170-LB: Do Telemedicine vs. In-Person Outpatient Type 1 Diabetes Visits Immediately Improve Glycemic Control?

Abstract

Background: Children with type 1 diabetes (T1D) require frequent outpatient evaluation to assess glucose trends, modify insulin doses, and stay up to date with screening. Continuous glucose monitoring (CGM) has become more prevalent in recent years and provides a detailed glycemic control assessment. Telemedicine is increasingly utilized in lieu of in-person visits, especially since the onset of the COVID-19 pandemic. Objective: To assess a difference in CGM profile parameters in the periods immediately before and after T1D follow-up visits and determine whether being seen by telemedicine versus in-person impacts this difference. Methods: A dual center retrospective chart review was conducted including outpatient T1D follow up visits for patients aged 5-21 years old utilizing Dexcom CGM during the 2021 calendar year. CGM profile parameters assessed were Time in Range (TIR) and Glucose Management Indicator (GMI) during the period 4-weeks leading up to each outpatient visit, compared to the 2-week and 4-week period immediately following. Results: A total of 269 outpatient visits (41.2% telemedicine) among 135 patients were included from both study sites. Mean TIR increased by 1.63 and 1.35% during the 2-week and 4-week period after each visit, respectively (p = 0.003, 0.013). Mean GMI also improved, decreasing by 0.07% and 0.06% during the 2-week and 4-week period after each visit, respectively (p = 0.003, 0.021). These changes in TIR and GMI were not statistically different between telemedicine versus in-person visits (p = 0.40, 0.29). Conclusions: This study detected a small, but statistically significant improvement in CGM profile parameters immediately after outpatient visits. Telemedicine versus in-person visits were comparable. These findings suggest that multiple visits over time are needed to obtain a sustainable, clinically relevant change in glycemic control, and telemedicine can be utilized just as effectively as traditional visits to achieve this goal. Disclosure C. J. Ferber: None. H. Wilhalme: None. S. Mittelman: None. T. Moin: None. R. A. Hicks: None.