Telehealth in Rural Montana: Promoting Realistic Independent Self-Management of Diabetes

Fondly known as "the last best place," Montana ranks 44th nationally in state population, fourth in land mass, and third for lowest population density in the United States.1 The state has only three counties with a population > 50,000; 53 of its 56 counties are defined as rural.2 Primary care providers (PCPs) who provide the bulk of diabetes care in rural areas experience multiple challenges, including limited health care resources, geographic isolation, and limited access to diabetes education centers.3 Diabetes is a prevalent and costly disease with significant morbidity and mortality.4 New health care delivery strategies to increase rural patients' access to care are needed. Study inclusion criteria included 1 referral by a PCP, 2 age > 21 years, 3 type 2 diabetes diagnosis (International Classification of Diseases, Ninth Revision, codes 250.xx), 4 at least one uncontrolled vascular risk factor per ADA guidelines (AlC > 7%, blood pressure > 130/80 mmHg, and LDL cholesterol > 100 mg/dl),5 and 5 a willingness to participate.