There is a commonly held belief that social determinants of health like income and education level may negatively impact the use of digital health programs, and that this could widen gaps in health equity.

However, a recent study from telemedicine technology and services vendor Teladoc Health found that participants were successful in controlling their diabetes through a remote diabetes monitoring program despite existing barriers to care access.

The findings revealed that although the evaluated SDOH were associated with differences across participants in their starting glucose levels, these differences disappear after one year of enrollment in the Teladoc Health diabetes management program.

Ultimately, SDOH don't appear to impact remote diabetes monitoring program utilization known to improve A1c by addressing individualized needs through education and coaching designed to address health literacy levels, the study found. In fact, the remote diabetes monitoring program may assist in addressing SDOH by providing individuals with a personalized experience to address their needs with health literacy and access to timely support, according to the study.

Healthcare IT News sat down with Dr. Teja Kompala, director of clinical products at Teladoc Health, to discuss the study and how telemedicine can help with SDOH.

Q. Please describe the remote diabetes-monitoring program/social determinants of health study you conducted. Who did you study, what was the nature of the SDOH, and what were the patients doing as part of the study?

A. Our study of people with diabetes suggests when these programs are designed with considerations of an individual’s health literacy levels, the barriers to care they may be facing and an understanding of their individualized coaching needs, SDOH do not appear to hinder high program engagement, which can lead to improved health and blood glucose measures.

The study, which was presented at the American Diabetes Association’s 82nd Scientific Session in June 2022, examines the extent to which members’ income level, education level and area deprivation index affected use of the Teladoc Health diabetes-management program.

Participants completed an electronic study survey within six weeks of study initiation, and data from the program were used to calculate outcomes of program utilization and glycemic control within 90 days of survey.

Participants were individuals aged 18-89 with either type 1 or type 2 diabetes and enrolled in the Teladoc Health diabetes management program for 12-18 months. Of the 1,308 respondents, the mean age was 51, 54% were female, 13% Black, 5% Asian, 12% Hispanic and 84% living with type 2 diabetes.

Q. What were the results you realized after one year of patients in the program? And how did SDOH affect the results?

A. Our findings revealed that although the evaluated SDOH were associated with differences across participants in their starting glucose levels, these differences disappear after one year of enrollment in the diabetes-management program.

After adjusting for participant characteristics, diabetes duration and medication usage, they did not negatively impact measures of program utilization or glycemic control.

The study revealed that a person’s income and education level do not negatively impact measures of program utilization or health outcomes when using our diabetes-management solution. In fact, our findings suggest that programs that address individualized needs can help break down barriers to care.

It’s clear, however, that we must continue to consider the individual needs of members to provide improved care and outcomes for everyone, everywhere.

Q. How does all of this address the belief held by some that some SDOH can negatively affect the use of digital health?

A. There is the notion that social determinants of health can affect access and worsen outcomes, widen disparities, and that tools like this will just make it worse, but our research and outcomes suggest otherwise.

Remote monitoring diabetes programs may assist in addressing social determinants of health by providing individuals with a personalized experience to address their needs with health literacy and access to timely support. Overall, these remote monitoring devices expand access to real-time symptom-management support, reducing unnecessary healthcare utilization and improving health outcomes.

Q. Did your findings reveal in any way that digital health, in this case the remote diabetes monitoring program, helped SDOH?

A. A huge learning for us is the impact that thoughtful design, presentation and cultural awareness can have on the success of a remote diabetes monitoring program. We designed a program so anyone, regardless of their social determinants of health, could be high program utilizers, which we know translates to clinical improvement.

Take, for example, health literacy, which is a large component of the success of this program. We saw significant differences in health literacy levels throughout this population, where some individuals didn’t understand their disease and couldn’t get their diagnosis right.

Our program is built and written in such a way, however, to support these varying levels of health literacy, that those individuals were able to achieve great health outcomes after prolonged use of the program. In addition, cellularly connected devices enable easy access, and program designs that help remove financial barriers can drive engagement.

We hope to continue research around health literacy and income level to improve program design for enhanced engagement and outcomes.

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.