Telemonitoring, Telemedicine and Time in Range During the Pandemic: Paradigm Change for Diabetes Risk Management in the Post-COVID Future

Abstract

People with diabetes are at greater risk for negative outcomes from COVID-19. Though this risk is multifactorial, poor glycaemic control before and during admission to hospital for COVID-19 is likely to contribute to the increased risk. The COVID-19 pandemic and restrictions on mobility and interaction can also be expected to impact on daily glucose management of people with diabetes. Telemonitoring of glucose metrics has been widely used during the pandemic in people with diabetes, including adults and children with T1D, allowing an exploration of the impact of COVID-19 inside and outside the hospital setting on glycaemic control. To date, 27 studies including 69,294 individuals with T1D have reported the effect of glycaemic control during the COVID-19 pandemic. Despite restricted access to diabetes clinics, glycaemic control has not deteriorated for 25/27 cohorts and improved in 23/27 study groups. Significantly, time in range (TIR) 70–180 mg/dL (3.9–10 mmol/L) increased across 19/27 cohorts with a median 3.3% (− 6.0% to 11.2%) change. Thirty per cent of the cohorts with TIR data reported an average clinically significant TIR improvement of 5% or more, possibly as a consequence of more accurate glucose monitoring and improved connectivity through telemedicine. Periodic consultations using telemedicine enables care of people with diabetes while limiting the need for in-person attendance at diabetes clinics. Reports that sustained hyperglycaemia and early-stage diabetic ketoacidosis may go untreated because of the lockdown and concerns about potential exposure to the risk of infection argue for wider access to glucose telemonitoring. Therefore, in this paper we have critically reviewed reports concerning use of telemonitoring in the acute hospitalized setting as well as during daily diabetes management. Furthermore, we discuss the indications and implications of adopting telemonitoring and telemedicine in the present challenging time, as well as their potential for the future.

Glycaemic control during the lockdown for COVID-19 in adults with type 1 diabetes: A meta-analysis of observational studies

“…In the pediatric age, glucose metrics during lockdown were stable as compared to the pre-lockdown period in some studies [20,36,37] and significantly improved in others [20,38]. These results also sustain the role of technology for management of diabetes that may provide even greater aid during challenging condition as it has been recently reviewed [39]. This is further supported by the results of Longo et al [13] showing that subjects with type 1 diabetes on hybrid closed loop systems with telemedicine support had a significant improvement of metrics of glucose control during the pandemic lockdown.…”

Sensor-Based Technology: Bringing Value to People with Diabetes and the Healthcare System in an Evolving World

“… 67 As noted above in the patient and HCP surveys, the pandemic has driven a switch to remote monitoring and virtual consultation, both of which can be facilitated by the FreeStyle Libre system. Numerous published studies have demonstrated that glucose control did not deteriorate while access to regular diabetes clinical services was interrupted; and, in many cases, improved across selected metrics 68 including time in range, time above range, average glucose, and GMI.…”

“…The majority of the studies indicated that flash glucose monitoring was associated with successful diabetes management during enforced social distancing. 68 These include large studies in Scotland 69 and Spain 70 demonstrating that % time in range (%TIR) 3.9–10 mmol/L (70–180 mg/dL) over this period increased, with associated improvements in glycemic variability. Smaller studies across Europe involving groups of people with T1DM using the FreeStyle Libre system have typically shown improvements in %TIR and average glucose during enforced social distancing, 71–73 including for children and adolescents; 74 , 75 and, either improvement or no change in % time in hypoglycemia over the same period, including for groups at higher risk of hypoglycaemia.…”

Effectiveness of video consultations in type 1 diabetes patients treated with insulin pumps in the outpatient clinic: protocol for a randomised controlled trial

“…A recent review of type 1 DM using telemonitoring and telemedicine during COVID-19 pandemic found that the majority of studies reported a significant improvement of time in range (TiR). 8 However, the review included both children and adults, as well as insulin pump patients and patients using multiple daily injections. 8 Moreover, the impact of ‘lock down’ might have affected the results.…”

“… 8 However, the review included both children and adults, as well as insulin pump patients and patients using multiple daily injections. 8 Moreover, the impact of ‘lock down’ might have affected the results. Only few studies have evaluated telemedicine for use in DM patients with an insulin pump.…”