Diabetes-Related Stress and A1C Improved with Visits to Virtual Diabetes Clinic
Presenters: William H. Polonsky, PhD, and Ronald F. Dixon, MD
Participation in a virtual diabetes clinic that incorporates a telehealth program to support people with type 2 diabetes mellitus (T2DM) leads to a reduction in diabetes-related distress and an improvement in hemoglobin A1c (A1c) level. Users of real-time continuous glucose monitoring (rtCGM) had a significantly greater reduction in distress than nonusers.
“In total, what we think these data tell us is that ongoing individualized lifestyle and clinic support. . .may be key contributors to explaining these reductions in diabetes distress,” said William H. Polonsky, PhD, from the Behavioral Diabetes Institute of the University of California San Diego.
Individuals with diabetes often feel overwhelmed by the numerous and often complex tasks required for daily self-care regimens, leading to diabetes-related stress, and more than one third of adults with T2DM meet criteria for elevated levels of distress. “Diabetes-related stress is a critical element of diabetes-specific quality of life,” he said. “Not only is it common, it’s linked to poor self-management adherence, suboptimal glycemic control, and a higher prevalence of complications.”
The retrospective exploratory analysis evaluated the change in diabetes distress among participants of the Onduo Virtual Diabetes Clinic (VDC) who reported at least moderate distress (score ≥ 2.0) on the diabetes distress scale (DDS17) at enrollment. The VDC is a telehealth program that incorporates a health coach, mobile app, connected blood glucose meter, rtCGM devices, and the opportunity for live consultations with board-certified endocrinologists. The program is intended to support people with T2DM in the primary care setting between office visits.
Of the 735 participants who had an initial DDS17 score ≥ 2.0, 228 completed a follow-up survey at ≥ 3 months. At enrollment, survey completers had a mean age of 51.8 years, 73.2% were women, mean body mass index was 36.8 kg/m2, and their mean DDS17 overall score was 3.0. During program participation, 94.7% used a connected blood glucose meter, and 33.8% used rtCGM intermittently, with both values being significantly higher (P < .001) than the survey noncompleters. Mean follow-up was 179.4 days.
The overall DDS17 score declined from a mean of 3.0 at baseline to 2.5 at follow-up (P < .001). Significant reductions in stress were recorded for each of the DDS17 subscales: regimen-related distress (P < .001), emotional distress (P < .001), interpersonal distress (P = .002), and physician-related distress (P = .006).
Greater reductions in the overall DDS17 score (–0.7 vs. –0.4; P = .012) and regimen-related distress (–1.3 vs. –0.7; P < .001) were reported by the 77 participants who were prescribed and used intermittent rtCGM compared with the 171 nonusers.
On multivariate linear regression, the DDS17 score (P < .001), older age (P = .013), and rtCGM use (P = .048) were significant predictors of improvement in DDS17.
Participation in the VDC for 6 months was also associated with significant improvement in A1c in all participants not meeting the American Diabetes Association treatment target, with greater improvement in those with intermittent rtCGM use, reported Ronald F. Dixon, MD, president and CEO of the Onduo Physicians Group PC.
Included in this analysis were 213 rtCGM users and 399 nonusers who participated in the VDC. Baseline A1c level was 7.8%, 33.0% were on insulin, and 23.5% were taking a sulfonylurea. After a mean follow-up of 6.1 months, A1c decreased significantly in CGM and non-CGM groups by 0.9% and 0.4%, respectively (both P < .001). When stratified by CGM use, among participants with baseline A1c > 9.0%, the change in A1c was –3.3% in the rtCGM users versus 1.7% in the nonusers (P < .001). The difference in the change in A1c level between users and nonusers of rtCGM was also significant for baseline A1c of 8.0% to 9.0% (P = .004) and baseline A1c of 7.0% to < 8.0% (P = .023). There was no significant difference in the change in those with baseline A1c < 7.0%.
Links to abstracts: Change in A1C with and without Intermittent Use of CGM in Adults with Type 2 Diabetes Participating in the Onduo Virtual Diabetes Clinic and Participation in a Virtual Diabetes Clinic and Reduced Diabetes-Related Distress in Individuals with Type 2 Diabetes
William H. Polonsky, PhD, disclosed advisory panel fees from Intarcia Therapeutics and Roche Diabetes Care; and consultant fees from Abbott, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk Inc., Onduo, Sanofi US, and Xeris Pharmaceuticals, Inc. Ronald F. Dixon, MD, is president and CEO of Onduo Physicians Group PC.