학술논문
Improved CGM Glucometrics and More Visits for Pediatric Type 1 Diabetes Using Telemedicine During 1 Year of COVID-19
Clinical Research Article
Clinical Research Article
Document Type
Report
Source
Journal of Clinical Endocrinology & Metabolism. October 2022, Vol. 107 Issue 10, pe4179, 6 p.
Subject
Language
English
ISSN
0021-972X
Abstract
The COVID-19 pandemic upended routine care for chronic diseases such as type 1 diabetes (T1D). This prompted many around the world to investigate changes in glycemic control associated with pandemic [...]
Purpose: The COVID-19 pandemic led to rapid adoption of telemedicine for the care of youth with type 1 diabetes (T1D). We assessed the utility of a primarily virtual care model by comparing glucometrics from a pediatric sample with T1D using continuous glucose monitoring (CGM) both before and during the pandemic. Methods: Pediatric patients aged 1 to 17 years with T1D duration [greater than or equal to] 1 year if [greater than or equal to] 6 years old or [greater than or equal to] 6 months if < 6 years old, with [greater than or equal to] 1 visit with recorded CGM data both prepandemic (April 1, 2019-March 15, 2020) and during the pandemic (April 1, 2020-March 15, 2021) were included. Data were extracted from the electronic health record. Results: Our sample comprised 555 young people (46% male, 87% White, 79% pump-treated), mean age 12.3 [+ or -] 3.4 years, T1D duration 5.9 [+ or -] 3.5 years, baseline glycated hemoglobin A1c 8.0 [+ or -] 1.0% (64 [+ or -] 10.9 mmol/mol). Diabetes visit frequency increased from 3.8 [+ or -] 1. 7 visits/prepandemic period to 4.3 [+ or -] 2.2 visits/pandemic period (P < 0.001); during pandemic period, 92% of visits were virtual. Glucose management indicator (GMI) improved slightly from 7.9% (63 mmol/mol) prepandemic to 7.8% (62 mmol/mol) during the pandemic (P < 0.001). Those with equal or greater visit frequency (n = 437 [79% of sample]) had significant improvement in GMI (8.0% to 7.8% [64 to 62 mmol/mol], P < 0.001), whereas those with lower visit frequency did not (7.8 [62 mmol/mol], P = 0.86). Conclusions: Children and adolescents with T1D using CGM before and during the pandemic showed an overall increase in visit frequency using primarily telemedicine-based care and improved CGM glucometrics. Further research is needed to understand factors associated with successful use of telemedicine for pediatric T1D. Key Words: pediatric T1D, COVID-19, CGM, diabetes technology Abbreviations: CGM, continuous glucose monitoring; EHR, electronic health record; GMI, glucose management indicator; HbA1c, glycated hemoglobin; T1D, type 1 diabetes
Purpose: The COVID-19 pandemic led to rapid adoption of telemedicine for the care of youth with type 1 diabetes (T1D). We assessed the utility of a primarily virtual care model by comparing glucometrics from a pediatric sample with T1D using continuous glucose monitoring (CGM) both before and during the pandemic. Methods: Pediatric patients aged 1 to 17 years with T1D duration [greater than or equal to] 1 year if [greater than or equal to] 6 years old or [greater than or equal to] 6 months if < 6 years old, with [greater than or equal to] 1 visit with recorded CGM data both prepandemic (April 1, 2019-March 15, 2020) and during the pandemic (April 1, 2020-March 15, 2021) were included. Data were extracted from the electronic health record. Results: Our sample comprised 555 young people (46% male, 87% White, 79% pump-treated), mean age 12.3 [+ or -] 3.4 years, T1D duration 5.9 [+ or -] 3.5 years, baseline glycated hemoglobin A1c 8.0 [+ or -] 1.0% (64 [+ or -] 10.9 mmol/mol). Diabetes visit frequency increased from 3.8 [+ or -] 1. 7 visits/prepandemic period to 4.3 [+ or -] 2.2 visits/pandemic period (P < 0.001); during pandemic period, 92% of visits were virtual. Glucose management indicator (GMI) improved slightly from 7.9% (63 mmol/mol) prepandemic to 7.8% (62 mmol/mol) during the pandemic (P < 0.001). Those with equal or greater visit frequency (n = 437 [79% of sample]) had significant improvement in GMI (8.0% to 7.8% [64 to 62 mmol/mol], P < 0.001), whereas those with lower visit frequency did not (7.8 [62 mmol/mol], P = 0.86). Conclusions: Children and adolescents with T1D using CGM before and during the pandemic showed an overall increase in visit frequency using primarily telemedicine-based care and improved CGM glucometrics. Further research is needed to understand factors associated with successful use of telemedicine for pediatric T1D. Key Words: pediatric T1D, COVID-19, CGM, diabetes technology Abbreviations: CGM, continuous glucose monitoring; EHR, electronic health record; GMI, glucose management indicator; HbA1c, glycated hemoglobin; T1D, type 1 diabetes