ArticleDiabetes care2026
Glycemic Outcomes of Endocrinology Consultation for Type 2 Diabetes by Visit Modality: A Retrospective Cohort Study.
Article in Diabetes care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThis 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
methodsThis 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.
resultsIn 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.
conclusionse-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.
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