Characteristics and longitudinal clinical outcomes of people with type 2 diabetes in regional areas accessing a tertiary telehealth service: A retrospective cohort study.

Abstract

Background: The prevalence of type 2 diabetes is rising in Australia, particularly in regional areas where access to specialist care is limited. To address this, Queensland Health (Queensland, Australia) established a telehealth network, including the Diabetes Telehealth Service (DTS) at the Princess Alexandra Hospital (PAH). The service facilitates video consultations between city-based endocrinologists and regional health centres, with local clinicians providing in-person support. While telehealth interventions have been evaluated in short-term studies, there is a need for longitudinal data to assess their long-term effectiveness in routine diabetes care. This study aims to describe the clinical characteristics and outcomes of patients with type 2 diabetes accessing care from the PAH DTS.

Methods: This retrospective cohort study used data from the PAH DTS to follow adults with type 2 diabetes over 24 months. Data was collected as part of routine care and analysed to assess changes in glycated haemoglobin (HbA1c) levels and cardiovascular risk factors. Statistical analyses included descriptive analysis, t-tests, Chi-squared tests, and fixed effects regression models.

Results: The study included 374 patients with type 2 diabetes, with a mean age of 57.9 years and a mean duration of diabetes at enrolment of 11.6 years. Baseline HbA1c levels were available for 86% of the patients, with a median HbA1c of 8.4%. The median number of appointments in the 24-month period was 2, and the average time between a person's first and last visit was 72 weeks. The average change in HbA1c between these visits was -0.8%. Statistically significant changes were also seen in cholesterol levels, weight, body mass index, and diastolic blood pressure. A linear regression analysis revealed that the greatest decrease in HbA1c levels occurred within the first 3 months since the initial clinic visit. HbA1c levels continued to decrease over the 24-month follow-up period, but the rate of decrease slowed after the first 3 months.

Conclusion: This study provides valuable insights into the telehealth model of care for tertiary diabetes in regional, rural, and remote settings. It demonstrates the effectiveness of this model in improving glycaemic control, particularly in the initial months, while also highlighting areas for improvement.