Takeaway: Research shows that Advanced Comprehensive Diabetes Care (ACDC) lowers HbA1c among Veterans with refractory poor control – and that the ACDC program is ideally suited for implementation across the VA healthcare system. In 2018, ACDC was named a winner of the Diffusion of Excellence National Shark Tank Competition. In FY2020, ACDC was designated an Office of Rural Health (ORH) Rural Promising Practice, and by the end of FY2020, 230 Veterans living in rural settings had received ACDC across 7 VA healthcare sites.
Within the VA healthcare system, diabetes is the top cause of renal failure, amputation, and blindness, and is a major risk factor for cardiovascular disease. Controlling type 2 diabetes by lowering hemoglobin A1c (HbA1c) reduces both complications and costs related to diabetes (4th costliest condition in VA). Many Veterans who live in rural settings maintain an elevated HbA1c because they lack access to effective diabetes management approaches that are amenable to rural delivery.
Led by HSR&D investigator Matthew Crowley, MD, the Advanced Comprehensive Diabetes Care (ACDC) telehealth program is delivered by VA Home Telehealth (HT) nurses, and augments standard HT telemonitoring with self-management support and specialist guided medication management. With help from the Iowa City Veterans Rural Health Resource Center during FY2017-2020, Dr. Crowley and colleagues delivered ACDC to 230 Veterans with type 2 diabetes at 7 rural VA sites. Similar to results of an initial randomized trial, HbA1c fell by a significant 1.4% at 6 months in these previously refractory Veterans (equal to a greater than 50-point drop in average blood glucose). Most of this benefit persisted at 18 months following the start of intervention delivery.
Impacts
In 2018, the ACDC telehealth program was named a winner of the Diffusion of Excellence National Shark Tank Competition. In FY2020, ACDC was designated an Office of Rural Health (ORH) Rural Promising Practice, and by the end of FY2020, 230 Veterans living in rural settings had received ACDC across 7 VA healthcare sites. Investigators also have developed an easy-to-use ACDC Program Toolkit to help facilitate establishment and delivery of the program. Further, because ACDC uses only existing VA staffing and infrastructure, requires minimal training, and calls for new no hiring, any VA site can deliver the program. Thus, ACDC is ideally suited for implementation in clinical practice, including in rural areas, and is appropriate for broad dissemination across the VA healthcare system in order to address the problem of suboptimal diabetes control.
