“The majority of people with type 2 diabetes (T2D) in the United States are not reaching standard cardiometabolic goals,” explains William H. Polonsky, PhD. “We know that people with T2D are more likely to succeed when they have consistent follow-up and medication management, along with ongoing support to help them make and maintain positive lifestyle changes. In recent years, there has been an emergence of virtual diabetes clinics that can support people with diabetes and their clinicians between primary care visits.”

However, primary care practices who treat people with T2D often have limited time for patient care, limited access to specialist education, and limited experience with advanced technologies, all of which have been shown to improve outcomes, Dr. Polonsky adds. “Worse yet, patients often feel abandoned and alone with their T2D, feeling confused about how best to manage it.”

For a study published in Clinical Diabetes, Dr. Polonsky and colleagues aimed to determine whether participation in a telehealth program for people with T2D would reduce diabetes-related distress, especially for those reporting moderate to severe distress upon enrollment. The 17-item Diabetes Distress Scale (DDS17) was used to assess patient-perceived difficulties and concerns related to diabetes experienced during the past month. Both baseline and follow-up questionnaires were sent to participants electronically via the program’s app.

Ongoing Individualized Lifestyle & Clinical Support Is Key

Dr. Polonsky cited two key takeaways from this study. “First, participation in the program was associated with significant reduction in diabetes distress after 6 months in people with T2D who reported clinically relevant levels of diabetes-related distress upon enrollment,” he says. “We hypothesize that the noted improvement, especially in regimen-related distress and emotional burden, may be attributed to the ongoing individualized lifestyle and clinical support provided by the care team. Second, the intermittent use of real-time CGM is an important differentiating feature of this program, compared with other telehealth programs, and the evidence suggests that this may be an important contributor to reductions in diabetes-related distress.”

The Figure, Dr. Polonsky notes, shows changes in DDS17 overall score from baseline to follow-up. “There was a significant reduction in overall diabetes distress and in all four subscales: regimen-related, emotional burden, interpersonal distress, and physician-related distress at 6 months,” he says. The Table shows change in DDS17 score by real-time CGM use/nonuse. “Diabetes-related distress improved significantly in both users and nonusers of real-time CGM,” Dr. Polonsky says. “However, real-time CGM users had an approximately two times greater reduction in overall distress, as well as in regimen-related distress and emotional burden, compared with those who did not use CGM. This suggests that this advanced diabetes technology may contribute to improved quality of life and clinical outcomes.”

The Program Is Beneficial, but Resources Are Limited

Physicians, particularly endocrinologists, should note that people with T2D who report symptoms indicative of diabetes-related distress are likely to benefit from additional diabetes education and support and access to advanced diabetes management technology, including CGM, regardless of their treatment regimen, Dr. Polonsky says. “However, this remains challenging for many primary care practices who treat the majority of people with T2D, due to limited access to diabetes educators, limited insurance coverage, and lack of awareness regarding CGM.”

Dr. Polonsky encourages future research on the topic. “I suspect that a larger, controlled, prospective study would be able to document in a clearer and comprehensive fashion that virtual clinic programs such as these have a positive impact on quality of life and clinical outcomes for people with T2D,” he says. “Furthermore, it’s important to determine which component of these programs, or which combination of these components, may be most critical in the achievement of improved quality of life and clinical outcomes. Going forward, we will likely see more research move from the traditional clinic setting to remote data collection through online portals and apps. This new paradigm aligns with changes we are seeing in healthcare delivery due to the COVID-19 pandemic.”