Abstract
Background
The COVID-19 pandemic poses new challenges to health care providers and the delivery of continuous care. Although many diabetes technologies, such as insulin pumps and continuous glucose monitors, have been established, the data from these devices are rarely assessed. Furthermore, telemedicine has not been sufficiently integrated into clinical workflows.
Objective
We sought to remotely support children with type 1 diabetes and their caregivers, enhance the clinical outcomes and quality of life of children with diabetes, increase multiple stakeholders’ engagement with digital care via a participatory approach, evaluate the feasibility of using an interoperable open-source platform in a university hospital setting, and analyze the success factors and barriers of transitioning from conventional care to digital care.
Methods
Service design methods were used to adapt clinical workflows. Remote consultations were performed on a monthly and on-demand basis. Diabetes device data were uploaded from patients’ homes to an open-source platform. Clinical and patient-reported outcomes were assessed before, during, and after the COVID-19 lockdown period in Germany.
Results
A total of 28 children with type 1 diabetes and their caregivers enrolled in this study and completed 6 months of remote visits. Of these 28 participants, 16 (57%) also opted to attend at least one of their regular visits remotely. After 3 months of remote visits, participants’ time in range (P=.001) and time in hyperglycemia (P=.004) significantly improved, and their time in hypoglycemia did not increase. These improvements were maintained during the COVID-19 lockdown period (ie, between months 3 and 6 of this study). Participants’ psychosocial health improved after 6 months.
Conclusions
Remote consultations and commonly shared data access can improve the clinical outcomes and quality of life of children with type 1 diabetes, even during challenging circumstances. A service design approach helped with the delivery of comprehensive and holistic solutions that accounted for the needs of multiple stakeholders. Our findings can inform the future integration of digital tools into clinical care during and beyond the pandemic.
Trial Registration
German Clinical Trials Register DRKS00016170; https://tinyurl.com/skz4wdk5
Reference69 articles.
1. Sustaining and Realizing the Promise of Telemedicine
2. PfiesterEGomberARojasDAl-BajarMWoffordKOrtizLMwoloJBimpehYvan der HofenEBrauneKImplications of the covid-19 pandemic on chronic care: global perspectives from people with type 1 diabetesBMJ Opinions202011062021-02-26https://blogs.bmj.com/bmj/2020/11/06/implications-of-the-covid-19-pandemic-on-chronic-care-global-perspectives-from-people-with-type-1-diabetes/
3. Entwurf eines Gesetzes für eine bessere Versorgung durch Digitalisie-rung und Innovation (Digitale-Versorgung-Gesetz – DVG)Digitales Versorgungsgesetz2020-09-04https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/Gesetze_und_Verordnungen/GuV/D/Digitale-Versorgung-Gesetz_DVG_Kabinett.pdf
4. Telemedicine Diabetes Consultations are Cost-Effective, and Effects on Essential Diabetes Treatment Parameters are Similar to Conventional Treatment: 7-Year Results from the Svendborg Telemedicine Diabetes Project
5. Use of Telemedicine to Improve Adherence to American Diabetes Association Standards in Pediatric Type 1 Diabetes
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