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Monthly videoconferencing improves self-management, not HbA1c, in adolescents with type 1 diabetes
Adolescents with type 1 diabetes assigned to monthly videoconference sessions with a diabetes nurse educator and social worker for 6 months showed improvements in aspects of self-care but did not improve their glycemic control vs. those assigned to usual care, according to study findings presented at the annual Pediatric Academic Societies Meeting in Baltimore.
“Based on this pilot study, a telehealth intervention incorporating monthly videoconference visits with a diabetes nurse educator and social worker over 6 months is a feasible method of increasing interaction between adolescents with type 1 diabetes and the diabetes care team and may improve aspects of diabetes self-management,” Erinn T. Rhodes, MD, MPH, director of endocrinology health care research and quality, division of endocrinology, Boston Children's Hospital, told Endocrine Today. “A longer and/or more intensive intervention may be needed to improve glycemic control.”
In a randomized controlled trial, Rhodes and colleagues analyzed data from 32 children aged 13 to 17 years with type 1 diabetes and HbA1c at least 8% (mean age, 14 years; 56% girls; 81% white). Researchers assigned 16 participants to a telehealth arm, including separate monthly videoconference sessions with a diabetes nurse educator and social worker for 6 months, focusing on diabetes self-management and social support (12 sessions; mean HbA1c, 9%), in addition to developing a diabetes action plan and usual care. The control arm (n = 16; mean HbA1c, 9.4%) was assigned to usual care and received study reminder postcards twice monthly for 6 months. Participants completed a 14-item self-care inventory to assess their perception of adherence to diabetes self-care recommendations at the conclusion of the study. Primary outcome was 6-month change in HbA1c. Researchers used a generalized estimating equations model for repeated measures comparing outcomes between arms in an intention-to-treat analysis.
In the telehealth group, 88% completed at least one videoconference session with a diabetes nurse educator, 75% completed at least five sessions, 81% completed at least one videoconference session with a social worker, and 69% completed at least five social worker sessions.
At 6 months, researchers observed no significant between-group differences in HbA1c (0.35% for telehealth vs. 0.08% for usual care) or in the overall self-care inventory score (0.05 for telehealth vs. –0.12 for usual care).
However, researchers observed mean improvements in the four self-care inventory subscales in the telehealth arm vs. improvement in a single subscale in the control arm. Researchers noted the greatest difference in the “insulin and food regulation” subscale (0.19 for telehealth vs. –0.33 for controls; P = .06).
“Our findings reinforce that improving glycemic control in adolescents with type 1 diabetes may be challenging,” Rhodes said. “However, improving diabetes self-management is likely an important step in the pathway to improving glycemic control, and telehealth provides a flexible medium to target diabetes self-management in adolescents.” – by Regina Schaffer
Reference :
Rhodes E, et al. #3115.1. Presented at: Pediatric Academic Societies Meeting; April 30-May 3, 2016; Baltimore.
Disclosure: Rhodes reports receiving research funding from Merck unrelated to this study.
Perspective
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Telehealth interventions are getting more and more attention as more states pass laws requiring third-party payers to reimburse for telehealth. Telehealth can be a valuable adjunct for optimum diabetes management in youths with type 1 diabetes, as the daily demands require a great deal of support, supervision and reinforcement. However, the literature is clear that the most successful interventions that improve adherence and glycemic control are behavioral-based interventions delivered by psychologists trained specifically in diabetes and youth. Adolescence is a challenging time for most all young people, and then you superimpose type 1 diabetes on those young people, and living a quality life unencumbered becomes quite difficult. Ideally, the care of youths with type 1 diabetes would include regular clinic visits with a team made up of pediatric endocrinologists, certified diabetes educators, dietitians, medical social workers and pediatric psychologists augmented by weekly problem-solving and behavior support via videoconferencing or texting.