Remote monitoring and treatment of children and adolescents with type 1 diabetes

Abstract

RATIONALE: Continuous subcutaneous insulin infusion (CSII) is an effective method for optimizing glycemic control in children with type 1 diabetes mellitus (DM1). However, the use of CSII does not always result in adequate glycemic control. Telehealth can be applied as one of the methods to improve the effectiveness of treatment.AIMS: To evaluate the use of remote medical support of children and adolescents with DM1 and its influence on glycemic control, quality of life, and incidence of acute complications of DM1.MATERIALS AND METHODS: We conducted a 24-week multi-institutional prospective open-label controlled clinical trial. 180 children and adolescents were included in this study and divided into the following categories: 1) age 8–18 years; 2) DM1 at least 1 year; 3) pump insulin therapy Medtronic Paradigm (Medtronic MiniMed, USA) at least 6 months; 4) self-monitoring of glycemia at least 4 times a day and replacement of the insulin pump infusion system at least once every 3 days; 5) inadequate glycemic control of DM1: the level of glycated hemoglobin (HbA1c) 7.5% or higher. Patients were assigned to a remote consultation group (RC; n=100) or a traditional control group (TC; n=80). All patients were trained on the basic principles of DM1 and CSII, and we measured initial HbA1c, then after 12 and 24 weeks, also registered and analyzed glycemic indicators and daily doses of insulin, evaluated and corrected the treatment. Patients or their parents in the RC group sent pump data via the Internet to the pump insulin therapy center at least once every 2 weeks at home and received treatment recommendations in response.RESULTS: The total number of patients included in the study in all institutions was 180 children at 8–18 years. Patients in both groups did not differ in age, gender, duration of DM1 and CSII, and HbA1c level. The total amount of remote consultations for all institutions was 949. The decrease in the level of HbA1c by the end of the study against the initial one was statistically significantly greater in the RC group: 1.17% compared to 0.59% in the TC group (p<0.05). The proportion of patients who reached the target level of HbA1c (<7.5%) was significantly higher in the RC group (32%) compared to the TC group (12.5%, p<0.05). During the study, the incidence of DKA and severe hypoglycemia in the RC group was statistically significantly lower.CONCLUSIONS: Remote monitoring in children with DM1 resulted in significant improvements in glycemic control (HbA1c, glycemic variability, and hypoglycemic frequency). The accumulation of evidence on the effectiveness and safety of telehealth in DM should contribute to implementing this approach in practical health care.

The effect of the COVID-19 pandemic on telemedicine in pediatric diabetes centers in Italy: Results from a longitudinal survey

“…Even before the pandemic, the increased use of technology to manage type 1 diabetes offered the possibility to remotely access data for convenient downloaded by patients [1] , [2] , [10] . However, pre-COVID-19, in most countries including Italy, the use of telemedicine in pediatric diabetes centers was largely voluntary, lacking legal traceability and proper codification to reimburse each center by the health service [6] .…”

“…The digitalization of healthcare has evolved over many years, from telemedicine and remote patient engagement to new digital approaches for diagnostics and information exchange. Already rising before the pandemic [1] , [2] , the COVID-19 outbreak in early 2020 accelerated the widespread adoption of virtual healthcare [3] , [4] , [5] .…”

Newest Diabetes-Related Technologies for Pediatric Type 1 Diabetes and Its Impact on Routine Care: a Narrative Synthesis of the Literature

“…Telephone and video calls, electronic messages and use of telemedicine platforms were used by several groups worldwide [68,70,94]; however, there is a need for training in the use of digital tools [74], and an effort to reduce discrepancy in access, even in economically developed countries [77], which includes internet speed and safety. The most important question is the impact of distance care on patients' glycemic control and, although data are still limited, there is favorable evidence for improved glycemic control, reduction of severe hypoglycemia and in the incidence of DKA [65,71]. Digital platforms and initiatives capable of increasing patients' access to induce transformation on general health care strategies, such as "Sugarsquare," "gamification apps," and "Advanced Intelligent Distant -Glucose Monitoring," appear to be promising e-health initiatives that find good acceptance in the chronic care required by T1D, especially for this new generation of pediatric and adolescents [64,[75][76][77]94].…”

“…The accumulation of evidence on the effectiveness and safety of telehealth in diabetes care should contribute to implementing this approach in practical health care [65]. Remote medical care, or telehealth, had been practiced increasingly for people with T1D with positive impact on their metabolic control [66].…”

“…Technology also allows the integration of care that goes beyond glycemic control, as demonstrated by the AID-GM (Advanced Intelligent Distant-Glucose Monitoring) webbased program for integration of blood glucose profile and other data (sleep patterns, physical activity, food intake, and other inputs), which may announce the dawn of what is called "e-Health" in diabetes care [76]. Remote monitoring in children with DM1 resulted in significant improvements in glycemic control (HbA1c, glycemic variability, and hypoglycemic frequency) [65]. However, inequalities in access to technology and eHealth even in high-income societies, with access to good and affordable health services, may happen [77].…”