a diabetes educator every 2-4 weeks. A medication algorithm was used to titrate insulin and non-insulin medications and initiate additional treatments.
Results: Patients were followed for an average of 27.6 months. Baseline A1c average of 10.248 was reduced to an average of 8.392 (absolute reduction of 1.856 or 18% reduction from baseline). Compared to baseline, at 12 months patients reported improvement in their self-rated diabetes knowledge, self-monitoring behaviors, and self-management behaviors. Participants increased their outpatient visits with primary care providers and Endocrinology. Average cost for both endocrinology and PCP visits decrease from pre-enrollment to one year post enrollment.
In conclusion, by combining diabetes education, medication algorithms, and remote glucose monitoring, participants improved their knowledge of diabetes and self-care and experienced improved glycemic control.
J. Bruch: None. M.D. Stancil: None. J.M. Odom: None. B.A. Nelson: Speaker's Bureau; Self; Dexcom, Inc.. L.S. Reulbach: None. R. Russ-Sellers: None. A. Ghizzoni Burns: None. M.R. Lindholm: None. J. Dawson: None. N.A. Schwecke: None.