One-time phone consultation compares favourably to in-person care for T2D management

A single phone consultation performs as well as traditional face-to-face consultations in terms of helping individuals with type 2 diabetes (T2D) achieve short-term glycaemic control, as shown in a study from Singapore.

Over 4 months, HbA1c decreased by a mean of 0.16 percentage points (95 percent confidence interval [CI], −0.26 to –0.07) for individuals who underwent face-to-face consultations and by a mean of 0.11 percentage points (95 percent CI, −0.20 to –0.02) for those who opted for a phone consultation. [BMJ Open 2023;13:e063094]

Telephone consultation met the noninferiority criterion against face-to-face consultations (p<0.05), according to the investigators.

However, they acknowledged that the difference in mean change in HbA1c between the phone and face-to-face consultation groups varied by baseline diabetic control. The corresponding between-group difference in mean change in HbA1c was 0.31 percentage points among individuals with HbA1c ≥9 percent, 0.03 percentage points among those with HbA1c 8.0–8.9 percent, and 0.02 percentage points among those with HbA1c 7.0–7.9 percent.

In the HbA1c ≥9 percent subgroup, the upper limit of the one-sided 95 percent CI was more than the prespecified noninferiority margin of 0.5 percentage points, indicating that telephone consultation was inferior to face-to-face consultation for these individuals, the investigators explained.

In the other two subgroups, the upper limit of the one-sided 95 percent CI was less than the prespecified noninferiority margin, demonstrating noninferiority of telephone consultation to face-to-face consultation for individuals with a baseline HbA1c of 7.0–8.9 percent, they added.

Telehealth for the less tech savvy

“As far as we know, this is the first study in Singapore to assess telephone consultations for T2D. Telephones are ubiquitous and consultations over the telephone are more accessible and readily accepted by the elderly or those less technologically inclined as no special equipment or mobile applications are needed,” according to the investigators.

Telephone consultation is a telemedicine modality and is inherently different from video consultation, which also provides another means to substitute for in-person visits. During video consultations, the patient and physician are able to make eye contact and build better rapport than when talking over a phone.

“However, videoconferencing can be a barrier for the less technologically inclined,” the investigators said. “This study adds to the body of evidence of the utility of telephone consultations in the management of patients with diabetes.”

Rethinking delivery of care

In Singapore, using telemedicine to manage chronic diseases had not been explored previously due to the easy accessibility of primary care clinics. But the COVID-19 pandemic has prompted a surge in the adoption of telemedicine. In fact, the use of telemedicine in diabetes care has demonstrated notable benefits. This type of healthcare delivery allows for more frequent monitoring and follow-up assessments by the healthcare team and, thus, have the potential to improve glycaemic control, as evidenced by studies utilizing various technological portals such as email, videoconference, and internet web pages. [Eur J Endocrinol 2015;172:R93-101; J Med Internet Res 2020;22:e16791; PLoS Med 2016;13:e1002163; https://rb.gy/0kb17]

“T2D is a chronic disease and long-term good glycaemic control is essential to prevent the development of diabetic complications. This study has provided reassurance that in the current COVID-19 pandemic, telephone consultations can be employed as a short-term measure, in line with social distancing measures and preventing overcrowding in clinics,” according to the investigators.

“[However], telephone consultations may not be as effective for patients with HbA1c of 9.0 percent and above, [and] this should be further studied to delineate its effectiveness in poorly controlled diabetes,” they added.