Glycemic Outcomes of Endocrinology Consultation for Type 2 Diabetes by Visit Modality: A Retrospective Cohort Study

OBJECTIVE: This study examined the association of consult modality (i.e., electronic consultation [e-consult], synchronous telemedicine, or in person) with 6-month HbA1c improvement to <8% (64 mmol/mol) among adults with uncontrolled type 2 diabetes. The impact of factors that affect diabetes management complexity on this association was also explored. RESEARCH DESIGN AND METHODS: This retrospective cohort study included adults with type 2 diabetes and HbA1c ≥ 8% seen for initial outpatient endocrinology consultation from 31 January 2021 to 1 April 2023 within the Veterans Health Administration. We used mixed-effects logistic regression to assess the association of consultation modality with 6-month HbA1c < 8%, adjusted for relevant patient-level variables. RESULTS: In total, 21,847 patients were included: 93.1% were men; mean age was 64 years; 54.7% were White; 5,180 received e-consults; 4,377 participated in synchronous telemedicine; and 12,290 had in-person visits. Almost half (49.5%) achieved 6-month HbA1c <8%. Compared with in-person care, patients who received e-consults (adjusted odds ratio [aOR] 0.77; 95% CI 0.71-0.83) and synchronous telemedicine (aOR 0.86; 95% CI 0.80-0.93) were less likely to have 6-month HbA1c < 8%. In sensitivity analysis, audio-only telemedicine was associated with lower odds of 6-month HbA1c < 8% (aOR 0.78; 95% CI 0.71-0.86), whereas video-based telemedicine was not (aOR 0.98; 95% CI 0.88-1.09). There were no significant differences in the associations of patient-level characteristics with glycemic outcomes across care modalities. CONCLUSIONS: e-Consult and audio-only telemedicine for initial endocrinology consultations were associated with inferior 6-month glycemic outcomes compared with in-person care among adults with uncontrolled type 2 diabetes, and video telemedicine had similar glycemic outcomes. e-Consult and audio-only telemedicine care protocols may need to incorporate additional support for patients to achieve glycemic outcomes equivalent to in-person consultation.