12603 The Effect Of Telemedicine On Glycemic Control In Patients With Type 2 Diabetes
Authors: Bacha Dania Salih , Alkwatli Kenda , Xiao Huijun , Bena James , Rao Pratibha P R 
Published: October 2024

Disclosure: D. Salih Bacha: None. K. Alkwatli: None. H. Xiao: None. J. Bena: None. P.P. Rao: None.

Introduction: The COVID-19 pandemic accelerated the adoption of telemedicine, expanding access to healthcare services for patients and providers. However, concerns persist regarding whether patients with chronic diseases derive similar benefits compared to traditional in-person visits. In this study, we aim to compare the effectiveness of telemedicine to in-person visits in managing patients with Type 2 Diabetes (T2D). Methods: In this retrospective study, we included patients with T2D with a glycated hemoglobin (HbA1c) level &gt;8% who were seen by endocrinology providers at Cleveland Clinic from July 2020 to January 2022. Patients who had telemedicine visits only or in-person visits only for their follow-ups were selected for the telemedicine group and the in-person group, respectively. Patients who had mixed telemedicine and in-person follow-up visits and those who had an initial visit without subsequent laboratory measurements were excluded. The primary outcome was the absolute change in HbA1c levels. The secondary outcomes were the absolute change in low density lipoprotein (LDL) and urine albumin creatinine ratio (UACR). The changes in outcomes were evaluated at three intervals post-baseline: 3, 6, and 12 months. Linear mixed effect models were conducted to assess mean changes at each time point, with adjustment of baseline variable, age, and interaction between follow-up time and visit groups. To compare telemedicine with in-person visits, a one-sided non-inferiority test with a non-inferiority margin of 0.5% for HbA1c changes, and two-sided superiority tests for secondary outcomes were performed. Results: A total of 7,605 patients were identified: 6,774 patients (89.1%) in the in-person group and 831 patients (10.9%) in the telemedicine group. The percentage of females was 53% and 45%, the percentage of Whites was 61% and 65%, and the median age was 63 and 57 years in the in-person and the telemedicine groups, respectively. At baseline, HbA1C levels were similar in both groups (9.1%). Both groups showed a significant reduction in Hb1AC over all time periods tested (p&lt;0.001). Estimated mean HbA1c changes were slightly higher in the telemedicine group across all time intervals. At 3 and 6 months, telemedicine visits were non-inferior to in-person visits in the reduction of HbA1c levels (p=0.04 and p= 0.038, respectively); however, this was not the case at 12 months. Both the in-person and telemedicine groups experienced a significant reduction in LDL and UACR at each follow up visit (p&lt;0.05); however, there was no statistical difference between the two groups in the effectiveness of lowering these outcomes. Conclusion: Our study suggests that telemedicine is non-inferior to in-person visits in the short-term follow-up for glycemic control. There was no significant difference between in-person and telemedicine visits in controlling hyperlipidemia and albuminuria.

Presentation: 6/3/2024