By Melinda Young
Executive Summary
A virtual diabetes boot camp program can help patients improve their health, even when it is difficult to attend in-person appointments.
- Providers guide patients with difficulty controlling their diabetes to the program through a unique electronic referral.
- The team helped patients monitor their blood glucose and symptoms. Team members, including an endocrinologist, a diabetes educator, and a dietitian, regularly held telemedicine visits with patients for 12 weeks.
- Patients’ medications were adjusted as often as once per week, which was faster than in-person visits.
Research shows a multidisciplinary team, including telehealth members, can create a virtual diabetes program that helps patients improve their health.1
“Managing chronic, complex patients is very important,” says Salim Saiyed, MD, vice president and chief medical informatics officer at the University of Pittsburgh Medical Center. “Especially during COVID times, a lot of these patients weren’t able to come in for their appointments. But it still was important to manage their diabetes.”
The solution was a virtual diabetes boot camp program, tailored and personalized to each patients’ needs. “We created this program with a nutritionist, endocrinologist, and dietitian to work with patients on a weekly basis with the goal of improving their diabetes,” Saiyed says. “Data show that 75% of patients who completed that program were able to improve their diabetes at the end of the program.”1
The program was entirely virtual. “That is a phenomenal achievement,” Saiyed says. “We did this program in less than three months. Pulling off a program like this in a pretty large health system, in three months, is unheard of.”
The virtual boot camp program uses a unique referral in the electronic health record, identifying it as a new clinical service. Physicians and staff were trained to use the software that provides a web-based data platform for viewing information from multiple patient devices. These are displayed together on one timeline. Researchers designed the diabetes boot camp program to be replicated by other healthcare organizations.
“Other health systems could recreate this program for diabetes or other chronic conditions that require monitoring and a lot of care,” Saiyed explains. “It requires a multidisciplinary team.”
The program started in July 2020, during the COVID-19 pandemic. “We realized we can’t have this piecemeal approach to diabetes, and we needed to put this together quickly,” he adds.
The program included a home monitoring component in which patients uploaded their blood glucose levels, which the team monitored.
“They had a weekly meeting or appointment with someone from the team,” Saiyed says. “This would have been harder to do if they had to come to the clinic every week because that takes an hour or two hours out of their day.”
The program was simple and easy. Medications were adjusted as needed, and the team gave patients feedback on their diet and the results of their data.
“We were adjusting and intervening on a weekly basis,” Saiyed says. “That probably wouldn’t happen in a clinic because it would be a month before we’d see the patient again.”
The entire team, including the endocrinologist and primary care physician, worked together seamlessly. “Patients were motivated,” Saiyed adds. “Some had self-selection bias, but they had to be referred into the program.”
Those referred were patients whose glucose levels were not well controlled and were motivated to improve their condition. “Usually, their physician would notice their diabetes was not controlled, and they’d talk to the patient and say, ‘We have this virtual boot camp program for 12 weeks. Would you like to be enrolled?’” Saiyed says. “Then, the referral is sent, and the program coordinator would make sure patients met all of the criteria before enrolling them.”
Once approved, the program coordinator sent patients an electronic enrollment process and ensured the patients knew how to use the electronic portal. They would even hold a mock visit. When a patient was ready, the 12-week program began.
The boot camp team primarily met with patients via video, but also called those who struggled with access. Dietitians and a diabetes educator would talk with patients about how to manage their illness through nutrition and weekly medication adjustments. On average, the virtual meetings lasted 20 to 30 minutes, but could go for as long as an hour.
“They’d talk with the dietitian about nutrition and the diabetes educator about working on coping mechanisms for exercising, and they’d work with the endocrinologist on the medical side,” Saiyed explains.
All appointments were scheduled electronically through the health platform in the patient portal. “We work with their schedule to make sure they know when the next appointments are, and we have appointment reminders as well,” Saiyed says.
The biggest challenge involved the patient selection process. “It was really good to have tech-savvy patients who were comfortable uploading their glucose readings and were motivated to work with the team,” Saiyed explains. “It doesn’t work when the patient needs a lot of help.”
Also, a patient population that lacks access to internet connectivity would be difficult to enroll in the virtual program. “We were a little selective on the patients enrolled in the program,” Saiyed says. “We made sure patients met the criteria to enroll in the program and enroll on the platform. If they were having trouble with the platform, we wouldn’t have them go through it.”
Patients reported high satisfaction with the program. Enrollees did not have to drive as long as an hour to see their endocrinologist. They saved gas money and time.
The only drawback involves funding. “Some payers will reimburse for physician visits, but most don’t reimburse for the diabetes educator or nutritionist visits by telehealth,” Saiyed says. “There is some self-funding, and we do have an internal grant to continue the program.”
- Saiyed S, Joshi R, Khattab S, Dhillon S. The rapid implementation of an innovative virtual diabetes boot camp program: A case study. JMIR Diabetes 2022;7:e32369.
