Telehealth improves clinic attendance, lowers distress for young people with diabetes
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Adolescents and young adults with type 1 diabetes who primarily attend diabetes clinic visits via telehealth have better overall attendance and less diabetes distress compared with those who attend in person, according to study data.
In findings published in the Journal of Diabetes Science and Technology, a cohort of adolescents and young adults with type 1 diabetes receiving care at Children’s Hospital of Los Angeles were randomly assigned to an intervention adapted from the Colorado Young Adults with Type 1 Diabetes (CoYoT1) care model or standard care via either telehealth or in-person visits. Regardless of the intervention, participants who attended telehealth visits had no changes in physician-related diabetes distress from baseline to the end of the study, whereas those attending in-person visits had worse physician-related diabetes distress at the final visit.
“Adolescents and young adults with type 1 diabetes are at high risk for diabetes distress, which is associated with poor diabetes outcomes,” Jennifer Raymond, MD, MCR, chief of the division of endocrinology, diabetes and metabolism at Children’s Hospital Los Angeles, told Healio. “Stabilizing diabetes distress may result in improved clinical outcomes and increased engagement in diabetes care during a time when young people with type 1 diabetes typically disengage from the health care system.”
Raymond and colleagues recruited 68 adolescents and young adults aged 16 to 25 years with type 1 diabetes for at least 6 months attending Children’s Hospital of Los Angeles. Participants received care from six physicians, three who used the CoYoT1 care intervention model and three who delivered standard care. Participants were given the option to retain their prestudy physician. Otherwise, all participants were randomly assigned to the intervention or standard care. All participants were also randomly assigned to attend all of their visits in-person or three visits via telehealth with one in-person visit. Appointments took place approximately every 3 months. Demographics and clinical data were obtained from electronic medical records. Participants completed the Diabetes Distress Scale, the Diabetes Empowerment Scale-Short Form and the Center for Epidemiologic Studies Depression Scale at baseline and all four visits.
Of the cohort, 39 primarily attended their clinic visits by telehealth and 29 primarily attended in-person visits. Those who attended primarily telehealth appointments had a mean 3.33 visits during the study period compared with 2.47 visits for those attending in person (P = .007).
“Adolescents and young adults with type 1 diabetes are traditionally challenged with engagement in routine diabetes care,” Raymond said. “Telehealth may be an option for increasing successful visit completion. From a patient perspective, this may result in more proactive care with an improvement in diabetes outcomes. From a clinician and diabetes center standpoint, this will result in successful utilization of clinician time and improve patient access.”
Physician-related diabetes distress was unchanged for adolescents and young adults attending telehealth visits, whereas participants attending in-person visits had an increase in physician-related distress from baseline to the final visit (P = .04). No significant differences were observed between telehealth and in-person participants with the other diabetes distress domains.
Participants who were randomly assigned to the CoYoT1 care intervention and participated via telehealth had a significant reduction in HbA1c during the study compared with those receiving standard care in-person (change in HbA1c = –0.83%; P = .04). Adolescents and young adults receiving standard care via telehealth or the intervention in-person did not have a significant difference in HbA1c change compared with standard care in-person.
Raymond said future studies should explore other aspects of telehealth, including how the form of care shifts diabetes distress experiences by patients, how providers can expand their telehealth skills, how the telehealth experience can be personalized and how the telehealth experience varies for people living in marginalized communities.
For more information:
Jennifer Raymond, MD, MCR, can be reached at jraymond@chla.usc.edu.
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