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


CONCLUSIONS
Participation in a T-Care program may lead to significantly reduced CHD risk among older patients with T2D, despite clinical inertia.
Geriatric Research, Education, and Clinical Center and Research Service, Bruce W. Carter Veterans Affairs Medical Center, 1201 NW 16 Street, Miami, FL 33125, USA. stuti.dang@va.gov
Stuti
S
Dang
Alex
A
Sanchez
Lisset
L
Oropesa
Bernard A
BA
Roos
Hermes
H
Florez
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D016009:Chi-Square Distribution; D002784:Cholesterol / Q000097:blood; D003327:Coronary Disease / Q000097:blood / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000628:therapy; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017216:Telemedicine / Q000379:methods*; D014728:Veterans
D002784:Cholesterol