Leslie Eiland, MD, discusses the benefits of remote monitoring among patients with type 1 diabetes (T1D) living in rural America.
Support of a local diabetes educator is important when it comes to improving health for rural patients with type 1 diabetes, 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 81st Scientific Sessions.
Can you tell us a little bit about your work?
My name is Leslie Eiland. I'm an endocrinologist at the University of Nebraska Medical Center in Omaha, Nebraska. I am also the medical director of the endocrine telehealth program and the physician champion for telehealth at Nebraska Medicine.
How did you carry out your research on use of diabetes technologies for remote monitoring in ambulatory/rural settings?
Back in 2013, our division started our endocrine telehealth program, meaning we set up a telehealth site at a rural community hospital in central Nebraska and since then have expanded to 9 locations. Prior to COVID-19, if you wanted to do telehealth or video visits, it had to be done in a rural area, which is not that hard in Nebraska and Iowa where I practice—it's most of the geography—and it had to be done at a place of service. Patients had to travel to a rural hospital or clinic in order to see me over screen. Our clinics are anywhere from an hour-and-a-half to 8 hours from Omaha. When we started this clinic, or we started this program, and now have 9 sites, that's how we were caring for people with diabetes and other general endocrine issues for the last 8 years.
But then, with the public health emergency being declared around the time of COVID-19, that changed a lot of things in that you no longer had to have a patient in a rural area to have a telehealth visit. It could be anywhere, urban or rural. Home was recognized as a place of service. So people no longer had to travel to those visits in order for the visit to be an official visit or reimbursable. People could log in from home like many of us have been doing. There were a lot of changes. My research prior to COVID-19 has looked at type 1 diabetes (T1D) and how effective these telehealth clinics are in managing T1D.
What were the main findings of this research?
We feel that, based on our findings, for people who were seen in our clinics over the last 8 years for at least 3 visits with T1D, their glycated hemoglobin (A1Cs) have declined steadily over time. That's been independent or irrespective of whether they were previously seen by their primary care provider, a private endocrinologist, an academic endocrinologist, across the board. People's A1Cs slowly declined over time and the decline was consistent. The longer they were seen in our clinics the longer, or the greater, A1C decline they had. We think that some of that may be due to, because again, all these people were being seen at rural community hospitals, not home visits. We do think there's something important that happens there, in that they get the support of a local diabetes educator.
Almost all of our sites have a local certified diabetes educator there facilitating the visit, being available for interim education. I think the combination of the academic specialist with the local certified diabetes educator, and a certified diabetes care and education specialist who understands the more specific aspects of their local community really leads to good care for people with T1D.