Remote glucose monitoring is feasible for patients and providers using a commercially available population health platform

Abstract

ObjectiveRemote patient monitoring (RPM) holds potential to enable more individualized and effective care for patients with type 1 diabetes (T1D), but requires population analytics to focus limited clinical resources on patients most in need. We explored the feasibility of RPM from patient and provider standpoints using a commercially available data analytic platform (glooko Population Health) among a cohort of youth with T1D.Study designPatients aged 1-20 years with established T1D (≥12 months) and CGM use (≥3 months) were recruited to participate. Participants’ CGM devices were connected to the glooko app and linked to the research team’s glooko account during a one-month baseline period. This was followed by a six-month intervention period during which participants with >15% of glucose values >250 mg/dl or >5% of values <70 mg/dl each month were contacted with personalized diabetes management recommendations. Participants were surveyed about their experiences, and effects on glycemic control were estimated via change in glucose management indicator (GMI) generated from CGM data at baseline and completion. Changes in time spent within various glucose ranges were also evaluated, and all glycemic metrics were compared to a non-randomized control group via difference-in-difference regression, adjusting for baseline characteristics.ResultsRemote data-sharing was successful for 36 of 39 participants (92%). Between 33%-66% of participants merited outreach each month, and clinician outreach required a median of 10 minutes per event. RPM was reported to be helpful by 94% of participants. RPM was associated with a GMI change of -0.25% (P=0.047) for the entire cohort, and stratified analysis revealed greatest treatment effects among participants with baseline GMI of 8.0-9.4% (GMI change of -0.68%, P=0.047; 19.84% reduction in time spent >250 mg/dl, P=0.005).ConclusionsThis study demonstrates the feasibility of RPM for patients with T1D using a commercially available population health platform, and suggests that RPM with clinician-initiated outreach may be particularly beneficial for patients with suboptimal glycemic control at entry. However, larger randomized studies are needed to fully explore the glycemic impact of RPM.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04696640, identifier NCT04696640.

The Glycemia Risk Index Predicts Performance of Diabetes Self-Management Habits in Youth With Type 1 Diabetes Mellitus

“…The GRI was developed in an adult population; however, patterns of glycemia, as reflected in metrics such as hemoglobin A1c (HbA1c), are known to differ in adults versus children. 5 Studies that have examined the GRI in youth with T1D showed that GRI scores differed between treatment modalities, 6-14 so the GRI metric appears to be sensitive to changes in care when assessed as an outcome; however, it is unclear how the GRI relates to other indicators of glycemia. We aimed to examine how GRI values may relate to T1D self-management habits in youth using CGMs.…”

Correlation Between the Glycemia Risk Index and Longitudinal Hemoglobin A1c in Children and Young Adults With Type 1 Diabetes

“…Studies in youth with T1D have evaluated the impact of changes in diabetes care modalities (eg, initiation of hybrid closed-loop therapy) on youths’ GRI scores and HbA1c. 6-14 Prior research also demonstrates the prognostic significance of HbA1c for predicting risk for T1D-associated complications. 15 Therefore, positive correlations existing between an individual’s GRI score and longitudinal HbA1c measures may analogously suggest that the GRI holds predictive potential (similar to that of HbA1c) for identifying individuals who are at risk for suboptimal near- and long-term health outcomes.…”