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Home-based video visits for pediatric patients with poorly controlled type 1 diabetes
Stephanie Crossen1, Nicole Glaser1, Hadley Sauers-Ford2
1Division of Pediatric Endocrinology and Diabetes, University of California, CA, USA.
Insights
Home-based video visits improved glycemic control in children with type 1 diabetes (T1D). This telehealth approach enhanced care frequency and patient satisfaction, demonstrating feasibility for managing T1D remotely.
Area of Science:
- Pediatric Endocrinology
- Digital Health
- Diabetes Management
Background:
- Type 1 diabetes (T1D) management is intensive, requiring frequent monitoring and interventions.
- Current care models involve quarterly visits, but more frequent patient-provider contact may improve outcomes.
- Advancements in telehealth enable remote data sharing and video consultations for diabetes care.
Purpose of the Study:
- To assess the feasibility and impact of home-based video visits on glycemic control in pediatric patients with poorly controlled T1D.
- To evaluate patient satisfaction with telehealth interventions in T1D management.
- To determine if video visits increase the frequency of subspecialty care.
Main Methods:
- A six-month study involving pediatric T1D patients with hemoglobin A1c (HbA1c) ≥8%.
- Participants received home-based video visits every 4-8 weeks, in addition to standard clinic appointments.
- Data on clinic visit frequency and HbA1c levels were collected at baseline and six months; patient satisfaction surveys were administered.
Main Results:
- Of 57 enrolled patients, 36 completed the study, averaging 4.0 video visits.
- In-person care frequency increased (3.2 to 3.7 visits/year, P=0.04).
- Mean HbA1c reduction was 0.8% (95% CI 0.2-1.4%), with 100% patient satisfaction.
Conclusions:
- Home-based video visits are a feasible and satisfactory method for managing pediatric T1D.
- Telehealth interventions can enhance the frequency of diabetes subspecialty care.
- Video visits show promise for improving glycemic control in pediatric T1D patients.
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.
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