How the first endocrinology visit is delivered may affect short-term glycemic outcomes in adults with type 2 diabetes mellitus (T2DM). In a retrospective cohort study published in Diabetes Care, video telemedicine achieved 6-month glycated hemoglobin (HbA1c) outcomes comparable to in-person care, while electronic consultation (e-consult) and audio-only visits were associated with lower target attainment.

The study included 21,847 adults with T2DM and HbA1c ≥8% who received an initial outpatient endocrinology consultation within the Veterans Health Administration between January 31, 2021, and April 1, 2023. Mean age was 64 years, 93.1% were men, and 54.7% were White. Of the cohort, 5,180 received e-consults, 4,377 had synchronous telemedicine visits, and 12,290 attended in-person visits.

Overall, 49.5% achieved HbA1c <8% at 6 months. After adjustment for patient-level factors, e-consults were associated with lower odds of reaching target versus in-person care (adjusted odds ratio [aOR] 0.77; 95% confidence interval [CI] 0.71-0.83). Synchronous telemedicine was also associated with lower odds overall (aOR 0.86; 95% CI 0.80-0.93).

Sensitivity analyses showed important differences by telemedicine format. Audio-only visits were associated with lower odds of HbA1c target attainment (aOR 0.78; 95% CI 0.71-0.86), whereas video-based visits showed outcomes similar to in-person care (aOR 0.98; 95% CI 0.88-1.09). Associations between patient characteristics and glycemic outcomes did not significantly differ across modalities.

The findings suggest that video telemedicine had glycemic outcomes similar to in-person care for initial endocrinology consultations. In contrast, e-consult and audio-only telemedicine were associated with lower 6-month glycemic target attainment and may require additional support to achieve outcomes comparable with in-person visits.