This document discusses how telemedicine can help improve diabetic management. It defines telemedicine as using technology to provide remote clinical care and education. Two studies are described that found telemedicine interventions reduced HbA1c and cholesterol levels in diabetic patients. The document outlines steps to adopting telemedicine and its benefits, such as improving access to care, convenience, and cost savings through better management.

1. GET TING TO KNOW TELEMEDICINE & DIABETIC MANAGEMENT
Bhisnauth Churaman
Florida Gulf Coast University

2. WHAT IS TELEMEDICINE?
• It is the use of telecommunications and electronic information
technologies to aid and promote distant clinical patient care,
public health initiatives, and patient and professional health
education.
• The technologies of telemedicine includes: (a) The internet, (b)
videoconferencing, (c) streaming media, (d) store and forward
imaging, and (e) other wireless communications.
(Office of the National Coordinator for Health Information Technology, 2017)

3. UNFAMILIARITY WITH TELEMEDICINE
• The general concept of telemedicine is known,
however familiarity and a better understanding
of how telemedicine works is needed.
• Therefore, the goals of this presentation are to
gain a better understanding of telemedicine and
understand how it can improve diabetic
management and patient health outcomes.
• Target audience: Patients, families, and
healthcare providers.

4. OVERVIEW OF
TELEMEDICINE & DIABETES MANAGEMENT
• Problem: Diabetes and prediabetes affects over 100 million adults in the
United States (Centers for Disease Control & Prevention, 2017).
• With such prevalence clinicians must look to innovative resources to improve
diabetic management and battle this epidemic.
• The use of telemedicine is proving to be a viable option to help provide
better support and promote self-management of diabetes.
• With the use of telemedicine providers are able to offer a more collaborative
treatment plan that favors better long term patient outcomes.
(Healthcare Information and Management Systems Society, 2015)

5. HOW DOES TELEMEDICINE & DIABETES
MANAGEMENT WORK?
• Example 1:
• Study: “TeleHealth Improves Diabetes Self-Management in an Underserved Community.”
• This was a one-year randomized clinical trial that was conducted to evaluate a remote comprehensive diabetes self-management
education (DSME) intervention via Diabetes TeleCare, which was carried out by a nurse/ certified diabetic educator and dietitian in rural
South Carolina.
• Intervention: Diabetes Telecare with 13 sessions of DSME, 3 sessions were conducted in person, while the other 10 were conducted via
videoconferencing. Makeup sessions were done via telephone.
• Results: Significant decrease in hemoglobin A1c in the Diabetes TeleCare group compared with usual care, along with reduction the
low-density lipoprotein (LDL) or bad cholesterol.
(Davis et al., 2010)

6. HOW DOES TELEMEDICINE & DIABETES
MANAGEMENT WORK?
• Example 2:
• Study: “Telemedicine in the management of Type I Diabetes.”
• A retrospective chart review was conducted on 32 patients with Type 1 diabetes who were enrolled in the Atlanta VAMC Endocrinology
Telehealth Clinic (June 2014-October 2016).
• These patients/veterans lived in rural Alabama and Georgia.
• Methods: Instead of traveling to Veterans Affairs (VA) medical centers, patients would go to a local community-based outpatient clinic
for their telehealth appointment.
• Telehealth appointments last 30-60 minutes and included consultation with an Atlanta-based endocrinologist, and a telehealth
pharmacist via webcam/telehealth monitor. This appointment also included vital signs measurement.
• Results: Modest decrease in mean hemoglobin A1c, no major increase in hypoglycemic episodes, patient travel saving time of 78
minutes for one way, $72.94 of travel reimbursement savings for the VA, 88% patient adherence to telehealth appointments, and 100%
of patients recommend the use of this telehealth service.
(Xu et al., 2018)

7. TELEMEDICINE ADOPTION INTO CLINICAL PRACTICE
• Step 1: Become familiar with federal and state laws regarding the use of telemedicine (ex. Is a separate license needed to
treat patients in another state?).
• Step 2: Identify a telemedicine service model that best fits your organization/meets the needs of the patient population
(ex. Store-and-forward applications, in which your organization is the originating site used to connect patients to other
providers. The VA in Cape Coral, Florida uses this model to connect their patients to medical providers at their main
location in Bay Pines, Florida).
• Step 3: Select the appropriate technology and support needed to implement the identified telemedicine service model
(ex. Electronic stethoscope, encrypt data to protect privacy and confidentiality).
• Step 4: Determine if there are specific clinical practice guidelines that must be followed, while using telemedicine to care
for patients (ex. Various medical specialty societies have updated clinical practice guidelines specific to telemedicine).
(Rheuban, 2015)

8. BENEFITS OF USING TELEMEDICINE FOR DIABETES
MANAGEMENT
• Diabetes is a chronic condition for which virtual management allows for patients to connect more often with their health care
providers.
• Research conducted on the effects of telemedicine on blood sugar levels revealed that patients who used some form of telemedicine
had lower hemoglobin A1c (3 month blood sugar average), reduction in LDL/bad cholesterol, and a reduction in their body mass index.
• Improve access to health care especially for those living in rural areas.
• More convenient (reduction or elimination of travel time).
• Cost improvement: More frequent patient-provider communication, allows for better diabetic management, thus reducing urgent care
visits and hospitalizations.
(Goad, 2018)

9. BENEFITS

10. REFERENCES
• Centers for Disease Control & Prevention. (2017). New CDC report: More than 100 million Americans have diabetes or prediabetes. Retrieved from
https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html
• Davis, R., Hitch, A., Salaam, M., Herman, W., Zimmer-Galler, I., & Mayer-Davis, E. (2010). TeleHealth improves diabetes self-management in an underserved community:
Diabetes TeleCare. Diabetes Care, 33, 1712-1717. doi:10.2337/dc09-1919
• Goad, K. (2018). Telemedicine and diabetes care. Retrieved from http://www.diabetesforecast.org/2018/02-mar-apr/telemedicine-and-diabetes.html
• Healthcare Information and Management Systems Society. (2015). Effects of telemedicine on the management of diabetes. Retrieved from https://www.himss.org/effects-
telemedicine-management-diabetes
• Office of the National Coordinator for Health Information Technology. (2017). Telemedicine and telehealth. Retrieved from https://www.healthit.gov/topic/health-it-
initiatives/telemedicine-and-telehealth
• Rheuban, K.S. (2015). Adopting telemedicine in practice. Retrieved from https://www.stepsforward.org/modules/adopting-telemedicine
• Xu, T., Pujara, S., Sutton, S., & Rhee, M. (2018). Telemedicine in the management of Type 1 diabetes. Retrieved from https://www.cdc.gov/pcd/issues/2018/17_0168.htm