Monitoring Diabetes Remotely Transforms Lives in Rural South Carolina
Virtual Care Breaks Down Barriers to Care By Connecting Providers With Patients
There wasn’t much in Pineville, South Carolina, when Darlene Fludd was growing up. Even the nearest grocery store was a town away. But the farming community in Berkeley County had something others lacked: a health clinic.
Rural areas have long confronted steep barriers to care. Hospitals, urgent clinics, and specialists aren’t around the corner like they are in cities. The challenge of securing transportation, time off work, and childcare makes medical appointments a luxury for too many people.
The reason Pineville had a clinic was because of the tireless efforts of Maude Callen, a public health trailblazer and one of the state’s first professionally trained nurse midwives. She built the clinic with donations that poured in after she appeared in the seminal LIFE magazine photo essay “Nurse Midwife” in 1951. Callen spent the next two decades caring for people the rest of the world had overlooked.
Fludd remembers Callen and the nurses who administered vaccinations at her school — the caregivers who traveled so that community members didn’t have to. “Seeing them take care of people made me want to do the same,” she said.
So she did.
Today, Fludd is a family nurse practitioner and diabetes care and education specialist at Clemson Rural Health. She uses her expertise to serve rural communities like Pineville, following in Callen’s footsteps. But as Fludd answers the call each day, she breaks down barriers in ways never before possible, thanks to advances in remote patient monitoring and virtual care.
Through Carium’s innovative virtual care platform, Fludd and her colleagues transform lives. There was the mother who entered her third pregnancy with dangerously high sugar levels. Then came the patient with chronic kidney disease. And of course, the woman seeking diabetes support who walked into Clemson Rural Health’s new clinic in Orangeburg County.
They all faced considerable risks — and now they’re all on the path to healthy, happy lives.
Connecting Rural Communities to Virtual Care
Clemson Rural Health delivers transformative care to underserved communities across South Carolina. The organization aims to reduce premature mortality and preventable hospitalizations by promoting healthy behaviors that improve quality of life.
As part of this mission, Clemson Rural Health runs a program that cares for prediabetic and diabetic women, as well as a targeted initiative that supports pregnant women with diabetes. Care teams serve counties with among the highest levels of diabetes prevalence and mortality in the state.
“We knew that diabetes was something that we were going to have to tackle in an innovative and intentional way,” Dianna Colvin, Clemson Rural Health’s communications director, said.
To reach people where they are, nurse practitioners crisscross the area in mobile health units — converted trucks with built-in exam rooms and labs. But for some patients, even making it to the locations where the mobile health units park can be challenging.
So, Clemson Rural Health partnered with Carium through Palmetto Care Connections, a telehealth network that assists health care providers in connecting rural and underserved South Carolinians to quality services through broadband, technology and telehealth programs.
With Carium, they were able to quickly launch an end-to-end virtual care platform that connects women with healthcare teams.
The digital platform combines remote patient monitoring and communication capabilities on a single dashboard. Patients use the app to record their biometric data and connect with their specialists. Care teams log on from the other side to consult results, host video sessions, and share educational materials.
“We’re not here to tell people what they need,” Colvin said. “We’re here to empower women to take control of their health.”
Meeting Rural Patients’ Needs
Fludd has seen diabetes’ devastating impact in South Carolina.
Before joining Clemson Rural Health, Fludd often cared for truck and school bus drivers who needed medical exams for their employment. But time and again, she couldn’t pass the drivers for work. Their high sugar levels demanded insulin treatments that barred them from driving professionally because of concerns over their vision and the risk of passing out while behind the wheel, Fludd explained. Even worse, many of them didn’t know how to manage their condition effectively.
Fludd fixed that.
She began teaching her patients how to take control of their sugar levels to protect their health and livelihood. She brought that same mission to Clemson Rural Health, working out of the clinic in Orangeburg County. But instead of patients coming to see her, she often connects with them through the virtual care platform.
Fludd starts by checking the biometric data that her patients log through the Carium app using remote monitoring devices such as glucose and blood pressure sensors. She refers to the charts on her weekly check-in calls, walking patients through the numbers and explaining what they mean for their health. Depending on the data, Fludd may discuss treatment plans or lifestyle changes. And she can even send them educational materials directly through the app.
The data in each patient’s dashboard enables Fludd to make evidence-based decisions rather than reacting to a single, in-office measurement. Better yet, she can personalize treatment in ways once unimaginable.
Take the patient whose sugar levels always spiked around the same time every morning. After noticing the trend, Fludd called the woman, who described her daily routine. The trigger turned out to be a hazelnut creamer packed with sugar. “I think she used more hazelnut creamer than coffee,” Fludd said. The patient switched to a healthier alternative.
The virtual care platform nurtures one-to-one connections and a whole-team approach. Fludd’s specialist colleagues, like dieticians, also connect with patients through the app. Patients and their caregivers, meanwhile, can share biometric data with external providers.
Clemson Rural Health even provides some women with smart tablets loaded with the Carium app and prepaid data. That means financial constraints and insufficient internet access don’t block anyone from receiving the care they need.
Taken together, the technology is driving a growing and increasingly personalized healthcare transformation in rural South Carolina.
“It’s working,” Fludd said. “We’re helping a lot of people.”
Statewide Potential Grows With Virtual Care in Rural Homes
Less than a year has passed since Clemson Rural Health launched its targeted diabetes program with help from Carium and opened the new clinic in Orangeburg County. But the early outcomes are already inspiring.
The diabetes program has reached 39 women, while the intervention for high-risk pregnancies has enrolled 53 women and guided 17 healthy births.
One participant was a 21-year-old mother of two who contacted a nurse practitioner at Clemson Rural Health the moment she thought she was pregnant again. She struggled to manage her Type 1 diabetes during her second pregnancy and entered her third pregnancy with high blood sugar. But thanks to continuous monitoring, streamlined engagement through virtual care, and her supportive healthcare team, she drastically reduced her levels in a few months.
Fludd has seen many patients reduce their blood sugar from dangerous to healthy levels, but one stands out. A woman with chronic kidney disease overhauled her diet and took control of her diabetes in just a few months. Even though her blood sugars are now in a healthy range, she wants to stay in the program.
“Seeing that kind of transition is exciting for us,” Colvin said. “That's why we opened up our clinic and launched the virtual care platform. And that's why we're working so hard to keep them going.”
Colvin hopes stellar early results prove to local lawmakers, health systems, and insurers that the program deserves greater investment. “I don’t think anybody else in the state is doing this on this level and to this magnitude,” she said. “Hopefully, we’ll be able to replicate it around the state.”
“I don’t think anybody else in the state is doing this on this level and to this magnitude,” Dianna Colvin, Clemson Rural Health’s communications director, said. “Hopefully, we’ll be able to replicate it around the state.”
And people are taking notice.
A woman recently walked into the Orangeburg clinic looking for help managing her diabetes. A friend had recommended the clinic’s program. Now, the woman is about to connect to the virtual care platform.
When she does, she’ll become the latest rural South Carolina resident to see just how powerful life-changing care can be when it’s only a click away.
Learn more about how Clemson Rural Health is further reducing barriers posed by social determinants of health by meeting patients where they are. Don't miss ‘Take it to the people’: Inside the Rise of Virtual Care in Rural South Carolina.
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