The relationship of a diabetes telehealth eye care program to standard eye care and change in diabetes health outcomes.

Several studies suggest that telehealth eye care programs that combine retinal imaging, education, and some care management can improve patient adherence to annual, comprehensive eye examinations and follow-up treatments. Little is known, however, about whether such programs relate to other, more distal outcomes that affect diabetic eye disease, such as blood glucose control. This paper assesses the relationship of participation in a diabetes telehealth eye care program with standard, face-to-face eye care as well as improvements in other diabetes-related health outcomes. We conducted a retrospective study using data from electronic medical records of Joslin Diabetes Center (n=13,752). The data span 2 years: baseline and follow-up. Subjects' eye care groups were no eye care, eye care outside of the clinic, standard eye care at the clinic, or participation in the Joslin Vision Network telehealth eye care program. We analyzed the relationship of participation in the telehealth eye care program at baseline to follow-up eye care groups and changes in hemoglobin A1c, low density lipoprotein levels, and systolic blood pressure. The results show that participation in the telehealth eye care program was significantly correlated with whether subjects later obtained standard eye care, improvement in hemoglobin A1c, and improvement in low density lipoprotein. Thus, telehealth eye care programs that incorporate evaluation, education, and care planning are related to use of recommended eye care and improvements in certain diabetes-related health outcomes. Such programs can address the many aspects of care necessary to reduce risk of vision loss due to diabetic retinopathy and other diabetes-related complications. Future research might test hypotheses suggested by sociological and psychological theories regarding causation between participation in a telehealth eye care program and other diabetes care.