Home-based video visits for pediatric patients with poorly controlled type 1 diabetes

Abstract

Introduction Management of type 1 diabetes (T1D) is labor-intensive, requiring multiple daily blood glucose measurements and insulin injections. Patients are seen quarterly by providers, but evidence suggests more frequent contact is beneficial. Current technology allows secure, remote sharing of diabetes data and video-conferencing between providers and patients in their home settings. Methods Home-based video visits were provided for six months to pediatric T1D patients with poor glycemic control, indicated by a hemoglobin A1c (HbA1c) ≥8% at enrollment. Video visits were conducted every 4–8 weeks in addition to regularly scheduled clinic visits. Dates of clinic visits and HbA1c values were abstracted from the medical record at baseline and six months. Patients were surveyed at video visits regarding technical issues, and after six months a standardized survey was administered to assess satisfaction with video-based care. Results A total of 57 patients enrolled and 36 completed six months of video visits. Patients completing six months averaged 4.0 video visits (SD 1.1). Their frequency of in-person care also increased from 3.2 clinic visits/year at baseline to 3.7 clinic visits/year during the study ( P = 0.04). Mean HbA1c reduction among patients completing six months was 0.8% (95% CI 0.2–1.4%); 94% of these patients were “very satisfied” while 6% were “somewhat satisfied” with the experience. Discussion This study demonstrates that home-based video visits are feasible and satisfactory for pediatric patients with poorly controlled T1D. Furthermore, use of video visits can improve frequency of subspecialty care and resulting glycemic control in this population.

A Systematic Review of Pediatric Telediabetes Service Models

“…In total, the literature search resulted in the selection of 29 studies that met the inclusion criteria. [1][2][3][4]7,9,11,12,[14][15][16][17]20,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] The search and screening process is shown in the PRISMA flow diagram ( Supplementary Fig. S1).…”

“…Studies were conducted in 13 different countries, with the majority of services from the United States (n = 15, 52%). 1,4,7,17,[26][27][28][29][30][33][34][35][36]39,40 The most common study type was a randomized controlled trial (RCT) (n = 11, 38%). 3,7,11,16,17,20,25,28,30,31,37 Most studies were conducted over 24 weeks (n = 9, 31%), 1,4,[15][16][17]20,26,27,31 with the minimum study length at 12 weeks, 3,12,26 and the maximum study length at 240 weeks.…”

“…The majority of included studies used remote monitoring (n = 19, 66%) as the main mode for delivering pediatric telediabetes services. [1][2][3][4]9,11,12,14,16,17,20,25,26,31,32,[34][35][36][37] Other modes included real-time videoconference (n = 9, 31%), 7,15,[27][28][29]33,[38][39][40] or a combination of remote monitoring and real-time videoconference modes (n = 1, 3%). 30 Storeand-forward was not used by any of the included studies.…”

“…Three articles (10%) were allocated a complete score of 18. 7,20,28 The main reasons for reductions in score were failure to adequately report certain items such as the rationale, reliability, and validity of measures (n = 14, 48%) 2, [14][15][16][25][26][27]29,[33][34][35][36][37][38] ; study limitations (n = 13, 45%) 2,4,9,11,14,25,[32][33][34][35][36][37][38] ; and the context for the intervention (n = 12, 41%). 2,4,12,16,17,25,27,31,32,[35][36][37]…”

“…Seventeen studies examined HbA1c (Table 2), and some of these studies also reported additional outcome measures. [2][3][4]11,12,[15][16][17][25][26][27][29][30][31][32]37,40 The remaining studies did not report HbA1c and focused on satisfaction, feasibility, psychosocial effectiveness, usability, or a combination of these ( Table 2). The results for change in HbA1c varied, making it difficult to determine the clinical effectiveness of pediatric telediabetes.…”