Virtual clinics can reduce diabetes distress

A/Prof Bill Polonsky

There is evidence that participation in a virtual diabetes program can help reduce diabetes-related distress in people with type 2 diabetes.

Associate Professor Bill Polonsky told the ADA Scientific Sessions that this was exciting data given there has been dramatic expansion in innovative diabetes care interventions into the virtual space including due to COVID-19.

A clinical psychologist and diabetes educator from the Behavioural Diabetes Institute and University of California San Diego, Associate Professor Polonsky said about a third of people with diabetes meet the criteria for diabetes-related distress.

This was particularly important as it has also been shown to be associated with diminished self-management adherence, suboptimal glycaemic control and a higher prevalence of complications.

“We see that addressing diabetes-related distress is not just important for helping our patients to feel better, but is likely to help them manage the tough job of diabetes more successfully as well. That’s why we focus on it, that’s why we think it is an important outcome,” he said.

Associate Professor Polonsky, who was the 2020 recipient of the ADA Outstanding Diabetes Educator Award, presented data comparing diabetes-related distress before and after participation in the Onduo Virtual Diabetes Clinic.

The program offers participants telehealth support inbetween primary care office visits, including lifestyle health coaches and video consultations with endocrinologists for medication management. While participants can use connected blood glucose monitoring, the program also has the ability to prescribe and ship rtCGM devices for higher-risk participants.

Associate Professor Polonsky reported on outcomes for 735 participants between August 2018 and April 2019 with baseline moderate to high diabetes distress as measured by a score of ≥2.0 on the Diabetes Distress Scale (DDS17). However only 228 participants had completed the follow-up survey.

In those participants, the study found a significant improvement in overall diabetes distress before and after enrolment in the Onduo Virtual Diabetes Clinic (from 3.0 to 2.5).

The improvement was also seen in each of the four DDS17 sub-scales: regimen-related distress, emotional burden, interpersonal distress and physician-related distress.

The largest improvement was seen in regimen-related distress (from 3.8 to 2.9) and emotional burden (from 3.4 to 3.0).

Associate Professor Polonsky said a significantly larger drop in diabetes distress, and especially in regimen-related distress, was evident in CGM users compared to BGM users.

While he said the study was not a randomised controlled trial – with CGM provided for those most in need – CGM users were apparently feeling less burdened, less confused and more in control.

“It’s something we all see clinically – the incredible value of CGM. We can make better use of this in virtual and in live settings,” he said.

He also noted that older people were more likely to benefit from the Virtual Diabetes Clinic.

“This data suggests that participation in the Onduo Virtual Diabetes Clinic was associated with significant decreases in diabetes distress among type 2 diabetes adults with elevated distress at baseline,” he concluded.

“Ongoing individualised lifestyle and clinical support provided by the Virtual Diabetes Clinic care team may be key contributors to reductions in diabetes distress.”

However prospective RCTs were required, he added.

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