Margaret Zupa, MD, MS, Receives NIH K Award for Research into Improving Quality of Telemedicine Care for Patients with Complex Type 2 Diabetes

Margaret Zupa, MD, MS, assistant professor of Medicine in the UPMC Division of Endocrinology and Metabolism was awarded a 2024 NIH K23 grant to support her research into improving the quality of care delivered through telemedicine in patients with complex type 2 diabetes.

Dr. Zupa joined the division in 2020 after completing her internal medicine residency, followed by her endocrinology fellowship at UPMC. Dr. Zupa also earned a Master of Science degree from the University of Pittsburgh Institute on Clinical Research Education in 2021.

Dr. Zupa's primary research focus includes ways to improve health care delivery for adults with type 2 diabetes at high risk of complications. Her current work, which forms the basis of her NIH K Award involves examining the quality of diabetes care provided through telemedicine for adults with complex type 2 diabetes who have elevated HbA1c. Additionally, Dr. Zupa’s work has focused on the involvement of family and health supporters in the care of adults with type 2 diabetes and delivery of diabetes self-management education and support to patients at high risk of diabetes complications.

“We’ve seen the adoption and use of telemedicine dramatically increase during the last four years, with significant benefits for patients, providers, and health care systems. This tool can help level the playing field in terms of access to specialized care, particularly for specialties like endocrinology in which there aren’t enough providers to meet the increased need for our services. The same is true for patients living in geographically challenged areas of the country, for certain under-resourced patient populations, and others,” says Dr. Zupa.

“But telemedicine is not a cure-all, and as we’re seeing right now, the models and application of it for patients with complex type 2 diabetes may not be on par with the standard in-person delivery model of care. My research is designed to figure out why that’s the case and how we can build a better model of telemedicine care for complex type 2 diabetes that improves quality of care and long-term outcomes.”

Challenges in Complex Type 2 Diabetes (T2D) Management

Complex T2D management demands a multifaceted approach, incorporating regular monitoring, medication adjustments, and comprehensive diabetes self-management education. The nuances of managing this condition require a level of interaction, data sharing, and team-based care that present new challenges to consistently implement outside of traditional, in-person health care settings. Certain components of high-quality diabetes care, such as effective diabetes self-management education and seamless sharing of home blood glucose data, can be effectively delivered via telemedicine but require new approaches compared to in-person care delivery models. These challenges are not just logistical but also can impact the quality of care delivered.

“As endocrinologists, we have a distinct opportunity to leverage our specialized knowledge in diabetes management. While the majority of type 2 diabetes patients are managed in primary care, prior research indicates that those who receive care from endocrinologists may achieve better outcomes and be more likely to meet quality measures. This can be especially important for adults with type 2 diabetes who have more complex disease,” says Dr. Zupa. “Given the rapid development of new medications and technologies in diabetes care, like telemedicine, there is a significant opportunity to optimize the use of these tools for patient care.”

K Award Research Project Details and Objectives

Health care tools and technologies like telemedicine have proven to be effective for individuals who face barriers to in-person care, because of factors like geographic isolation, limited mobility, lack of transportation, substandard or a lack of reliable internet access, and other socio-economic impediments. However, the increased adoption of modalities like virtual care or telemedicine presents specific challenges for patients with complex T2D who depend on multiple daily insulin injections and likely have several comorbidities. These complexities can make effective patient management via telemedicine more difficult and less efficacious.

Dr. Zupa’s K Award is focused on designing an improved telemedicine model for complex type 2 diabetes patients who are not meeting treatment goals (those who have HbA1C levels above 8%). Her project will attempt to refine how high-quality endocrinology care can be delivered through telemedicine to this patient population who is at risk for significant negative health consequences of diabetes and faces barriers to accessing in-person care.

Dr. Zupa’s research includes a comprehensive assessment aimed at identifying the existing gaps in telemedicine care for adults with T2D. This involves collecting data through analysis of electronic medical record data, as well as surveys and interviews with health care providers and patients with type 2 diabetes.

Based on the insights learned from this work, Dr. Zupa will develop a care protocol designed to overcome the identified barriers in telemedicine care and improve the effectiveness of the approach. Her protocol will attempt to leverage the potential of telemedicine to consistently deliver essential elements of diabetes management, such as self-management education and consistent data sharing of blood glucose levels to facilitate timely treatment adjustments. The feasibility of this framework will be tested against standard telemedicine practices in real-life settings to evaluate its impact on care delivery and patient and clinician experiences.

“My research aims to develop a comprehensive telemedicine care protocol for complex type 2 diabetes, grounded in both quantitative outcomes data and insights from clinicians and patients,” says Dr. Zupa. “The pilot protocol designed will detail preparations for visits, support during consultations, and follow-up actions to ensure high-quality diabetes care is consistently delivered. We’re trying to establish a model that not only matches but potentially surpasses traditional telemedicine and in-person care quality for this population, while remaining feasible and effective within the real-life constraints of primary and specialty care settings.”

Further Reading

Learn more about Dr. Zupa and her research, and the UPMC Division of Endocrinology and Metabolism.

Grant Reference

Increasing Reach of Effective Virtual Specialty Care for Adults with Diabetes Through Tailored Modalities. Project Number: 1K23DK135794.