Televisits to Partially Substitute for Clinic Visits Are Feasible and Well Accepted by Tech-Savvy Patients With T1DM and Their Families: A Prospective Pilot Study

Abstract

Care for T1DM in pediatric patients is challenging and requires frequent adjustments of the insulin doses to meet the changing needs of children and young adults. Quarterly visits are recommended. 1 Patients frequently miss appointments due to work/school/extracurricular activities, associated travel expenses, lengthy visits and increasing copay fees. The frequency of clinic visits has been shown to be an independent predictor of A1C. 2 Our prospective pilot project was designed to determine the feasibility and acceptance of a yearlong intervention substituting three of four yearly recommended clinic visits with direct patient-physician videocalls via Vidyo Inc. The study was performed at a moderate sized pediatric diabetes program caring for about 750 children and young adults with T1DM as part of an academic tertiary health care center. Ten patients (7 males) aged 9-22 were recruited; all Caucasian (Table 1). Seven of 10 patients completed the study and attended 100% of quarterly appointments. Families of school age children and adolescents preferred evening hours, college students preferred late morning-early afternoon. Patients connected from a home or a dorm room. Most of the visits ran smoothly with no Internet connection issues. One family had consistent problems with videoconferencing and all visits had to be switched to phone calls. One college student forgot about the televisit and connected on her cell phone while she was a passenger in a car. Televisits lasted on average for 34 min (25-45 min), were preceded by review of the blood glucose (BG) data that were sent 100% of the time in advance (within 3-24 hours before the visit) ensured by ~3 reminders. Eight of 10 participants used an insulin pump and a half of them needed a review of the upload process. All visits were followed by a written communication (e-mailed securely) including insulin adjustments and recommendations regarding diabetes self-management. One or both parents participated in televisits with children and adolescents.

Impact of deprivation on glycaemic control in youth with type 1 diabetes in the southwestern region of France

“…Indeed, telehealth programs, specifically targeting adolescents, and young adults have been developed to help improve glycaemic control. Mobile applications and remote consultations have been used as telemedicine programs and studies have demonstrated they are well accepted by patients, are associated with an improvement in patient QoL and reduction in the health care cost 41,42 and that they are also effective as a therapeutic educational tool to enable better patient adherence to care and establish better glycaemic control 43 . Interestingly, it appears that telemedicine programs are most likely to benefit patients whose glycaemic control is already impaired 5,6 .…”

Outcomes of monthly video consultations as an add‐on to regular care for children with type 1 diabetes: A 6‐month quasi‐randomized clinical trial followed by an extension phase

“…Video consultations as a replacement for or as a supplement to outpatient appointments for children and adolescents with T1DM are increasingly being tested in studies. [2][3][4] Video consultation is still rarely offered in the German health service until recently; however, a need was already apparent for rural areas and specialist medical care. This study was financed by the Innovation Fund of the Federal Ministry of Health, because video consultation was identified as a promising form of future medical care, especially in specialist areas such as diabetology.…”

“…In contrast, a short consultation is often sufficient to jointly analyze the CGM and insulin data with the health care professional (HCP) and to initiate a change in insulin therapy, if necessary. Video consultations as a replacement for or as a supplement to outpatient appointments for children and adolescents with T1DM are increasingly being tested in studies 2‐4 . Video consultation is still rarely offered in the German health service until recently; however, a need was already apparent for rural areas and specialist medical care.…”

Paediatric diabetes care during the COVID‐19 pandemic: Lessons learned in scaling up telemedicine services

“…Many facilities, including our own, rapidly expanded telemedicine services to facilitate patient care. 1 Though telemedicine has been utilized for both paediatric and adult diabetes care before, [2][3][4][5][6][7][8][9][10][11] current endeavours by many institutions are now on an unprecedented scale. In some cases, health systems may have limited existing infrastructure due to previous state law limiting telemedicine services, such as in Pennsylvania.…”