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Dr Leslie Eiland Discusses Challenges Faced by Patients With T1D in Rural America


Leslie Eiland, MD, outlines some of the challenges of delivering optimal care to patients with type 1 diabetes (T1D) living in rural America.

Some patients with type 1 diabetes have issues that prevent them from having successful telehealth visits, said Leslie Eiland, MD, an endocrinologist at the University of Nebraska Medical Center in Omaha, Nebraska. Eiland's talk, "Use of Diabetes Technologies for Remote Monitoring in Ambulatory/Rural Settings," was presented at the American Diabetes Association's (ADA) 81st Scientific Sessions.


What are some barriers patients with type 1 diabetes (T1D) in rural America face and how can technology address these barriers?

When we started seeing more people with home visits after spring of 2020, we realized that home visits assume a lot, and some of our patients do have issues that prevent them from having successful telehealth visits. Home video visits assume that you have a decent level of tech or digital literacy. They assume that you have not only internet access, but just a stable internet connection that can perform at threshold speeds, able to have a 20-minute video visit with your provider or longer. And they assume that you have access to a connected device with a camera, which not everybody has. During my talk at ADA, I [went] over 6 specific patient examples: who the patients were, what their medical issues were, and then maybe how successful their video visit was and how we responded to some disparities that they had, like lack of internet or lack of smartphone and how we still were able to obtain their diabetes-related data during that visit.

Sometimes we had somebody who didn't have a smartphone, didn't have home internet, but did live close to one of our rural community hospitals, where we had a telehealth visit, where he was able to meet with a local CDCES [certified diabetes care and education specialist] prior to the visit who could upload his diabetes technology. In this case, he was using a CGM, a continuous glucose monitor, she could secure that, email that to me prior to the visit. That way, when we did connect through a visit at his community hospital, I was able to access all of his diabetes data, even though he did not personally have the ability to upload that and share that with me. I have some other elderly patients that live in rural areas. Over the winter, weather was horrible, COVID-19 was raging in their communities, and they had no smartphone, had no home internet. But a couple of my patients did use a Freestyle Libre flash glucose monitor and also used the receiver and I was able to walk them over the phone, through a phone visit, through the receiver, to help me generate a decent amount of glucose data and we were able to make safe changes to their regimen.

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