CoYoT1 Clinic: Innovative Telemedicine Care Model for Young Adults with Type 1 Diabetes

Abstract

In this cross-sectional pilot study, the CoYoT1 Clinic, incorporating Web-based videoconferencing and peer interactions, was feasible and acceptable for young adults with T1D. This model may potentially increase engagement with diabetes care in the young adult population. However, further research is needed to fully evaluate the intervention.

Virtual Coaching to Enhance Diabetes Care

“…12 In another study on 18-55-year-old patients with T1D, there was a tendency toward less impact of diabetes on quality of life in the group receiving telemedicine visits (P = 0.061). 13 Additional benefits of telemedicine were increased attendance at visits, 15,16 less time spent traveling to and attending visits, 11,13,17,18 and lower cost. 11,13 In addition, the use of telemedicine versus in-person visits did not affect the therapeutic relationship between providers and adolescent patients 19 and may actually empower patients to better manage their diabetes.…”

“…11,13 In addition, the use of telemedicine versus in-person visits did not affect the therapeutic relationship between providers and adolescent patients 19 and may actually empower patients to better manage their diabetes. 13,17,18 Virtual environments, which are Internet-based real-time computer-generated three-dimensional representations of a contrived or natural environment in which patients and clinicians self-represent as avatars, 20 are also being studied as a means of providing diabetes self-management (DSM) education to a greater number of individuals. Preliminary results suggest that virtual environments may be another viable means of overcoming both a shortage of diabetes clinicians and barriers to accessing in-office care.…”

Adapting home telehealth group appointment model (CoYoT1 clinic) for a low SES, publicly insured, minority young adult population with type 1 diabetes

“…In our previous prospective non-randomized trial, which enrolled T1D YA patients from a fairly homogeneous background (age 19.8 ± 1.6 years, 83% White, 86% Non-Hispanic, and 86% privately insured), enrollees who participated in CoYoT1 Clinic had improved clinic attendance compared to control group patients (71% of CoYoT1 patients attended four clinic visits over the study year, meeting ADA recommendations, versus 0% of control group patients), and trended towards completing HbA1c tests more frequently than control patients [24,25]. Patients in the CoYoT1 intervention also reported decreased diabetes distress, increased confidence in their abilities to manage their diabetes, and improved ability to communicate with others about their diabetes, compared to the control group.…”

“…Additionally, CoYoT1 patients reported a lower level of psychosocial burden associated with diabetes care over the course of the study year, whereas patients receiving standard care reported higher levels. Cumulatively, CoYoT1 patients experienced both increased clinical engagement and psychosocial improvements, while also maintaining glycemic control [24,25].…”

“…Recently, we evaluated "Team Clinic," our group appointment model for 13-to-18-year-old patients with T1D [16,17], and found that both patients and providers reported high levels of satisfaction, and patients also experienced increased self-management behaviors, visit frequency, and social support. Building on this success, coupled with previous research demonstrating the potential for telemedicine to increase access to medical care [15,[18][19][20][21][22][23], we designed CoYoT1 Clinic (Colorado Young Adults with Type 1 Diabetes; pronounced "coyote") to provide routine diabetes care for YA with T1D using a telehealth group appointment model, delivering developmentally-appropriate clinical care to patients at home or another preferred location via web-based video conferencing [24].…”