News|Articles|June 17, 2026

Telemedicine Diabetes Clinic Cuts HbA1c in Incarcerated Men

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Key Takeaways

A retrospective before-and-after evaluation in 115 men demonstrated a 1.6-point HbA1c reduction overall and a 2.6-point reduction in those with baseline HbA1c ≥9%.
Achievement of HbA1c <7% rose from 6.2% to 36.3%, with concurrent mean decreases in weight (2.7 kg) and LDL-C (9.0 mg/dL).
Medication patterns shifted toward cardiometabolic-benefit agents, with SGLT2 inhibitor use increasing to 70.4% and GLP-1 receptor agonists to 42.6%, while sulfonylureas declined.
Standard-of-care processes improved, including higher documentation rates for foot examinations and urinary microalbuminuria screening, suggesting more reliable chronic disease surveillance.
Implementation considerations include referral logistics avoided via telehealth, recent NCCHC support for clinically appropriate telehealth, and limited generalizability due to single-site, all-male, uncontrolled design.

An 18-month Illinois pilot linking prison clinicians to endocrinologists via telehealth achieved a mean HbA1c reduction of 1.6 percentage points across 115 incarcerated men with diabetes.

A telemedicine-based diabetes clinic serving incarcerated men in Illinois produced clinically significant reductions in hemoglobin A_1c (HbA_1c) and improvements in several standard-of-care measures over 18 months, according to a quality improvement study published in JAMA Network Open.

“This quality improvement study found that the DTC [diabetes telemedicine clinic] facilitated access and provided an alternative to in-person visits for delivering specialty diabetes care in a correctional facility, particularly among patients with high HbA_1c at baseline,” wrote the researchers of the study. “These findings highlight that telemedicine could be an effective and safe method of care delivery to this population.”

The DTC Team

The diabetes telemedicine clinic (DTC) was a collaborative pilot between the Illinois Department of Corrections (IDOC) and the University of Illinois Chicago (UIC) colleges of pharmacy and medicine, implemented at a medium-security male facility with approximately 1000 inmates. The study used a retrospective before-and-after design without a control group. The DTC team included a UIC endocrinologist, a clinical pharmacist, 2 nurse practitioners, and a clinic manager working alongside IDOC on-site clinical staff.

A total of 115 incarcerated men with diabetes and suboptimal glycemic control (baseline HbA_1c greater than 7%) were enrolled. Mean age was 51 years; 62.6% were Black or African American, and 93.9% had type 2 diabetes. Mean baseline body mass index was 34.0 kg/m², and 80% had comorbid hypertension.

The primary clinical outcome was HbA_1c. Mean HbA_1c fell from 9.2% at baseline to 7.6% at end of study, a reduction of 1.6 percentage points (95% CI, –2.0 to –1.3; P < .001). Among patients with baseline HbA_1c of 9% or greater, the mean reduction was 2.6 percentage points. The proportion of patients achieving HbA_1c below 7% increased from 6.2% to 36.3% (P < .001). Weight decreased by a mean of 2.7 kg, and low-density lipoprotein cholesterol fell by a mean of 9.0 mg/dL.

Glycemic Improvements Lead to Changes in Medication Use

A notable shift in the medication landscape accompanied the glycemic improvements. Sodium-glucose cotransporter 2 inhibitor use increased from 7.8% to 70.4% of patients, and glucagon-like peptide-1 receptor agonist use rose from 4.3% to 42.6%. Sulfonylurea use declined from 33.9% to 15.6%. Standard-of-care process metrics also improved: Documentation of foot examinations increased from 58.3% to 82.6% and urinary microalbuminuria from 80.0% to 94.8%.

Approximately 10% of the nearly 2 million incarcerated individuals in the US have diabetes, a population with disproportionately high rates of comorbid hypertension, kidney disease, and cardiovascular disease. Specialty referrals from correctional facilities typically require transportation, additional security staffing, and logistical coordination, barriers that telemedicine can circumvent. In a position statement adopted in December 2025, the National Commission on Correctional Health Care recommended the use of telehealth services to enhance access to and quality of care for incarcerated individuals and supported its use when clinically appropriate, with protocols that protect patient autonomy, confidentiality, and continuity of care.²

Limitations of the study include the before-and-after design without a contemporaneous control group, single-facility implementation, an all-male cohort, and the inability to isolate the effect of specific interventions such as medication changes from the overall telemedicine program.¹ The authors noted that generalizability across other correctional settings, particularly those with different staffing, infrastructure, or security levels, remains to be established.

References

Rebolledo JA, Thomas KC, Katz JB, et al. Telemedicine-based diabetes management for incarcerated individuals. JAMA Netw Open. 2026;9(6):e2618695. doi:10.1001/jamanetworkopen.2026.18695
Telehealth in correctional facilities (2025). National Commission on Correctional Health Care. Accessed June 17, 2026. https://ncchc.org/position-statements/telehealth-in-correctional-facilities-2025/