Videoconferencing for Teens With Diabetes

Abstract

Background: Adolescence is a developmental period associated with increased difficulty managing diabetes. During adolescence family functioning, including miscarried helping, family conflict, and acceptance of illness, is an important predictor of adherence to treatment recommendations. Multiple barriers exist to receiving behavioral health interventions to address suboptimal adherence. We hypothesized that behavioral family systems therapy–diabetes (BFST-D) delivered via telehealth would yield changes in family functioning that were not significantly different than changes in clinic-based treatment. Furthermore, that BFST-D would significantly improve overall family functioning. Methods: Ninety adolescent participants and their parents were randomized to receive BFST-D via telehealth or traditional (Clinic) treatment conditions. Repeated measures ANOVAs were used to assess changes in mean scores across pre, post, and follow-up assessments. Mediation analyses were conducted using methods outlined by Sobel and were confirmed by bootstrapping. Results: Changes in miscarried helping, family conflict and adjustment to illness were not significantly different across groups. Overall, clinically significant improvements were identified in youth- and parent-reported miscarried helping, family conflict, and acceptance of illness. Reductions in family conflict mediated the relationship between changes in miscarried helping and acceptance of illness. In addition, improvements in family functioning were associated with changes in adherence and glycemic control. Conclusions: Results provide strong support for BFST-D (and similar interventions) delivered via telehealth as yielding outcomes no different than clinic-based treatment. In addition, further support was provided for the effectiveness of BFST-D.

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.…”

Virtual Coaching to Enhance Diabetes Care

“…Research has found that glycemic and psychologic outcomes from telemedicine visits were equivalent to or better than in-person visits for both children and adults with type 1 diabetes (T1D). [11][12][13][14][15] When behavioral family systems therapy for teenagers with diabetes was delivered using a videoconferencing service, overall family conflict was reduced and parents reported improved acceptance of illness. 12 In another study on 18-55-year-old patients with T1D, there was a tendency toward less impact of diabetes on quality of life in the group receiving telemedicine visits (P = 0.061).…”

“…[11][12][13][14][15] When behavioral family systems therapy for teenagers with diabetes was delivered using a videoconferencing service, overall family conflict was reduced and parents reported improved acceptance of illness. 12 In another study on 18-55-year-old patients with T1D, there was a tendency toward less impact of diabetes on quality of life in the group receiving telemedicine visits (P = 0.061). 13 Additional benefits of telemedicine were increased attendance at visits, 15,16 less time spent traveling to and attending visits, 11,13,17,18 and lower cost.…”