148-LB: Glycemic Outcomes of Telemedicine Endocrinology Care for Adults with T2D

Current specialty care for T2D via telemedicine may not be as effective for patients with clinical complexity given barriers to delivery of key care elements, such blood glucose data sharing and involvement of multidisciplinary teams. In this retrospective cohort study, adults who had a telemedicine endocrinology visit for T2D in a large health system from May-October 2020 were followed through May 2022 to assess follow-up care modality and HbA1c change. Patients were assigned to telemedicine (n=1,182, baseline HbA1c 7.6%) and in-person (n=1,049, baseline HbA1c 7.4%) cohorts based on follow-up care modality. Multivariable regression models estimated the association of baseline insulin regimen and key comorbidities (macrovascular disease and psychological conditions) with HbA1c change over 12 months in each cohort. Patients who used multiple daily injections (MDI) had less HbA1c improvement at 12 months vs those not on insulin in both cohorts, and HbA1c change was significantly worse for patients on MDI who used only telemedicine (HbA1c change telemedicine-only 0.77% higher, 95% CI 0.59-0.94; HbA1c change in-person 0.52% higher, 0.34-0.70, p<0.001 for both; see figure). Key comorbidities were not associated with HbA1c change in either cohort. These results indicate that patients in endocrinology care who use complex insulin regimens may need additional support to achieve HbA1c improvement, especially with telemedicine.