Virtual Endocrinology Care Emphasizing Data-Driven Insights and Continuous Engagement and its Impact on Glycemic Outcomes in Patients with Uncontrolled Diabetes: A Real-World Retrospective Case Series (Preprint)

BACKGROUND Steady Health’s novel virtual care model incorporates continuous glucose monitoring (CGM) and a multi-disciplinary approach to timely person-centered diabetes care. OBJECTIVE This real-world retrospective case series explores the early glycemic outcomes of its patients with uncontrolled diabetes. METHODS All patients of Steady Health with an initial time in range (TIR) below 70% from their first 4 weeks of available CGM data and who had completed onboarding by February 2021 were included in this analysis. We compared the change in TIR, time below range (TBR), and average blood glucose (BG) from their first 4 weeks to their latest 4 weeks of available CGM data. Hemoglobin A1c (HbA1c) was also compared at baseline and at end of study. Patients completed a questionnaire assessing their satisfaction with Steady’s intervention. RESULTS A total of 53 patients (66% with type 1 diabetes, 83% treated with insulin) were included in this analysis. This cohort had a median (IQR) baseline TIR of 53.0 (40.9, 61.7) % and saw a median (IQR) change in TIR of +16.6 (+6.0, +27.9) % (p<0.001) over a median duration of care of 11 months, equating to nearly 4 more hours spent between 70-180 mg/dL a day. Of the 27 patients who had both baseline and follow-up HbA1c results, their median (IQR) baseline HbA1c was 8.6 (7.5, 11.4) % (70 mmol/mol), while their median (IQR) change in HbA1c (95% CI) was -1.2 (-2.6, -0.2) % (p=0.001). Importantly, these glycemic improvements were achieved with a median decrease in TBR by -0.3 (-1.1, 0.0) % (p<0.001). Forty patients (75.5%) improved TIR by ≥ 5%, and 27 (50.9%) achieved TIR ≥ 70% by the end of the study. Glycemic improvements were greatest among patients with the lowest baseline TIR and those who collaborated most intensively with Steady Health’s clinicians. Twenty-five of these patients responded to a questionnaire assessing levels of satisfaction with their care and all of them agreed that Steady Health had had a positive impact on their diabetes management. CONCLUSIONS Our findings suggest that patients with uncontrolled diabetes can achieve significant glycemic improvements working with a virtual multi-disciplinary care team that uses CGM to provide continuous clinical feedback and support.