Five-Year Experience with Telemedicine Clinics for Youth with Type 1 Diabetes (T1D)

Poor access to specialty care is a problem for youth with T1D in rural America, where 79% of children live over 20 miles from a pediatric endocrinologist. Rural families are less likely to have adequate T1D follow-up per ADA guidelines. Telemedicine may mitigate such issues. Since 2012, the Barbara Davis Center for Diabetes telemedicine program has provided care for over 290 pediatric T1D patients in rural Wyoming and Colorado via real-time, encrypted videoconferencing. This study sought to determine how increased access to specialty care via telemedicine affects glycemic control over a 3 to 5 year follow-up period. Glycemic control was analyzed for 21 patients with at least 3 years follow-up since initial use of telemedicine. Data were analyzed by age group (< 12 years (pre-pubertal, n=13) vs. ≥12 years (post-pubertal, n=8)) and treatment method at baseline (insulin pump, n=8 vs. multiple daily injections (MDI), n=13). Mean T1D duration at baseline was 4.1 ± 3.5 years and mean follow-up time was 4.1 ± 0.6 years. Mean change in A1c was 0.0 ± 2.0% (p=0.96 for baseline vs. follow-up A1c). Median (interquartile range (IQR)) A1c at baseline and at follow-up were 9.2 (8.2, 10.0)% and 9.0 (8.5, 10.1)% respectively. One third of patients had a clinically significant increase in A1c of more than 0.5%, a third had a decrease of more than 0.5% and a third had a change in A1c of less than 0.5%. The post-pubertal group showed worse change in glycemic control compared to the pre-pubertal group (mean A1c change 0.2 ± 3.0 vs. -0.1 ± 1.3% respectively (p=0.78)). Patients on MDI at baseline showed mean A1c change of -0.5 ± 1.4% compared to a mean A1c change for patients on insulin pumps of 0.9 ± 2.7% (p=0.21). Of 13 MDI patients, 7 transitioned to insulin pump use during follow-up. Overall, glycemic control was no worse and pump use increased with 5 years of telemedicine clinics for T1D youth. While further work is needed to improve overall glycemic control, use of telemedicine reduces barriers and improves access to T1D specialty care for rural families.