Background: Managing T1D as a YA is challenging due to changing physiology, psychosocial demands, and increasing independence. Fewer than one-third of YA with T1D meet the ADA guidelines of quarterly diabetes visits and only one in seven attain the recommended hemoglobin A1c level of <7%. YA from disadvantaged ethnic, racial, and socioeconomic backgrounds face even greater T1D management obstacles.

Methods: The CoYoT1 Care model was adapted for diverse, predominantly publicly insured, YA with T1D at a large urban hospital. A 15-month 4-arm randomized controlled trial collected data on 68 YA, ages 16-25. Participants received either CoYoT1 Care or Standard Care via in-person or Telehealth (TH) , prior to COVID-19; all in-person visits transitioned to TH in March 2020. CoYoT1 Care consists of patient-centered provider visits with bimonthly virtual T1D peer group sessions.

Results: YA who attended >50% of study visits by TH attended more visits during the study period (3.4) than those who primarily attended in-person (2.6, p<0.0001) . Those who were seen more by TH also had stable levels of diabetes distress versus increased distress in those attending in-person visits (p=0.02) . A conjoint analysis conducted with YA found that not having to travel to clinic for visits was TH’s greatest benefit; technical problems and not always having private space were its biggest challenges. Participants also rated access to a clinic coordinator and TH visits as extremely valuable.

Conclusions: TH was successfully adapted for diverse YA with T1D, resulting in increased attendance and stable diabetes distress compared to in-person care. Participants overwhelmingly indicated that the benefits associated with TH, such as saving time and money traveling and parking, outweighed any technical challenges. Larger studies with longer term follow-up, not occurring during a global pandemic, are needed to refine TH’s role in patient-centered care of YA with T1D.


J.Raymond: None. J.L.Fogel: None. M.W.Reid: None. E.Salcedo-rodriguez: None. D.Fox: None. E.Pyatak: Research Support; Abbott Diabetes.


Donaghue Foundation

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