Telehealth-assisted care coordination of older veterans with type 2 diabetes lowers coronary heart disease risk despite clinical inertia

Stuti Dang, Alex Sanchez, Lisset Oropesa, Bernard A. Roos, Hermes Florez

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Background: The purpose of this study was to determine the impact of a telehealth care coordination (T-Care) program on coronary heart disease (CHD) risk in older adults with type 2 diabetes (T2D). Methods: Forty-one patients with T2D, 68.7 (±8.9) years old, were enrolled in the T-Care program and followed up for 2 years. Data were collected on blood pressure (BP), lipids, and medications. CHD risk or Framingham risk score (FRS) was estimated by using the calculation for 10-year CHD risk based on the risk estimates derived from the experience of the Framingham Heart Study. Clinical inertia was defined as the lack of dose adjustment or new medication for BP or lipid management when appropriate, per standard-of-care guidelines. Results: After 2 years of T-Care intervention, significant reductions were demonstrated in FRS (23.4 ± 13.5 to 18.2 ± 10.4, P = 0.007), systolic BP (140 ± 22.7 to 128.2 ± 18.5 mm Hg, P = 0.05), and diastolic BP (74 ± 13.8 to 68.7 ± 13.9 mm Hg, P = 0.07), but not low-density lipoprotein (LDL) cholesterol (100.2 ± 30.1 to 91.2 ± 26.6 mg/dL, P = 0.7). Clinical inertia for lipids was found in 17.1% of our patients; only those without clinical inertia showed significant reduction in the LDL cholesterol component of the FRS. In contrast, clinical inertia for BP was documented in 12.2% of our patients, but reduction in the BP component of the FRS was independent of the presence of clinical inertia. Conclusion: Participation in a T-Care program may lead to significantly reduced CHD risk among older patients with T2D, despite clinical inertia.

Original languageEnglish (US)
Pages (from-to)995-1001
Number of pages7
JournalDiabetes Technology and Therapeutics
Volume12
Issue number12
DOIs
StatePublished - Dec 1 2010

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology
  • Medical Laboratory Technology

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