Objectives: Effective treatment of patients with type 2 diabetes mellitus requires a multidisciplinary approach. Our study provided telemedicine healthcare delivery, using a model of collaborative drug therapy management (CDTM) protocol incorporating medical nutrition therapy (MNT) interventions by Dietitians and Pharmacists. Methods: We conducted a retrospective chart review of patient data collected between December 2014 and December 2015. We compared five intervention groups of patients (n=12,370) receiving different levels of treatment from Pharmacists, Registered Dietitian/Nutritionist, and/or the Call Center, using Telemedicine consultation techniques over a one-year period. The control group received their supplies through the mail without any contacts with the Call Center, Pharmacists, or Dietitians. The cross-sectional data collected for A1c were analyzed using ANOVA to assess for within-group differences in A1c reduction among groups with different risk factors. Results: Roughly, 18 percent of study participants were identified as high-risk, with a serum A1c level greater than 10%. Lower A1c and low density lipoprotein (LDL) cholesterol levels were reported for patients who received at least four prescription refills over the study period, (-0.113 and -4.931, respectively). Results reveal that average A1c levels for the intervention groups were lower compared to the control group. Overall, interventions led by Dietitians and Pharmacists resulted in a higher reduction in A1c levels in the high-risk group of patients with type 2 diabetes. Conclusions: This study showed that using Telemedicine consultation, led by Dietitians and Pharmacists, resulted in a more effective intervention for patients with diabetes and resulted in a positive change of lowering plasma A1c levels and LDL cholesterol as a secondary outcome. For future study, using the same multidisciplinary intervention and telehealth format, a longitudinal data collected over a minimum of 6-months would allow for tracking of changes in A1c and LDL cholesterol in the individuals with type 2 diabetes. Keywords: Diabetes, Telemedicine, Telehealth, Pharmacist and Dietitian led intervention, A1c, LDL cholesterol
Statistics: the cost of diabetes: the staggering cost of diabetes Internet.
2.
Nathan DM. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study at 30 Years: Overview. Diabetes Care. 2013;37(1):9–16.
3.
Bryant,* W, Greenfield,* JR, Chisholm DJ, Campbell LV. Diabetes guidelines: easier to preach than to practise? Medical Journal of Australia. 2006;185(6):305–9.
4.
Housden L, Wong ST, Dawes M. Effectiveness of group medical visits for improving diabetes care: a systematic review and meta-analysis. Canadian Medical Association Journal. 2013;185(13):E635–44.
5.
Mundt MP, Agneessens F, Tuan WJ, Zakletskaia LI, Kamnetz SA, Gilchrist VJ. Primary care team communication networks, team climate, quality of care, and medical costs for patients with diabetes: A cross-sectional study. International Journal of Nursing Studies. 2016;58:1–11.
6.
Isaksson U, Hajdarevic S, Abramsson M, Stenvall J, Hörnsten Å. Diabetes empowerment and needs for self‐management support among people with type 2 diabetes in a rural inland community in northern Sweden. Scandinavian Journal of Caring Sciences. 2014;29(3):521–7.
7.
Zgibor JC, Songer TJ. External Barriers to Diabetes Care: Addressing Personal and Health Systems Issues. Diabetes Spectrum. 2001;14(1):23–8.
8.
Silva-Tinoco R, Cuatecontzi-Xochitiotzi T, De la Torre-Saldaña V, León-García E, Serna-Alvarado J, Guzmán-Olvera E, et al. Role of social and other determinants of health in the effect of a multicomponent integrated care strategy on type 2 diabetes mellitus. International Journal for Equity in Health. 2020;19(1).
9.
Davidson MB. How Our Current Medical Care System Fails People With Diabetes. Diabetes Care. 2009;32(2):370–2.
10.
Choe H, Mitrovich S, Dubay D, Hayward R, Krein S, Vijan S. Proactive case management of high-risk patients with type 2 diabetes by a clinical pharmacist: a randomized controlled trial. Am J Manag Care. 2005;253–60.
11.
Cohen LB, Taveira TH, Wu WC, Pirraglia PA. Pharmacist-led telehealth disease management program for patients with diabetes and depression. Journal of Telemedicine and Telecare. 2019;26(5):294–302.
12.
Daly A, Michael P, Johnson EQ, Harrington CC, Patrick S, Bender T. Diabetes White Paper: Defining the Delivery of Nutrition Services in Medicare Medical Nutrition Therapy vs Medicare Diabetes Self-Management Training Programs. Journal of the American Dietetic Association. 2009;109(3):528–39.
13.
Campbell RK. Role of the pharmacist in diabetes management. American Journal of Health-System Pharmacy. 2002;59(suppl_9):S18–21.
14.
Bains SS, Egede LE. Associations Between Health Literacy, Diabetes Knowledge, Self-Care Behaviors, and Glycemic Control in a Low Income Population with Type 2 Diabetes. Diabetes Technology & Therapeutics. 2011;13(3):335–41.
15.
Osborn CY, Bains SS, Egede LE. Health Literacy, Diabetes Self-Care, and Glycemic Control in Adults with Type 2 Diabetes. Diabetes Technology & Therapeutics. 2010;12(11):913–9.
16.
Nigam S. Telehealth and telemedicine: using technology to extend the reach and offset the insufficient supply of healthcare professionals. TMT. 2018;(1).
17.
Taylor AM, Bingham J, Schussel K, Axon DR, Dickman DJ, Boesen K, et al. Integrating Innovative Telehealth Solutions into an Interprofessional Team-Delivered Chronic Care Management Pilot Program. Journal of Managed Care & Specialty Pharmacy. 2018;24(8):813–8.
18.
Greenwood DA, Hankins AI, Parise CA, Spier V, Olveda J, Buss KA. A Comparison of In-person, Telephone, and Secure Messaging for Type 2 Diabetes Self-Management Support. The Diabetes Educator. 2014;40(4):516–25.
19.
Davis RM, Hitch AD, Salaam MM, Herman WH, Zimmer-Galler IE, Mayer-Davis EJ. TeleHealth Improves Diabetes Self-Management in an Underserved Community. Diabetes Care. 2010;33(8):1712–7.
20.
Henley N, Chen-Maynard D, Pablo-Bandong E. Multidisciplinary Team in Ambulatory Management of Diabetes Mellitus Using Telehealth Among a Sample of Medicaid Patients. Telehealth and Medicine Today. 2022;
Citation
Copyright
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
