A Soldier performs a glucose screening. A person diagnosed with diabetes is lacking insulin or is insulin resistant so that the body can’t process sugars normally. (U.S. Army photo by Sgt. Jessica A DuVernay)

ATLANTA — About 5% of the United States population has been diagnosed with type 1 diabetes, and the great majority are diagnosed before age 25. Since a diabetes diagnosis prevents enlistment in the military, relatively few veterans have the condition compared to type 2 diabetes, which affects about a fourth of VHA patients.

In many areas, therefore, specialty care for type 1 diabetes can be difficult to access, especially among veterans who live in rural areas.

A recent study in the journal Preventing Chronic Disease involved veterans with type 1 diabetes who live in rural Alabama and Georgia, noting that they face barriers to receiving specialty diabetes care because of the lack of endocrinologists in the Central Alabama Veterans’ Health Care System.1

The study team led by researchers from the Mayo Clinic in Rochester, MN, and Emory University in Atlanta, suggested, “Telemedicine is a promising solution to help increase access to needed health care. We evaluated telemedicine’s effectiveness in delivering endocrinology care from Atlanta-based endocrinologists.”

To test their theory, researchers conducted a retrospective chart review of patients who were enrolled in the Atlanta VAMC Endocrinology Telehealth Clinic from June 2014 to October 2016. Their focus was on hemoglobin A1c levels, changes in glycemic control, time savings for patients, cost savings for the VHA, appointment adherence rates, and patient satisfaction with telehealth.

Results were based on 32 patients with type 1 diabetes who received telehealth care, assuring they had guideline-accordant care for their condition.

The study found that patients trended toward a decrease in mean hemoglobin A1c and glucose variability, although they also had a nonsignificant increase in hypoglycemic episodes.

Benefits went beyond better care, however. Patients also saved 78 minutes of one-way travel time, while the VHA saved $72.94 in travel reimbursements per patient visit.

Missed appointments weren’t much of a problem, as patients adhered to 88% of scheduled telehealth appointments on average. At the same time, 100% of surveyed patients responded they would recommend telehealth to other veterans.

“Specialty diabetes care delivered via telemedicine was safe and was associated with time savings, cost savings, high appointment adherence rates, and high patient satisfaction,” study authors concluded. “Our findings support growing evidence that telemedicine is an effective alternative method of health care delivery.”

1Xu T, Pujara S, Sutton S, Rhee M. Telemedicine in the Management of Type 1 Diabetes. Prev Chronic Dis. 2018 Jan 25;15:E13. doi: 10.5888/pcd15.170168. PubMed