Telemedicine/RDN Study Presented at ADA

MHIF Researcher, Gretchen Benson, RD, CDE presenting the ENHANCED study findings on Sunday, June 24 at The American Diabetes Association conference in Orlando, FL.

New Study Shows Additional Support from Telemedicine and RDN Helps Improve Risk Factor Control in Patients with Type 2 Diabetes

Minneapolis, MN – June 25, 2018 — A team-based approach to diabetes care that incorporates supplemental support from a registered dietitian nutritionist (RDN) via telemedicine can help patients with type 2 diabetes better manage their disease than those who don’t receive additional support. That’s according to findings from a recent study by The Minneapolis Heart Institute Foundation® (MHIF) that were presented June 25 at the American Diabetes Association Scientific Sessions in Orlando, Fla.

According to the results of the ENHANCED (Dietitians Helping Patients Care for Diabetes) randomized control trial, patients from two rural clinics who received phone coaching from an RDN/certified diabetes educator (CDE) in addition to care from their primary care physician experienced a statistically significant increase in meeting their optimal “D5” care goals (mean increase from 3.1 to 3.7 for the 5 goals) when compared with a control group that did not receive additional support (mean increase from 2.9 to 3.2). The five measures included in the Minnesota-based “D5” criteria include A1C under 8%, blood pressure less than 140/90 mmHg, not using tobacco, and taking statin and aspirin as appropriate. Optimal management of these D5 measures reduces the risk of heart attacks, strokes, kidney disease, and eye disease, among other health complications.

“It’s well established that primary care physicians face significant time constraints when caring for patients, and that especially in rural areas, there is a growing shortage of physicians,” said Gretchen Benson, RD, CDE, a study investigator and population health program manager for MHIF. “Our study sought to investigate the impact of a collaborative, team-based approach to diabetes care that expanded prescribing rights for dietitian diabetes educators, since achieving optimal care often requires frequent visits, medication adjustments and ongoing support for making lifestyle changes.

Throughout the 12-month study, RDNs provided those assigned to the intervention with lifestyle coaching and prescribed medications for blood pressure, cholesterol and/or blood glucose, as appropriate, to meet diabetes care goals. The intervention group had over two times the rate of taking an aspirin or statin as appropriate compared to the control group. The intervention group also increased their daily servings of both fruit and whole grains, while patients in the control group made no improvement in their daily fruit servings and actually decreased their daily whole grains.

According to Michael Miedema, MD, MPH, study principal investigator for MHIF and preventive cardiologist, “These outcomes provide evidence that expanding the role of the RDN as part of a multi-disciplinary care team may be a viable option to improve diabetes care and subsequently decrease cardiovascular disease complications.”

The study, which received primary funding from the Diabetes Care and Education (DCE) practice group of the Academy of Nutrition and Dietetics, focused on 120 patients age 40-75 with type 2 diabetes who were meeting three or fewer measures of the D5 criteria and were actively receiving primary care at Hutchinson Health in Hutchinson, Minn., or New Ulm Medical Center in New Ulm, Minn. The intervention group consisted of 61 participants who received additional outreach and telemedicine support from an RDN/CDE, along with regular care from a primary care physician (PCP). The control group consisted of 59 participants who received information about their D5 measures and were told to follow-up with their PCP if their measures were out of range at the baseline visit.

According to Benson and Miedema, MHIF and DCE were interested in studying how to improve diabetes care because of the strong connection between diabetes and cardiovascular disease. Individuals with diabetes are two to three times more likely to have a heart attack compared with people who do not have diabetes. Researchers chose New Ulm in part because MHIF and Allina Health have partnered for nearly a decade on the award-winning Hearts Beat Back®: The Heart of New Ulm Project, a population-based prevention demonstration project designed to reduce the number of heart attacks that occur in that community. Hutchinson was chosen because of their similar population and dedication to improving community health.

About the Minneapolis Heart Institute Foundation®

The Minneapolis Heart Institute Foundation (MHIF) strives to create a world without heart and vascular disease. To achieve this bold vision, it is dedicated to improving the cardiovascular health of individuals and communities through innovative research and education.

  • Scientific Innovation and Research — MHIF is a recognized research leader in the broadest range of cardiovascular medicine and population health initiatives. Each year MHIF leads more than 175 active research projects and publishes more than 175 peer-reviewed abstracts. Cardiologists, hospitals and communities around the world adopt MHIF protocols to save lives, improve care and create healthier living opportunities.
  • Education and Outreach — MHIF provides more than 10,000 hours of education each year putting its research into practice to improve outcomes. And, MHIF leads cutting-edge, transformative population health research to connect, engage, inform and empower individuals and communities to improve their health.

The Minneapolis Heart Institute Foundation’s work is funded by generous donors and sponsors and supports research initiatives of Minneapolis Heart Institute® at Abbott Northwestern Hospital. Minneapolis Heart Institute® physicians provide care for patients at Abbott Northwestern Hospital in Minneapolis and at 38 community sites across Minnesota and western Wisconsin. More information can be found at https://mplsheart.org