Care for T1DM in pediatric patients is challenging and requires frequent adjustments of the insulin doses to meet the changing needs of children and young adults. Quarterly visits are recommended. 1 Patients frequently miss appointments due to work/school/extracurricular activities, associated travel expenses, lengthy visits and increasing copay fees. The frequency of clinic visits has been shown to be an independent predictor of A1C. 2 Our prospective pilot project was designed to determine the feasibility and acceptance of a yearlong intervention substituting three of four yearly recommended clinic visits with direct patient-physician videocalls via Vidyo Inc. The study was performed at a moderate sized pediatric diabetes program caring for about 750 children and young adults with T1DM as part of an academic tertiary health care center. Ten patients (7 males) aged 9-22 were recruited; all Caucasian (Table 1). Seven of 10 patients completed the study and attended 100% of quarterly appointments. Families of school age children and adolescents preferred evening hours, college students preferred late morning-early afternoon. Patients connected from a home or a dorm room. Most of the visits ran smoothly with no Internet connection issues. One family had consistent problems with videoconferencing and all visits had to be switched to phone calls. One college student forgot about the televisit and connected on her cell phone while she was a passenger in a car. Televisits lasted on average for 34 min (25-45 min), were preceded by review of the blood glucose (BG) data that were sent 100% of the time in advance (within 3-24 hours before the visit) ensured by ~3 reminders. Eight of 10 participants used an insulin pump and a half of them needed a review of the upload process. All visits were followed by a written communication (e-mailed securely) including insulin adjustments and recommendations regarding diabetes self-management. One or both parents participated in televisits with children and adolescents.

Objective: In this study, we evaluated the feasibility of monthly insulin dose adjustments for students with type 1 diabetes mellitus (T1DM) through collaboration between pediatric diabetes clinic and school nurses. Methods: We conducted a single-arm adaptive feasibility trial with 30 students from a culturally diverse low-income community. School nurses were trained to download glucose meters and insulin pumps. Outcomes measures included the rate of glucose meter/insulin pump downloads occurred versus planned. We conducted 2 focus groups (N = 23) to seek feedback from school and clinic nurses on the collaboration and used content analysis to identify common themes. Results: The rate of glucose meter/insulin pump downloads was 27%. Feasibility obstacles were grounded in lack of time for nurses and psychosocial stressors in the community. We found a trend toward better diabetes control during the school year versus summer. We identified better communication between the school and clinic nurses and ongoing diabetes education for school nurses as strengths of the pilot. Conclusion: We propose shared clinic visits, care coordination, and behavioral health support as directions for future programs. Our findings provide directions for policy development to strengthen school nurse collaboration with diabetes clinics and improve care of students with T1DM from culturally diverse low-income communities.

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