In the United States, 30.3 million people (about 1 in 10) have diabetes. Rural populations have higher rates of diabetes and lower rates of participation in diabetes self-management education and support (DSMES) programs compared to residents of urban areas.
DSMES services help people manage their diabetes by eating healthy food, being active, checking their blood sugar, taking medicines, and handling stress. DSMES improves health and reduces diabetes complications and can be cost-effective or cost-saving for employers, insurers, and the US health care system. However, 62% of rural counties don’t have a DSMES program.
In 2012, the Eastern Montana Telemedicine Network began a DSMES initiative called Promoting Realistic Individual Self-Management. This initiative included a 3-year telehealth component conducted in five rural clinics, each serving 30 to 300 patients with diabetes each year. Among participating patients, 61% reported that they were checking their blood sugar correctly after 6 months, compared to 31% before the program started. In addition, 29% said they were following an appropriate diet, compared to 8% before the program.
The CDC-led National Diabetes Prevention Program (National DPP) is a public-private partnership working to build a nationwide system to deliver an affordable, evidence-based lifestyle change program to prevent or delay type 2 diabetes. Programs can be delivered in person or online, and online programs allow more access and flexibility. About 200 programs are available online.
The National DPP lifestyle change program can also be delivered by telehealth. For example, the Montana Department of Health and Human Services worked with Holy Rosary Healthcare of Miles City to start a telehealth pilot in eight remote communities.
From 2008 to 2015, almost 900 participants were enrolled in the pilot program, 29% of them at telehealth sites that connected to “host sites” through video conferencing. An evaluation of the program showed that weight loss and participation rates were the same for telehealth and in-person participants and suggested that telehealth delivery could increase access and participation.