Diabetes Care Network is a telemedicine based collaborative care pathway with team-based approach to improve diabetes care and scale the endocrine expertise. Veterans with poorly controlled type 2 diabetes were identified from electronic database, consultation completed via E-consult, and continuity care collaborated with primary care liaisons. We studied the efficacy and sustainability of our approach in improving diabetes care over 12 months.

Methods: Means (+/-SD), frequencies and percentages were presented, and Spearman correlations were assessed. Statistical significance set at p<0.05. Cohort (n=87) was predominantly white (90.8%) males (97.7%), with a mean age 67.2 (8.9), and had an average of 3.3 co-morbid conditions, 0.7 macro and 1.3 micro-vascular complications. Significant decline in A1C occurred from baseline A1C of 10.2% (1.4), to 8.1% (0.99) at 3 months, 7.6% (0.96) at 6 months, and 7.5 % (0.86) at 12 months (all p<0.0001). Proportion of patients out of 87 who achieved A1C of <8 were 38 (43.6%), 56 (64%), and 56 (64%) and those who achieved A1C <7 were 10 (11.4%), 21(24.1%), and 23 (26.4%) at 3, 6, and 12 months respectively. Non-significant improvements were noted in Weight {229.3 lbs (48.1) to 228.4 lbs (46.9)}, LDL {89.0 mg/dl (36.4) to 79.5 mg/dl (32.5)}, systolic BP {130.5 mmHg (16.1) to 123.9 mmHg (17.5)}, and triglycerides {226.9 mg/dl (195.3) to 159.3 (97.4)}. Compared to 12 months pre-enrollment period, no difference in healthcare utilization (ER visits or admissions) was noted in study period. From baseline to completion, non-significant improvement was noted in the use of anti-platelet agents, ACE/ARB, moderate to high-intensity statins and, in the frequency of Urine micro albumin measurements, annual foot and retinal exams.

Conclusion: A paradigm shift in diabetes care delivery is urgently needed. Use of telehealth technologies based collaborative pathways can scale the endocrine expertise and help attain better care for diabetic patients.


A. Bandi: None. M.J. Larson: None. S.J. Lutz-McCain: None. A.M. Summerville: None. B.K. Lumley: Employee; Spouse/Partner; Quest Diagnostics. M.Y. Boudreaux-Kelly: None.

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