Clinical Outcomes of Remote Training for Advanced Diabetes Technologies During the COVID-19 Pandemic

Abstract

New technologies for managing type 1 diabetes (T1D) offer health care providers (HCPs) a means to minimize face-toface visits and, consequently, COVID-19 exposure and missed time from work and school. 1 To align with COVID-19 pandemic restrictions, a remote training program was implemented in March 2020 at the Federico II University Hospital diabetes center, to onboard T1D patients to a hybrid closed-loop system (MiniMed 670G). The training program was performed by a Medtronic Training Therapy Specialist along with a diabetologist and a registered dietitian conducting a remote nutritional educational course. 2 Technical training was delivered in three steps: (1) Pump and Continuous Glucose Monitoring (CGM) components of the system, (2) Sensor Augmented Pump (SAP) function (Manual Mode), and (3) hybrid closed-loop Auto-mode function. Two-to-four remote individual training sessions (median duration 60 minutes, range 50-90 minutes) were completed using the Zoom video-conferencing platform. Follow-up remote visits with the diabetes team were scheduled one week, one month, and every second month after Auto-mode initiation.In the remote trained patients, we evaluated the changes in CGM metrics 3 between before training and one month after initiation of Auto-mode. These changes were compared with those observed in patients trained face-to-face. Participants signed an informed consent for the treatment of their data.One-month follow-up after Auto-mode initiation was available for 16 patients attending remote training and 28 trained face-to-face (44 and 46% men, age 42 ± 14 and 39 ± 11 years, duration of diabetes 25 ± 12 and 23 ± 9 years, respectively). Time in range (TIR) significantly improved by shifting to Auto-mode to a mean value >70% in both groups. Accordingly, statistically significant decreases in Glucose Management Indicator (GMI) and time above range (TAR > 180 mg/dL)