Assessing the Feasibility of Using an in-Home, Tablet-Based Telemonitoring Care Management Program in Black (B) and Hispanic/Latino (H/L) Disparity Patients with Type 2 Diabetes Mellitus (T2DM)

Presentation Number: SAT 602
Date of Presentation: April 1st, 2017

Alyson K. Myers*1, Aditya A. Bissoonauth1, Timothy Tong2 and Renee Pekmezaris3
1Northwell Health, Manhasset, NY, 2Hofstra Northwell School of Medicine, Hempstead, NY, 3Northwell Health, Great Neck, NY

Abstract

Background: B and H/L patients have disproportionately higher rates of T2DM when compared to whites1. In addition, these disparity populations have a greater number of diabetic complications including cardiovascular disease and renal failure2. The Institute of Medicine’s (IOM) report “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care” indicates that B and H/L’s experience a 50–100% higher burden of illness and mortality from diabetes than non-H/L white Americans, and that their disease remains poorly managed3. Although previous research suggests that patients receiving telemonitoring in the general population have improved glucose control, we do not know whether this effect generalizes to B and H/L patients with diabetes4. This 3-month study will provide further insight regarding telemonitoring feasibility as compared to follow-up phone calls in adult B and H/L patients with T2DM.

Clinical Case: Both patients were randomized to the intervention arm (telemonitoring group). They were instructed to record blood glucose (BG), physical activity, and medication adherence daily. In addition, they measured their weight, blood pressure, pulse, and pulse oxygenation. Both patients also engaged in video teleconference calls from the study investigator weekly for the first month and biweekly for the remaining months. These calls assessed vital signs, glycemic control, medication side effects, diet, sleep, and physical activity.

Case 1: 66 y/o B female with history of T2DM uncontrolled (HbA1C 9.7%), hyperlipidemia (HL), and hypertension (HTN) managed with Glipizide XL 2.5mg po qdaily and Metformin 1000mg po bid. Within a 1-month period, the patient showed a significant decrease in average weekly BG levels from 203 mg/dl lowered to 111 mg/dl, weight loss from 174.6lbs to 170.2lbs, and consistent self-report of adherence to medication regimen. Additionally, this patient made adjustments to her diet, including no meals after 8pm.

Case 2: 50 y/o B male with T2DM uncontrolled (HbA1C 12.4%), HL, and HTN managed with Glimepiride 4mg po qdaily and Metformin 1000mg po bid. Within a 1-month period the patient has shown no improvement in clinical outcomes, as the patient has not adhered to submitting his self-reported data. The patient has also not had any testing strips during the first 1.5 months of the study and missed his appointment with his primary care provider. The patient also has missed two weekly calls as he has shown difficulty in scheduling calls and having his tablet with him when he travels on business.

Conclusion: Although both patients were randomized to the telemonitoring group, issues of nonadherence were still relevant, including difficulty scheduling times with patients and a lack of self-reporting. Telemonitoring within this population can improve health outcomes with T2DM patients who are motivated to make changes and improve their glycemic control.

 

Nothing to Disclose: AKM, AAB, TT, RP