51
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Phillip M, Bergenstal RM, Close KL, Danne T, Garg SK, Heinemann L, Hirsch IB, Kovatchev BP, Laffel LM, Mohan V, Parkin CG, Battelino T. The Digital/Virtual Diabetes Clinic: The Future Is Now-Recommendations from an International Panel on Diabetes Digital Technologies Introduction. Diabetes Technol Ther 2021; 23:146-154. [PMID: 32905711 PMCID: PMC8098767 DOI: 10.1089/dia.2020.0375] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The increasing prevalence of diabetes, combined with a growing global shortage of health care professionals (HCP), necessitates the need to develop new approaches to diabetes care delivery to expand access to care, lessen the burden on people with diabetes, improve efficiencies, and reduce the unsustainable financial liability on health systems and payers. Use of digital diabetes technologies and telehealth protocols within a digital/virtual diabetes clinic has the potential to address these challenges. However, several issues must be resolved to move forward. In February 2020, organizers of the Advanced Technologies & Treatments for Diabetes Annual Conference convened an international panel of HCP, researchers, patient advocates, and industry representatives to review the status of digital diabetes technologies, characterize deficits in current technologies, and identify issues for consideration. Since that meeting, the importance of using telehealth and digital diabetes technologies has been demonstrated amid the global coronavirus disease (COVID-19) pandemic. This article summarizes the panel's discussion of the opportunities, obstacles, and requisites for advancing the use of these technologies as a standard of care for the management of diabetes.
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Affiliation(s)
- Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Richard M. Bergenstal
- International Diabetes Center at Park Nicollet, Health Partners, Minneapolis, Minnesota, USA
| | - Kelly L. Close
- Close Concerns and diaTribe, San Francisco, California, USA
| | - Thomas Danne
- Diabetes Centre for Children and Adolescents, AUF DER BULT, Kinder-und Jugendkrankenhaus, Hannover, Germany
| | - Satish K. Garg
- University of Colorado Denver and Barbara Davis Center for Diabetes, Aurora, Colorado, USA
| | | | - Irl B. Hirsch
- Division of Metabolism, Endocrinology, & Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Boris P. Kovatchev
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Lori M. Laffel
- Pediatric, Adolescent and Young Adult Section and Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialties Centre & Madras Diabetes Research Foundation, Chennai, India
| | | | - Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Centre-University Children's Hospital, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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52
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Williams M. Using telehealth for rural paediatric diabetics: Does it deliver good care? J Paediatr Child Health 2021; 57:109-113. [PMID: 32881136 DOI: 10.1111/jpc.15149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/26/2020] [Accepted: 08/09/2020] [Indexed: 12/27/2022]
Abstract
AIM To evaluate rural paediatric diabetic telehealth clinics including whether they meet clinical standards, provide equivalent care to central clinics, families were satisfied and difficulties were encountered. METHODS An audit of a telehealth service for children and adolescents with type 1 diabetes mellitus at four rural sites was conducted. The case notes for each patient for 2019 were reviewed to determine if standards of paediatric diabetic care were met. Interviews were conducted at a clinic at each site with the child, parent(s) and staff attending the clinics. A retrospective review of difficulties in service provision was undertaken with staff. RESULTS Nineteen children and adolescents were seen in the telehealth clinics over the year. Eighteen (95%) were seen four times with point-of-care measurement of glycosylated haemoglobin (HbA1c) and growth by the consultant paediatrician and diabetic nurse educator. Complication screening was achieved on time for 15 (78%) patients, with the remaining patients having had the tests ordered. Eleven (56%) patients were reviewed by a dietician, six (33%) by social worker and five (27%) by psychologist. All patients and parents reported receiving good support for their diabetes without any preferring to attend the central clinic. There were no significant technical difficulties. CONCLUSION Providing paediatric diabetic care through a telehealth service at rural hospitals meets standards of care and was provided without technical difficulties. It is preferred by patients and their parents to attending a central clinic. A model of service is presented that may be replicated elsewhere in Australia.
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Affiliation(s)
- Michael Williams
- Child and Adolescent Health Service, Mackay Base Hospital, Mackay, Queensland, Australia
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53
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Abstract
Diabetes management is well suited to use of telehealth, and recent improvements in both diabetes technology and telehealth policy make this an ideal time for diabetes providers to begin integrating telehealth into their practices. This article provides background information, specific recommendations for effective implementation, and a vision for the future landscape of telehealth within diabetes care to guide interested providers and practices on this topic. Note: This article was written prior to the COVID19 pandemic, and does not include information about recent telehealth policy changes that occurred during or as a result of this public health crisis.
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Affiliation(s)
- Stephanie Crossen
- Department of Pediatrics, University of California, Davis, Sacramento, California
- UC Davis Center for Health and Technology, Sacramento, California
- Address correspondence to: Stephanie Crossen, MD, MPH, Department of Pediatrics, University of California, Davis, 2516 Stockton Boulevard, Sacramento, CA 95817
| | - Jennifer Raymond
- Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Aaron Neinstein
- Department of Medicine, University of California, San Francisco, San Francisco, California
- UCSF Center for Digital Health Innovation, San Francisco, California
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54
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Fung A, Irvine M, Ayub A, Ziabakhsh S, Amed S, Hursh BE. Evaluation of telephone and virtual visits for routine pediatric diabetes care during the COVID-19 pandemic. J Clin Transl Endocrinol 2020; 22:100238. [PMID: 33072519 PMCID: PMC7548628 DOI: 10.1016/j.jcte.2020.100238] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS To evaluate pediatric type 1 diabetes telehealth visits during the COVID-19 pandemic, with a focus on assessing the usability of these visits and gathering patient perspectives. METHODS An online survey, which included a validated telehealth usability questionnaire, was offered via email to families with a telephone or virtual visit since the COVID-19-related cancellation of routine in-person care. Survey data was linked with the British Columbia (BC) Clinical Diabetes Registry. Outcomes between groups were assessed using Welch's t-test. Associations with type of visit as well as with desire to return to in-person care were assessed with logistic regression models. RESULTS The response rate was 47%. Of 141 survey respondents, 87 had clinical data available in the BC Clinical Diabetes Registry, and thus were included in our analysis. Overall, telephone and virtual visits were rated highly for usability. Telephone visits were easier to learn to use, and simpler to understand; however, telephone and virtual visits were similar across multiple areas. No factors associated with choosing one type of visit over the other, or with desire to return to in-person care, could be identified. 72% of participants want future telehealth care; however, some would like all future care to be in-person. CONCLUSIONS Telephone and virtual visits had impressive usability. Many families want telehealth to play a significant part in their future care.
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Affiliation(s)
- Alex Fung
- Division of Endocrinology, Department of Pediatrics, British Columbia Children’s Hospital and University of British Columbia, 4480 Oak St., Vancouver, BC V6H 3V4, Canada
| | - Mike Irvine
- Biostatistics Core, Clinical Research Support Unit, BC Children’s Research Institute, 938 W 28th Ave, Vancouver, BC V5Z 4H4, Canada
| | - Aysha Ayub
- Division of Endocrinology, Department of Pediatrics, British Columbia Children’s Hospital and University of British Columbia, 4480 Oak St., Vancouver, BC V6H 3V4, Canada
| | - Shabnam Ziabakhsh
- BC Women’s Hospital and Health Centre, Women’s Health Research Institute, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Shazhan Amed
- Division of Endocrinology, Department of Pediatrics, British Columbia Children’s Hospital and University of British Columbia, 4480 Oak St., Vancouver, BC V6H 3V4, Canada
| | - Brenden E. Hursh
- Division of Endocrinology, Department of Pediatrics, British Columbia Children’s Hospital and University of British Columbia, 4480 Oak St., Vancouver, BC V6H 3V4, Canada
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55
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Malandrucco I, Russo B, Picconi F, Menduni M, Frontoni S. Glycemic Status Assessment by the Latest Glucose Monitoring Technologies. Int J Mol Sci 2020; 21:E8243. [PMID: 33153229 PMCID: PMC7663245 DOI: 10.3390/ijms21218243] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022] Open
Abstract
The advanced and performing technologies of glucose monitoring systems provide a large amount of glucose data that needs to be properly read and interpreted by the diabetology team in order to make therapeutic decisions as close as possible to the patient's metabolic needs. For this purpose, new parameters have been developed, to allow a more integrated reading and interpretation of data by clinical professionals. The new challenge for the diabetes community consists of promoting an integrated and homogeneous reading, as well as interpretation of glucose monitoring data also by the patient himself. The purpose of this review is to offer an overview of the glycemic status assessment, opened by the current data management provided by latest glucose monitoring technologies. Furthermore, the applicability and personalization of the different glycemic monitoring devices used in specific insulin-treated diabetes mellitus patient populations will be evaluated.
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Affiliation(s)
- Ilaria Malandrucco
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita, Fatebenefratelli Hospital, 00186 Rome, Italy; (I.M.); (B.R.); (F.P.)
| | - Benedetta Russo
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita, Fatebenefratelli Hospital, 00186 Rome, Italy; (I.M.); (B.R.); (F.P.)
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Fabiana Picconi
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita, Fatebenefratelli Hospital, 00186 Rome, Italy; (I.M.); (B.R.); (F.P.)
| | - Marika Menduni
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Simona Frontoni
- Unit of Endocrinology, Diabetes and Metabolism, S. Giovanni Calibita, Fatebenefratelli Hospital, 00186 Rome, Italy; (I.M.); (B.R.); (F.P.)
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
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56
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Ladha S, Fox D, Bone JN, Amed S. An Analysis of Self-Reported Barriers to Type 1 Diabetes Care in a Pediatric Population in British Columbia, Canada. Can J Diabetes 2020; 45:383-389. [PMID: 33358268 DOI: 10.1016/j.jcjd.2020.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/22/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Our aim in this study was to identify patient-level barriers to attending pediatric type 1 diabetes mellitus (T1DM) clinic and to better understand the demographic and clinical characteristics of these reporting barriers. METHODS Patients were recruited from pediatric T1DM clinics throughout British Columbia. Barriers to attending clinic were identified through a survey. Demographic and clinical characteristics of patients who reported difficulty attending clinic appointments were compared with those who did not. RESULTS Of the 197 study participants, 31% reported difficulty attending appointments. Commonly reported barriers were distance to clinic and missing work. Younger child age and residing in northern regions increased the odds of reporting a barrier, whereas residing on Vancouver Island decreased odds of reporting a barrier. There were no differences in glycated hemoglobin levels between the 2 groups. CONCLUSIONS Approximately 1 in 3 patients identified challenges in attending T1DM appointments in British Columbia. Further research is needed to determine whether similar challenges exist in other provinces.
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Affiliation(s)
- Safia Ladha
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Danya Fox
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Jeffrey N Bone
- Department of Obstetrics and Gynecology, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Shazhan Amed
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada.
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57
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Mara CA, Peugh JL. Validity of Data Collected from Randomized Behavioral Clinical Trials During the COVID-19 Pandemic. J Pediatr Psychol 2020; 45:971-976. [PMID: 32968774 PMCID: PMC7797740 DOI: 10.1093/jpepsy/jsaa078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Constance A Mara
- Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine
| | - James L Peugh
- Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine
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58
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De Guzman KR, Snoswell CL, Taylor ML, Senanayake B, Haydon HM, Batch JA, Smith AC, Caffery LJ. A Systematic Review of Pediatric Telediabetes Service Models. Diabetes Technol Ther 2020; 22:623-638. [PMID: 32027176 DOI: 10.1089/dia.2019.0489] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Telediabetes may improve patient access to clinicians who specialize in the management of pediatric diabetes. Due to the diversity of telehealth modes, many different service models for pediatric telediabetes have been developed. This review describes pediatric telediabetes service models identified in the literature, investigates the reported changes in HbA1c of these interventions, and describes enablers and barriers to implementing a telediabetes service. Evaluation of current literature may inform the development and sustainability of telehealth services for pediatric diabetes management. Twenty-nine studies met inclusion criteria and were reviewed. This review has demonstrated that pediatric telediabetes can be delivered by remote monitoring and real-time videoconference modes. Overall, pediatric telediabetes increased interactions between patients and clinicians, improved access to specialized care, and facilitated increased diabetes monitoring. In some contexts, telediabetes also improved short-term glycemic control. Key enablers reported for telediabetes services were integration with existing workflows, dedicated staff, clinician and patient training, appropriate data security, technology with good usability, and the availability of technical support. Barriers included increases in patient responsibilities and clinician workload, and technical issues with equipment and software.
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Affiliation(s)
- Keshia R De Guzman
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | - Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Monica L Taylor
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Buddhika Senanayake
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Helen M Haydon
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Jennifer A Batch
- Department of Endocrinology and Diabetes, Queensland Children's Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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59
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Abstract
Management of type 1 diabetes mellitus for pediatric and young adult patients is well suited for telehealth. Diabetes management requires frequent communication with health care providers as well as the interpretation of many types of data that can be measured in the home and shared virtually to the provider by the patient. Telehealth technologies allow for a safe alternative and/or addition to in-person care for youth with diabetes. Telehealth increases access to health care, saves time and money, and results in improvements in rates of appointment adherence, patient satisfaction, and quality of life.
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Affiliation(s)
- Jennifer L Fogel
- Division of Endocrinology, Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA
| | - Jennifer K Raymond
- Division of Endocrinology, Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA; Keck School of Medicine of the University of Southern California, 1975 Zonal Avenue, Los Angeles, CA 90089, USA.
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60
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Ruiz de Adana MS, Alhambra-Expósito MR, Muñoz-Garach A, Gonzalez-Molero I, Colomo N, Torres-Barea I, Aguilar-Diosdado M, Carral F, Serrano M, Martínez-Brocca MA, Duran A, Palomares R. Randomized Study to Evaluate the Impact of Telemedicine Care in Patients With Type 1 Diabetes With Multiple Doses of Insulin and Suboptimal HbA 1c in Andalusia (Spain): PLATEDIAN Study. Diabetes Care 2020; 43:337-342. [PMID: 31831473 DOI: 10.2337/dc19-0739] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 11/16/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the impact of a telemedicine visit using the platform Diabetic compared with a face-to-face visit on clinical outcomes, patients' health-related quality of life (HRQoL), and physicians' satisfaction in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS PLATEDIAN (Telemedicine on Metabolic Control in Type 1 Diabetes Mellitus Andalusian Patients) (NCT03332472) was a multicenter, randomized, 6-month follow-up, open-label, parallel-group controlled study performed in patients with type 1 diabetes with suboptimal metabolic control (HbA1c <8% [<64 mmol/mol]), treated with multiple daily injections. A total of 388 patients were assessed for eligibility; 379 of them were randomized 1:1 to three face-to-face visits (control cohort [CC]) (n = 167) or the replacement of an intermediate face-to-face visit by a telemedicine visit using Diabetic (intervention cohort [IC]) (n = 163). The primary efficacy end point was the mean change of HbA1c levels from baseline to month 6. Other efficacy and safety end points were mean blood glucose, glucose variability, episodes of hypoglycemia and hyperglycemia, patient-reported outcomes, and physicians' satisfaction. RESULTS At month 6, the mean change in HbA1c levels was -0.04 ± 0.5% (-0.5 ± 5.8 mmol/mol) in the CC and 0.01 ± 0.6% (0.1 ± 6.0 mmol/mol) in the IC (P = 0.4941). The number of patients who achieved HbA1c <7% (<53 mmol/mol) was 73 and 78 in the CC and IC, respectively. Significant differences were not found regarding safety end points at 6 months. Changes in HRQoL between the first visit and final visit did not differ between cohorts, and, regarding fear of hypoglycemia (FH-15 score ≥28), statistically significant differences observed at baseline remained unchanged at 6 months (P < 0.05). CONCLUSIONS The use of telemedicine in patients with type 1 diabetes with HbA1c <8% (<64 mmol/mol) provides similar efficacy and safety outcomes as face-to-face visits.
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Affiliation(s)
- Maria S Ruiz de Adana
- Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Ciber de Diabetes y Enfermedades Metabólicas (CIBERDEM), Madrid, Spain
| | - Maria Rosa Alhambra-Expósito
- Endocrinology and Nutrition Department, Hospital Universitario Reina Sofía, Córdoba, Spain.,Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Córdoba, Spain
| | - Araceli Muñoz-Garach
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Endocrinology and Nutrition Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Inmaculada Gonzalez-Molero
- Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Ciber de Diabetes y Enfermedades Metabólicas (CIBERDEM), Madrid, Spain
| | - Natalia Colomo
- Endocrinology and Nutrition Department, Hospital Regional Universitario de Málaga, Málaga, Spain .,Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Ciber de Diabetes y Enfermedades Metabólicas (CIBERDEM), Madrid, Spain
| | - Isabel Torres-Barea
- Endocrinology and Nutrition Department, Hospital Universitario de Jerez, Jerez, Cádiz, Spain
| | - Manuel Aguilar-Diosdado
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, Cádiz, Spain.,Biomedical Institute of Research of Cadiz (INIBICA), Cadiz, Spain
| | - Florentino Carral
- Endocrinology and Nutrition Department, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
| | - Manuel Serrano
- Endocrinology and Nutrition Department, Complejo Hospitalario de Jaén, Jaén, Spain
| | - Maria A Martínez-Brocca
- Endocrinology and Nutrition Department, Hospital Universitario Virgen Macarena, Sevilla, Spain.,Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, Sevilla, Spain
| | - Ana Duran
- Medical Department, Sanofi Spain, Barcelona, Spain
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61
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Crossen SS, Marcin JP, Qi L, Sauers-Ford HS, Reggiardo AM, Chen ST, Tran VA, Glaser NS. Home Visits for Children and Adolescents with Uncontrolled Type 1 Diabetes. Diabetes Technol Ther 2020; 22:34-41. [PMID: 31448952 PMCID: PMC6945797 DOI: 10.1089/dia.2019.0214] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Home-based video visits were provided over one year as a supplement to in-person care for pediatric type 1 diabetes (T1D) patients with suboptimal glycemic control. We hypothesized that the intervention would be feasible and satisfactory for the target population and would significantly improve hemoglobin A1c (HbA1c) levels and completion of recommended quarterly diabetes clinic visits. Methods: This was a nonrandomized clinical trial. Fifty-seven patients aged 3-17 years with known T1D and HbA1c ≥8% (64 mmol/mol) were recruited to receive the intervention. The study population was 49% adolescent (13-17 years old) and 58% publicly insured patients. Video visits were scheduled every 4, 6, or 8 weeks depending on the HbA1c level. HbA1c levels as well as frequencies of clinic visits and of diabetes-related emergency department (ED) and hospital encounters were compared before and after the study. Results: Thirty participants completed 12 months of video visits. The study cohort demonstrated significant improvement in mean HbA1c in both intention-to-treat (N = 57) analysis (10.8% [95 mmol/mol] to 10.0% [86 mmol/mol], P = 0.01) and per-protocol (N = 30) analysis (10.8% [95 mmol/mol] to 9.6% [81 mmol/mol], P = 0.004). Completion of ≥4 annual diabetes clinic visits improved significantly from 21% at baseline to 83% during the study period for the entire cohort, P < 0.0001. The frequency of diabetes-related ED and hospital encounters did not change significantly. Conclusions: Home-based video visits are a feasible supplement to in-person care for children and adolescents with T1D and suboptimal glycemic control and can successfully improve HbA1c levels and adherence to recommended frequency of care in this high-risk clinical population.
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Affiliation(s)
- Stephanie S. Crossen
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
- Address correspondence to: Stephanie S. Crossen, MD, MPH, Department of Pediatrics, UC Davis Health, 2516 Stockton Boulevard, Sacramento, CA 95817
| | - James P. Marcin
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
| | - Lihong Qi
- Department of Public Health Sciences, University of California, Davis, Davis, California
| | - Hadley S. Sauers-Ford
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
| | - Allison M. Reggiardo
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
| | - Shelby T. Chen
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
| | - Victoria A. Tran
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
| | - Nicole S. Glaser
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
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62
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Frielitz FS, Müller-Godeffroy E, Hübner J, Eisemann N, Dördelmann J, Menrath I, Katalinic A, Hiort O, von Sengbusch S. Monthly Video-Consultation for Children With Type 1 Diabetes Using a Continuous Glucose Monitoring System: Design of ViDiKi, a Multimethod Intervention Study to Evaluate the Benefit of Telemedicine. J Diabetes Sci Technol 2020; 14:105-111. [PMID: 31315446 PMCID: PMC7189148 DOI: 10.1177/1932296819861991] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The introduction of continuous glucose monitoring (CGM) implies new challenges for diabetes care. As CGM systems are often directly linked to a web-based software solution, structured telemedicine care using a video-consultation may be a new option for families who care for children with type 1 diabetes mellitus (T1DM). METHODS "ViDiKi" (Virtual Diabetes Outpatient Clinic for Children and Youth) is a multicenter controlled trial carried out in Northern Germany. ViDiKi will examine if monthly telemedical consultations, in addition to regular care, will improve glycemic control and psychosocial outcomes. The primary outcome is glycemic control as measured by a change in glycated hemoglobin (HbA1c). A total of 240 participants aged between one year and 16 years using a CGM with multiple daily injections (MDI) or insulin pump therapy were recruited and assigned to a starter group or a six-month waiting control group. The sample size is designed to detect a between-group difference of 0.5% in HbA1c change at six months. Secondary outcomes are variability of blood glucose, health-related quality of life, self-efficacy, and satisfaction with telemedicine. To gain deeper insight into the experience of using telemedicine, qualitative interviews will be conducted. In a health-economic analysis, the costs of telemedicine and a cost-of-care analysis will be calculated. CONCLUSIONS The results from the ViDiKi study shall give important information on the feasibility and putative benefits of telemedicine in children with T1DM and their caregivers. GERMAN CLINICAL TRAILS REGISTER (DRKS) DRKS00012645.
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Affiliation(s)
- Fabian-Simon Frielitz
- Institute of Social Medicine and
Epidemiology, University of Luebeck, Germany
- Fabian-Simon Frielitz, Institute for Social
Medicine and Epidemiology, University of Luebeck, Ratzeburger Allee 160, Luebeck
23562, Germany.
| | - Esther Müller-Godeffroy
- Department of Pediatric Endocrinology
and Diabetology, University Medical Center, Campus Luebeck, Germany
| | - Joachim Hübner
- Institute of Social Medicine and
Epidemiology, University of Luebeck, Germany
| | - Nora Eisemann
- Institute of Social Medicine and
Epidemiology, University of Luebeck, Germany
| | - Jana Dördelmann
- Institute of Social Medicine and
Epidemiology, University of Luebeck, Germany
| | - Ingo Menrath
- Department of Pediatric Endocrinology
and Diabetology, University Medical Center, Campus Luebeck, Germany
| | - Alexander Katalinic
- Institute of Social Medicine and
Epidemiology, University of Luebeck, Germany
| | - Olaf Hiort
- Department of Pediatric Endocrinology
and Diabetology, University Medical Center, Campus Luebeck, Germany
| | - Simone von Sengbusch
- Department of Pediatric Endocrinology
and Diabetology, University Medical Center, Campus Luebeck, Germany
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63
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McDaniel NL, Novicoff W, Gunnell B, Cattell Gordon D. Comparison of a Novel Handheld Telehealth Device with Stand-Alone Examination Tools in a Clinic Setting. Telemed J E Health 2019; 25:1225-1230. [PMID: 30561284 PMCID: PMC6918850 DOI: 10.1089/tmj.2018.0214] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/28/2018] [Accepted: 08/28/2018] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: Research demonstrates that telemedicine is effective in pediatric settings but little is published to validate the quality of the data acquired by remote peripheral examination devices to accurately inform clinical decision-making.Introduction: The primary aim was to compare a novel Food and Drug Administration (FDA)-cleared multifunctional remote examination device (Tyto) with other stand-alone digital examination devices. The secondary aim was to ascertain whether either device produced images or sounds better able to provide clinical information to clinicians caring for children.Materials and Methods: Otoscopic images and heart and lung sounds from 50 patients of ages 2-18 years were acquired using the novel device and a stand-alone digital otoscope and stethoscope. Data were stored on a secure server for review by physicians (two pulmonary faculty, two general faculty, two cardiology faculty, and two cardiology fellows). Reviewers were blinded and they reviewed images and audio files in a randomized manner. Images and sounds were scored in terms of quality using a Likert scale. Means and standard deviations (and t-tests to compare those means) were calculated. Individual (heart sounds, lung sounds, and otoscopic images) and aggregate scores were compared.Results: The novel device provided higher sound and image quality with less chance of an inability to make a diagnosis than the stand-alone devices. The novel device had a superior mean comparative diagnostic score with a high intra- and inter-reliability of cardiac, pulmonary, and otoscopic diagnosis.Discussion and Conclusions: The novel device outperformed the stand-alone digital stethoscope and otoscope and was better able to provide usable data to support a clinical encounter.
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Affiliation(s)
- Nancy L. McDaniel
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Wendy Novicoff
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Brian Gunnell
- Department of Telemedicine, University of Virginia, Charlottesville, Virginia
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Abstract
PURPOSE OF REVIEW To review the current state of diabetes technology adoption and describe impact on outcomes in the context of age, gender, and ethnicity. We will discuss barriers and propose solutions that may help facilitate the adoption. RECENT FINDINGS We are witnessing rapid evolution and increase in adoption of diabetes technology in all its forms, including insulin delivery and glucose monitoring devices, mobile medical applications, and telemedicine. This technology has a great potential to improve diabetes-related outcomes, including acute and chronic complications as well as quality of life for people living with diabetes. However, currently available outcome data are showing modest efficacy and evidence for disparities when it comes to age, gender, and ethnicity. Despite multiple barriers, the adoption of technology is steadily increasing. It is clear that disparities exist in terms of access to and use of technology, but they may be at least in part driven by unmet needs of end users and as such are not unsurmountable. While more research is needed to identify the specific causes for the disparities, future development of diabetes technology that is based on adaptation of behavioral theories has a potential to address the gaps. The disparities can be lessened by understanding the needs of end users and with improvement in personalization of technology, allowing the right device to be used by the right patient. Targeted interventions to increase awareness and education and help navigate the processes involved in currently available technology may help diminish the gaps in health equity.
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Affiliation(s)
- Leslie Eiland
- Department of Internal medicine, Division of Diabetes, Endocrinology & Metabolism, University of Nebraska Medical Center, 984120 Nebraska Medical Center, Omaha, NE, 68198-4120, USA
| | - Thiyagarajan Thangavelu
- Department of Internal medicine, Division of Diabetes, Endocrinology & Metabolism, University of Nebraska Medical Center, 984120 Nebraska Medical Center, Omaha, NE, 68198-4120, USA
| | - Andjela Drincic
- Department of Internal medicine, Division of Diabetes, Endocrinology & Metabolism, University of Nebraska Medical Center, 984120 Nebraska Medical Center, Omaha, NE, 68198-4120, USA.
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Bakhach M, Reid MW, Pyatak EA, Berget C, Cain C, Thomas JF, Klingensmith GJ, Raymond JK. Home Telemedicine (CoYoT1 Clinic): A Novel Approach to Improve Psychosocial Outcomes in Young Adults With Diabetes. DIABETES EDUCATOR 2019; 45:420-430. [PMID: 31244396 DOI: 10.1177/0145721719858080] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the impact of a home telemedicine clinic model (CoYoT1 Clinic) on psychosocial and behavioral outcomes designed for young adults (YAs) with type 1 diabetes (T1D). METHODS YAs self-selected to participate in the CoYoT1 Clinic or serve as a usual care control. CoYoT1 Clinic visits consisted of an individual appointment with a provider and a group appointment with other YAs with T1D using home telemedicine. Psychosocial and behavioral functioning was assessed by 4 measures: Diabetes Distress Scale, Self-Efficacy for Diabetes Scale, Self-Management of Type 1 Diabetes in Adolescence Scale, and Center for Epidemiologic Studies Depression Scale. RESULTS Forty-two patients participated in the CoYoT1 Clinic and 39 patients served as controls. CoYoT1 participants reported lower levels of distress (P = .03), increased diabetes self-efficacy (P = .01), and improved ability to communicate with others about diabetes (P = .04) over the study period compared to controls. YA males in the control group reported increases in depressive symptoms (P = .03) during the study period, but CoYoT1 participants showed no changes. CONCLUSION Group home telemedicine for YAs with T1D positively affects diabetes distress, self-efficacy, and diabetes-specific communication. These positive findings have the potential to also affect the YAs' long-term diabetes outcomes. Further investigation of the model is needed.
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Affiliation(s)
- Marwan Bakhach
- Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Mark W Reid
- Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles, California
| | - Cari Berget
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, Colorado
| | - Cindy Cain
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, Colorado
| | - John Fred Thomas
- Department of Telehealth, School of Medicine, University of Colorado, Aurora, Colorado.,Department of Psychiatry, School of Medicine, University of Colorado, Aurora, Colorado.,Department of Epidemiology, School of Public Health, University of Colorado, Aurora, Colorado
| | - Georgeanna J Klingensmith
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, Colorado
| | - Jennifer K Raymond
- Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California
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66
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Abstract
Rates of diabetes are increasing worldwide and there is not a sufficient clinical workforce to care for these patients. Diabetes-related apps are a feasible way to provide diabetes education to large numbers of people with diabetes but attrition rates are high. Apps enhanced by virtual coaching may be a way to circumnavigate these problems. Virtual coaches are able to address common treatment barriers and other health disparities by providing data-driven individualized support in real time, at any time of day, and from anywhere. Enhanced glycemic benefits have been seen in those who use an app plus virtual coaching versus those who use an app alone, along with clinically meaningful behavior change, psychosocial effects, prolonged engagement, and high levels of satisfaction with the system. More research needs to be done to determine the longitudinal and widespread effects of virtual coaching in different populations.
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67
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Dayal P, Chang CH, Benko WS, Ulmer AM, Crossen SS, Pollock BH, Hoch JS, Kissee JL, Warner L, Marcin JP. Appointment completion in pediatric neurology telemedicine clinics serving underserved patients. Neurol Clin Pract 2019; 9:314-321. [PMID: 31583186 DOI: 10.1212/cpj.0000000000000649] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/04/2019] [Indexed: 11/15/2022]
Abstract
Background To determine whether telemedicine improves access to outpatient neurology care for underserved patients, we compared appointment completion between urban, in-person clinics and telemedicine clinics held in rural and underserved communities where neurology consultations are provided remotely. Methods In this retrospective study, we identified patients scheduled for outpatient care from UCDH pediatric neurologists between January 1, 2009, and July 31, 2017, in person and by telemedicine. Demographic and clinical variables were abstracted from electronic medical records. We evaluated the association between consultation modality and visit completion in overall and matched samples using hierarchical multivariable logistic regression. Results We analyzed 13,311 in-person appointments by 3,831 patients and 1,158 telemedicine appointments by 381 patients. The average travel time to the site of care was 45.8 ± 52.1 minutes for the in-person cohort and 22.3 ± 22.7 minutes for the telemedicine cohort. Telemedicine sites were located at an average travel time of 217.1 ± 114.8 minutes from UCDH. Telemedicine patients were more likely to have nonprivate insurance, lower education, and lower household income. They had different diagnoses and fewer complex chronic conditions. Telemedicine visits were more likely to be completed than either "cancelled" or missed ("no show") compared with in-person visits (OR 1.57, 95% CI: 1.34-1.83; OR 1.66, 95% CI: 1.31-2.10 matched on travel time to the site of care; OR 2.22, 95% CI: 1.66-2.98 matched on travel time to UCDH). Conclusions The use of telemedicine for outpatient pediatric neurology visits has high odds of completion and can serve as an equal adjunct to in-person clinic visits.
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Affiliation(s)
- Parul Dayal
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
| | - Celia H Chang
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
| | - William S Benko
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
| | - Aaron M Ulmer
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
| | - Stephanie S Crossen
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
| | - Brad H Pollock
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
| | - Jeffrey S Hoch
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
| | - Jamie L Kissee
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
| | - Leslie Warner
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
| | - James P Marcin
- Department of Pediatrics (PD, SSC, JLK, JPM) and Department of Neurology (CHC, WSB), University of California Davis Health; Center for Health and Technology (AMU, JPM), University of California Davis Health; Department of Public Health Sciences (BHP, JSH), University of California Davis Health; Center for Healthcare Policy and Research (JSH), University of California Davis Health, Sacramento; and Shasta Community Health Center (LW), Redding, CA
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68
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Crossen S, Glaser N, Sauers-Ford H, Chen S, Tran V, Marcin J. Home-based video visits for pediatric patients with poorly controlled type 1 diabetes. J Telemed Telecare 2019; 26:349-355. [PMID: 30871408 DOI: 10.1177/1357633x19828173] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Management of type 1 diabetes (T1D) is labor-intensive, requiring multiple daily blood glucose measurements and insulin injections. Patients are seen quarterly by providers, but evidence suggests more frequent contact is beneficial. Current technology allows secure, remote sharing of diabetes data and video-conferencing between providers and patients in their home settings. METHODS Home-based video visits were provided for six months to pediatric T1D patients with poor glycemic control, indicated by a hemoglobin A1c (HbA1c) ≥8% at enrollment. Video visits were conducted every 4-8 weeks in addition to regularly scheduled clinic visits. Dates of clinic visits and HbA1c values were abstracted from the medical record at baseline and six months. Patients were surveyed at video visits regarding technical issues, and after six months a standardized survey was administered to assess satisfaction with video-based care. RESULTS A total of 57 patients enrolled and 36 completed six months of video visits. Patients completing six months averaged 4.0 video visits (SD 1.1). Their frequency of in-person care also increased from 3.2 clinic visits/year at baseline to 3.7 clinic visits/year during the study (P = 0.04). Mean HbA1c reduction among patients completing six months was 0.8% (95% CI 0.2-1.4%); 94% of these patients were "very satisfied" while 6% were "somewhat satisfied" with the experience. DISCUSSION This study demonstrates that home-based video visits are feasible and satisfactory for pediatric patients with poorly controlled T1D. Furthermore, use of video visits can improve frequency of subspecialty care and resulting glycemic control in this population.
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Affiliation(s)
- Stephanie Crossen
- Division of Pediatric Endocrinology and Diabetes, University of California, CA, USA
| | - Nicole Glaser
- Division of Pediatric Endocrinology and Diabetes, University of California, CA, USA
| | | | - Shelby Chen
- Center for Health and Technology, University of California, CA, USA
| | - Victoria Tran
- Division of Pediatric Endocrinology and Diabetes, University of California, CA, USA
| | - James Marcin
- Center for Health and Technology, University of California, CA, USA
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Ashrafzadeh S, Hamdy O. Patient-Driven Diabetes Care of the Future in the Technology Era. Cell Metab 2019; 29:564-575. [PMID: 30269984 DOI: 10.1016/j.cmet.2018.09.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/01/2018] [Accepted: 09/02/2018] [Indexed: 02/07/2023]
Abstract
The growing burden of diabetes is fueled by obesity-inducing lifestyle behaviors including high-calorie diets and lack of physical activity. Challenges in access to diabetes specialists and educators, low adherence to medications, and inadequate motivational support for proper disease self-management contribute to poor glycemic control in patients with diabetes. Simultaneously, high patient volumes and low reimbursement rates limit physicians' time spent on lifestyle behavior counseling. These barriers to efficient diabetes care lead to high rates of diabetes-related complications, driving healthcare costs up and reducing the quality of patients' lives. Considering recent advancements in healthcare delivery technologies such as smartphone applications, telemedicine, m-health, device connectivity, machine-learning technology, and artificial intelligence, there is significant opportunity to achieve better efficiency in diabetes care and increase patient involvement in diabetes self-management, which ultimately may put an end to soaring diabetes-related healthcare expenditures. This review explores the patient-driven diabetes care of the future in the technology era.
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Affiliation(s)
- Sahar Ashrafzadeh
- Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA
| | - Osama Hamdy
- Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA.
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70
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Verification of a Portable Motion Tracking System for Remote Management of Physical Rehabilitation of the Knee. SENSORS 2019; 19:s19051021. [PMID: 30823373 PMCID: PMC6427361 DOI: 10.3390/s19051021] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/05/2019] [Accepted: 02/21/2019] [Indexed: 01/06/2023]
Abstract
Rehabilitation following knee injury or surgery is critical for recovery of function and independence. However, patient non-adherence remains a significant barrier to success. Remote rehabilitation using mobile health (mHealth) technologies have potential for improving adherence to and execution of home exercise. We developed a remote rehabilitation management system combining two wireless inertial measurement units (IMUs) with an interactive mobile application and a web-based clinician portal (interACTION). However, in order to translate interACTION into the clinical setting, it was first necessary to verify the efficacy of measuring knee motion during rehabilitation exercises for physical therapy and determine if visual feedback significantly improves the participant’s ability to perform the exercises correctly. Therefore, the aim of this study was to verify the accuracy of the IMU-based knee angle measurement system during three common physical therapy exercises, quantify the effect of visual feedback on exercise performance, and understand the qualitative experience of the user interface through survey data. A convenience sample of ten healthy control participants were recruited for an IRB-approved protocol. Using the interACTION application in a controlled laboratory environment, participants performed ten repetitions of three knee rehabilitation exercises: heel slides, short arc quadriceps contractions, and sit-to-stand. The heel slide exercise was completed without feedback from the mobile application, then all exercises were performed with visual feedback. Exercises were recorded simultaneously by the IMU motion tracking sensors and a video-based motion tracking system. Validation showed moderate to good agreement between the two systems for all exercises and accuracy was within three degrees. Based on custom usability survey results, interACTION was well received. Overall, this study demonstrated the potential of interACTION to measure range of motion during rehabilitation exercises for physical therapy and visual feedback significantly improved the participant’s ability to perform the exercises correctly.
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71
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Haig-Ferguson A, Loades M, Whittle C, Read R, Higson-Sweeney N, Beasant L, Starbuck J, Crawley E. "It's not one size fits all"; the use of videoconferencing for delivering therapy in a Specialist Paediatric Chronic Fatigue Service. Internet Interv 2018; 15:43-51. [PMID: 30619719 PMCID: PMC6312867 DOI: 10.1016/j.invent.2018.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND There are few specialist paediatric Chronic Fatigue Syndrome (CFS/ME) services in the UK. Therefore, the distance some families have to travel to reach these services can be a barrier to accessing evidence-based treatment. Videoconferencing technology such as Skype provides a means of delivering sessions remotely. This study aimed to explore the views of children and young people, their parents, and healthcare professionals of treatment delivered by videoconferencing in a specialist paediatric CFS/ME team. METHOD To explore the experiences of the participants, a qualitative design was selected. Twelve young people (age 9-18), and 6 parents were interviewed about their experience of treatment sessions delivered via videoconferencing within a specialist CFS/ME service. A focus group explored the views of healthcare professionals (N = 9) from the service. Thematic analysis was used. RESULTS Three themes were identified from the data: "Challenges and concerns", "Benefits" and "Treatment provision". Challenges and concerns that participants identified were; difficulties experienced with technology; a sense of a part of communication being lost with virtual connections; privacy issues with communicating online and feeling anxious on a screen. Participants felt that benefits of videoconferencing were; improving access to the chronic fatigue service; convenience and flexibility of treatment provision; a sense of being more open online and being in the comfort of their own home. In terms of treatment provision participants talked about videoconferencing as a part of a hierarchy of communication; the function of videoconferencing within the context of the chronic fatigue service; additional preparation needed to utilise videoconferencing and an assumption that videoconferencing is "part of young people's lives". CONCLUSIONS Although the experience of sessions provided by videoconferencing was different to sessions attended in person, participants tended to be positive about videoconferencing as an alternative means of accessing treatment, despite some barriers. Videoconferencing could be an additional option within an individualised care plan, but should not be an alternative to face to face support.
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Affiliation(s)
| | - Maria Loades
- Royal United Hospital, Bath, UK
- Department of Psychology, University of Bath, UK
- Bristol Medical School, University of Bristol, UK
| | | | - Rebecca Read
- Department of Psychology, University of Bath, UK
| | | | - Lucy Beasant
- Bristol Medical School, University of Bristol, UK
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72
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Albanese-O'Neill A, Beauchamp G, Thomas N, Westen SC, Johnson N, Schatz D, Haller MJ. Transition Education for Young Adults With Type 1 Diabetes: Pilot Feasibility Study for a Group Telehealth Intervention. JMIR Diabetes 2018; 3:e10909. [PMID: 30401674 PMCID: PMC6246967 DOI: 10.2196/10909] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 11/17/2022] Open
Abstract
Background Young adults with type 1 diabetes (T1D) experience a decline in glycemic outcomes and gaps in clinical care. A diabetes education and support program designed for young adults was delivered through group videoconference and mobile Web. Objective The objective of our study was to assess the feasibility, acceptability, and preliminary efficacy of the program as measured by attendance and webpage views, satisfaction, and pre- and postintervention psychosocial outcomes, respectively. Methods Young adults aged 18-25 years were recruited to attend five 30-minute group diabetes education videoconferences during an 8-week period. Videoconferences included an expert presentation followed by a moderated group discussion. Within 48 hours of each videoconference, participants were sent a link to more information on the study website. Feasibility was assessed using data on videoconference attendance and webpage views. Acceptability was assessed via a Satisfaction Survey completed at the conclusion of the study. Descriptive statistics were generated. Preliminary efficacy was assessed via a survey to measure changes in diabetes-specific self-efficacy and diabetes distress. Pre- and postintervention data were compared using paired samples t tests. Results In this study, 20 young adults (mean age 19.2 [SD 1.1] years) attended an average of 5.1 (SD 1.0) videoconferences equivalent to 153 (SD 30.6) minutes of diabetes education per participant during an 8-week period. Average participant satisfaction scores were 62.2 (SD 2.6) out of a possible 65 points. A total of 102 links sent via text message (short message service) or email resulted in 504 webpage views. There was no statistically significant difference between pre- and postintervention diabetes-specific self-efficacy or diabetes-related distress. Conclusions Delivery of diabetes education via group videoconference using mobile Web follow-up is feasible and acceptable to young adults with T1D. This model of care delivery has the potential to improve attendance, social support, and patient-reported satisfaction. Nevertheless, further research is required to establish the effect on long-term psychosocial and glycemic outcomes.
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Affiliation(s)
- Anastasia Albanese-O'Neill
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Giovanna Beauchamp
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Nicole Thomas
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Sarah C Westen
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | | | - Desmond Schatz
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Michael J Haller
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL, United States
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73
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Pihoker C, Forsander G, Fantahun B, Virmani A, Corathers S, Benitez-Aguirre P, Fu J, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2018: The delivery of ambulatory diabetes care to children and adolescents with diabetes. Pediatr Diabetes 2018; 19 Suppl 27:84-104. [PMID: 30144259 DOI: 10.1111/pedi.12757] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/10/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Gun Forsander
- Division of Diabetes, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg and The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bereket Fantahun
- Department of Pediatrics and Child Health at Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Anju Virmani
- Department of Pediatrics, Max, Pentamed and SL Jain Hospitals, Delhi, India
| | - Sarah Corathers
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Paul Benitez-Aguirre
- Sydney Medical School, Discipline of Child & Adolescent Health, The Children's Hospital at Westmead Clinical School Children's Hospital, Westmead, New South Wales, Australia
| | - Junfen Fu
- Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - David M Maahs
- Department of Pediatrics, Stanford University, Stanford, California
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74
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Sherr JL, Tauschmann M, Battelino T, de Bock M, Forlenza G, Roman R, Hood KK, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes technologies. Pediatr Diabetes 2018; 19 Suppl 27:302-325. [PMID: 30039513 DOI: 10.1111/pedi.12731] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 07/10/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Jennifer L Sherr
- Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Martin Tauschmann
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Tadej Battelino
- UMC-University Children's Hospital, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Martin de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Gregory Forlenza
- University of Colorado Denver, Barbara Davis Center, Aurora, Colorado
| | - Rossana Roman
- Medical Sciences Department, University of Antofagasta and Antofagasta Regional Hospital, Antofagasta, Chile
| | - Korey K Hood
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - David M Maahs
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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75
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Phelan H, Lange K, Cengiz E, Gallego P, Majaliwa E, Pelicand J, Smart C, Hofer SE. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes education in children and adolescents. Pediatr Diabetes 2018; 19 Suppl 27:75-83. [PMID: 30175451 DOI: 10.1111/pedi.12762] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/28/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Helen Phelan
- Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, Australia
| | - Karin Lange
- Department Medical Psychology OE 5430, Hannover Medical School, Hannover, Germany
| | - Eda Cengiz
- Division of Pediatric Endocrinology, Yale School of Medicine, New Haven, Connecticut, USA.,School of Medicine, Koc University, Istanbul, Turkey
| | - Patricia Gallego
- Department of Pediatrics, Children's Hospital London, Health Sciences Centre, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Edna Majaliwa
- Department of Paediatric and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Julie Pelicand
- Medical School, University of Valparaiso, San Felipe, Chile
| | - Carmel Smart
- Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, Australia
| | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
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76
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Guttmann-Bauman I, Thornton P, Adhikari S, Reifschneider K, Wood MA, Hamby T, Rubin K. Pediatric endocrine society survey of diabetes practices in the United States: What is the current state? Pediatr Diabetes 2018; 19:859-865. [PMID: 29582520 DOI: 10.1111/pedi.12677] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 02/13/2018] [Accepted: 03/22/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The Practice Management Committee (PMC) of the Pediatric Endocrine Society (PES) conducted a survey of its membership in February/March, 2016 to assess the current state of pediatric diabetes care delivery across multiple practice types in the United States. METHODS The PES distributed an anonymous electronic survey (Survey Monkey) via email to its membership and requested that only one survey be completed for each practice. RESULTS Ninety-three unique entries from the US were entered into analysis. Care is predominantly delivered by multidisciplinary teams, based at academic institutions (65.6%), with >85% of the provider types being physicians. Each 1.0 full time equivalent certified diabetes educators serves on average 367 diabetic youth. Fee-for-service remains the standard method of reimbursement with 57% of practices reporting financial loss. Survey respondents identified under-reimbursement as a major barrier to improving patient outcomes and lack of behavioral health (BH) providers as a key gap in services provided. CONCLUSIONS Our survey reveals wide variation in all aspects of pediatric diabetes care delivery in the United States. Pediatric Endocrinologists responding to the survey identified a lack of resources and the current fee for service payment model as a major impediment to practice and the lack of integrated BH staff as a key gap in service. The respondents strongly support its organizations' involvement in the dissemination of standards for care delivery and advocacy for a national payment model aligned with chronic diabetes care in the context of our emerging value-based healthcare system.
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Affiliation(s)
- I Guttmann-Bauman
- Department of Pediatrics, Oregon Health and Science University (OHSU), Portland, Oregon
| | - P Thornton
- Cook Children's Medical Center, Fort Worth, Texas
| | - S Adhikari
- UT Medical Center, Children's Medical Center, Dallas, Texas
| | - K Reifschneider
- Eastern Virginia Medical School - Children's Hospital of the Kings Daughters, Norfolk, Virginia
| | - M A Wood
- University of Michigan Medical School, Ann Arbor, Michigan
| | - T Hamby
- Department of Research Operations, Cook Children's Health Care System, Fort Worth, Texas
| | - K Rubin
- University of Connecticut School of Medicine, Department of Pediatrics and Head of Clinical Care Innovation, Connecticut Children's Medical Center, Hartford, Connecticut
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77
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Olson CA, McSwain SD, Curfman AL, Chuo J. The Current Pediatric Telehealth Landscape. Pediatrics 2018; 141:peds.2017-2334. [PMID: 29487164 DOI: 10.1542/peds.2017-2334] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2017] [Indexed: 11/24/2022] Open
Abstract
The growth and evolution of telehealth are opening new avenues for efficient, effective, and affordable pediatric health care services in the United States and around the world. However, there remain several barriers to the integration of telehealth into current practice. Establishing the necessary technical, administrative, and operational infrastructure can be challenging, and there is a relative lack of rigorous research data to demonstrate that telehealth is indeed delivering on its promise. That being said, a knowledge of the current state of pediatric telehealth can overcome many of these barriers, and programs are beginning to collaborate through a new pediatric telehealth research network called Supporting Pediatric Research on Outcomes and Utilization of Telehealth (SPROUT). In this report, we provide an update on the landscape of pediatric telehealth and summarize the findings of a recent SPROUT study in which researchers assessed pediatric telehealth programs across the United States. There were >50 programs representing 30 states that provided data on their implementation barriers, staffing resources, operational processes, technology, and funding sources to establish a base understanding of pediatric telehealth infrastructure on a national level. Moving forward, the database created from the SPROUT study will also serve as a foundation on which multicenter studies will be developed and facilitated in an ongoing effort to firmly establish the value of telehealth in pediatric health care.
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Affiliation(s)
- Christina A Olson
- Telehealth Department, Children's Hospital Colorado, Aurora, Colorado; .,Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - S David McSwain
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.,Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | | | - John Chuo
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.,Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania
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78
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Abstract
Background Veterans with type 1 diabetes who live in rural Alabama and Georgia face barriers to receiving specialty diabetes care because of a lack of endocrinologists in the Central Alabama Veterans Health Care System. Telemedicine is a promising solution to help increase access to needed health care. We evaluated telemedicine’s effectiveness in delivering endocrinology care from Atlanta-based endocrinologists. Methods We conducted a retrospective chart review of patients who were enrolled in the Atlanta VAMC Endocrinology Telehealth Clinic from June 2014 to October 2016. Outcomes of interest were hemoglobin A1c levels, changes in glycemic control, time savings for patients, cost savings for the US Veterans Health Administration, appointment adherence rates, and patient satisfaction with telehealth. Results Thirty-two patients with type 1 diabetes received telehealth care and in general received the recommended processes of diabetes care. Patients trended toward a decrease in mean hemoglobin A1c and glucose variability and a nonsignificant increase in hypoglycemic episodes. Patients saved 78 minutes of travel time (one way), and the VA saved $72.94 in travel reimbursements per patient visit. Patients adhered to 88% of scheduled telehealth appointments on average, and 100% of surveyed patients stated they would recommend telehealth to other veterans. Conclusions Specialty diabetes care delivered via telemedicine was safe and was associated with time savings, cost savings, high appointment adherence rates, and high patient satisfaction. Our findings support growing evidence that telemedicine is an effective alternative method of health care delivery.
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Affiliation(s)
- Timothy Xu
- Mayo Clinic School of Medicine, 200 1st St SW, Rochester, MN 55905. .,Emory University, Atlanta, Georgia
| | | | - Sarah Sutton
- Central Alabama Veterans Health Care System, Montgomery, Alabama
| | - Mary Rhee
- Emory University, Atlanta, Georgia.,Atlanta Veterans Affairs Medical Center, Decatur, Georgia
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79
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Ding H, Fatehi F, Russell AW, Karunanithi M, Menon A, Bird D, Gray LC. User Experience of an Innovative Mobile Health Program to Assist in Insulin Dose Adjustment: Outcomes of a Proof-Of-Concept Trial. Telemed J E Health 2017; 24:536-543. [PMID: 29261476 DOI: 10.1089/tmj.2017.0190] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Many patients with diabetes require insulin therapy to achieve optimal glycemic control. Initiation and titration of insulin often require an insulin dose adjustment (IDA) program, involving frequent exchange of blood glucose levels (BGLs) and insulin prescription advice between the patient and healthcare team. This process is time consuming with logistical barriers. OBJECTIVE To develop an innovative mobile health (m-Health) mobile-based IDA program (mIDA) and evaluate the user adherence and experience through a proof-of-concept trial. METHODS In the program, an m-Health system was designed to be integrated within a clinical IDA service, comprising a Bluetooth-enabled glucose meter, smartphone application, and clinician portal. Insulin-requiring patients with type-2 diabetes mellitus and stable BGL were recruited to use the m-Health system to record and exchange BGL entries, insulin dosages, and clinical messages for 2 weeks. The user experience was evaluated by a Likert scale questionnaire. RESULTS Nine participants, aged 58 ± 14 years (mean ± SD), completed the trial with average daily records of 3.1 BGL entries and 1.2 insulin dosage entries. The participants recognized the potential value of the clinical messages. They felt confident about managing their diabetes and were positive regarding ease of use and family support of the system, but disagreed that there were no technical issues. Finally, they were satisfied with the program and would continue to use it if possible. CONCLUSIONS The m-Health system for IDA showed promising levels of adherence, usability, perception of usefulness, and satisfaction. Further research is required to assess the feasibility and cost-effectiveness of using this system in outpatient settings.
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Affiliation(s)
- Hang Ding
- 1 The Australian e-Health Research Centre , CSIRO, Brisbane, Australia
| | - Farhad Fatehi
- 1 The Australian e-Health Research Centre , CSIRO, Brisbane, Australia .,2 Centre for Online Health, Centre for Health Services Research, Faculty of Medicine, The University of Queensland , Brisbane, Australia .,3 Tehran University of Medical Sciences , Tehran, Iran
| | - Anthony W Russell
- 4 Department of Diabetes and Endocrinology, The Princess Alexandra Hospital , Brisbane, Australia .,5 Faculty of Medicine, The University of Queensland , Brisbane, Australia
| | - Mohan Karunanithi
- 1 The Australian e-Health Research Centre , CSIRO, Brisbane, Australia
| | - Anish Menon
- 2 Centre for Online Health, Centre for Health Services Research, Faculty of Medicine, The University of Queensland , Brisbane, Australia .,4 Department of Diabetes and Endocrinology, The Princess Alexandra Hospital , Brisbane, Australia
| | - Dominique Bird
- 2 Centre for Online Health, Centre for Health Services Research, Faculty of Medicine, The University of Queensland , Brisbane, Australia
| | - Leonard C Gray
- 2 Centre for Online Health, Centre for Health Services Research, Faculty of Medicine, The University of Queensland , Brisbane, Australia
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80
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Wood J, Jenkins S, Putrino D, Mulrennan S, Morey S, Cecins N, Hill K. High usability of a smartphone application for reporting symptoms in adults with cystic fibrosis. J Telemed Telecare 2017; 24:547-552. [PMID: 28799841 DOI: 10.1177/1357633x17723366] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction In cystic fibrosis, exacerbations impair lung function and health-related quality of life, increase healthcare costs and reduce survival. Delayed reporting of worsening symptoms can result in more severe exacerbations and worse clinical outcomes; therefore there is a need for a novel approach to facilitate the early identification and treatment of exacerbations in this population. This study investigated the usability of a smartphone application to report symptoms in adults with cystic fibrosis, and the observer agreement in clinical decision-making between senior clinicians interpreting smartphone application responses. Methods Adults with cystic fibrosis used the smartphone application weekly for four weeks. The application comprised 10 yes/no questions regarding respiratory symptoms and two regarding emotional well-being. Usability was measured with the System Usability Scale; Observer agreement was tested by providing a cystic fibrosis physician and a nurse practitioner with 45 clinical scenarios. For each scenario the clinicians, who were blinded to each other's responses, were asked to indicate whether or not they would: (i) initiate telephone contact, and/or (ii) request a clinic visit for the individual. Results Ten participants (five female), aged mean (SD) 33 (11) years, FEV1 49 (27)% predicted completed the study. The mean (SD) System Usability Scale score was 94 (6). There was perfect agreement between clinicians for initiating contact with the participant ( κ = 1.0, p < 0.001), and near-perfect for requesting a clinic visit ( κ = 0.86, p < 0.001). Discussion The use of a smartphone application for reporting symptoms in adults with cystic fibrosis has excellent usability and near-perfect agreement between senior clinicians when interpreting the application responses.
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Affiliation(s)
- Jamie Wood
- 1 School of Physiotherapy and Exercise Science, Curtin University, Western Australia.,2 Physiotherapy Department, Sir Charles Gairdner Hospital, Western Australia.,3 Institute for Respiratory Health, Sir Charles Gairdner Hospital, Western Australia
| | - Sue Jenkins
- 1 School of Physiotherapy and Exercise Science, Curtin University, Western Australia.,2 Physiotherapy Department, Sir Charles Gairdner Hospital, Western Australia.,3 Institute for Respiratory Health, Sir Charles Gairdner Hospital, Western Australia
| | - David Putrino
- 4 Department of Telemedicine and Virtual Rehabilitation, Burke Institute of Medical Research, USA.,5 Department of Rehabilitation Medicine, Weill Cornell Medicine, USA
| | - Siobhain Mulrennan
- 3 Institute for Respiratory Health, Sir Charles Gairdner Hospital, Western Australia.,6 Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Western Australia
| | - Sue Morey
- 3 Institute for Respiratory Health, Sir Charles Gairdner Hospital, Western Australia.,6 Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Western Australia
| | - Nola Cecins
- 2 Physiotherapy Department, Sir Charles Gairdner Hospital, Western Australia
| | - Kylie Hill
- 1 School of Physiotherapy and Exercise Science, Curtin University, Western Australia.,3 Institute for Respiratory Health, Sir Charles Gairdner Hospital, Western Australia
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81
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Affiliation(s)
- Christina A Olson
- Telehealth Department, Children's Hospital Colorado, B720, 13123 East 16th Avenue, Aurora, CO 80045, USA.
| | - John F Thomas
- Telehealth Department, Children's Hospital Colorado, B720, 13123 East 16th Avenue, Aurora, CO 80045, USA
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82
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Guttmann-Bauman I, Kono J, Lin AL, Ramsey KL, Boston BA. Use of Telehealth Videoconferencing in Pediatric Type 1 Diabetes in Oregon. Telemed J E Health 2017; 24:86-88. [PMID: 28654350 DOI: 10.1089/tmj.2017.0072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION We reviewed the impact of telehealth videoconferencing clinics on outcomes of care in pediatric patients with type 1 diabetes in rural Oregon. METHODS We performed a chart review as well as the review of patient satisfaction questionnaires from 27 patients seen in the first year of the program. RESULTS The number of yearly visits to diabetes clinic increased from average 1.5 to 2.7, which was statistically significant (p < 0.0001). Glycemic control remained stable, and there was no difference in the amount of emergency department visits or hospitalizations related to diabetes. Patients expressed high satisfaction with the service and majority considered it equal to in-person visits. CONCLUSION We conclude that telehealth videoconferencing visits have the potential to improve care in pediatric diabetes patients, particularly the patients living in areas distant from subspecialty centers.
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Affiliation(s)
- Ines Guttmann-Bauman
- 1 Division of Pediatric Endocrinology, Oregon Health and Science University , Portland, Oregon
| | - Joannie Kono
- 1 Division of Pediatric Endocrinology, Oregon Health and Science University , Portland, Oregon
| | - Amber Laurie Lin
- 2 Biostatistics and Design Program, Oregon Health and Science University , Portland, Oregon
| | - Katrina L Ramsey
- 2 Biostatistics and Design Program, Oregon Health and Science University , Portland, Oregon
| | - Bruce A Boston
- 1 Division of Pediatric Endocrinology, Oregon Health and Science University , Portland, Oregon
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83
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Raymond JK. Models of Care for Adolescents and Young Adults with Type 1 Diabetes in Transition: Shared Medical Appointments and Telemedicine. Pediatr Ann 2017; 46:e193-e197. [PMID: 28489225 DOI: 10.3928/19382359-20170425-01] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Transitioning through adolescence and young adulthood is challenging, and even more so for patients living with a chronic disease such as type 1 diabetes. Patients in this age group encounter multiple obstacles to effectively managing their diabetes, experience suboptimal glycemic control, face higher rates of acute complications, and are often lost to medical follow-up. Comprehensive strategies and innovative clinical models are needed to engage this population in diabetes medical care, address barriers to ideal management, and improve outcomes. Telemedicine, shared medical appointments (SMA), or a combination of telemedicine and SMA are potential models to more successfully, efficiently, and satisfactorily address the urgent need for improved care in this high-risk population. This article reviews various clinical care models within these categories of telemedicine and SMA. [Pediatr Ann. 2017;46(5):e193-e197.].
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84
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Bouchonville MF, Paul MM, Billings J, Kirk JB, Arora S. Taking Telemedicine to the Next Level in Diabetes Population Management: a Review of the Endo ECHO Model. Curr Diab Rep 2016; 16:96. [PMID: 27549110 DOI: 10.1007/s11892-016-0784-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Worldwide increases in diabetes prevalence in the face of limited medical resources have prompted international interest in innovative healthcare delivery models. Project ECHO (Extension for Community Healthcare Outcomes) is a "telementoring" program which has been shown to increase capacity for complex disease management in medically underserved regions. In contrast to a traditional telemedicine model which might connect a specialist with one patient, the ECHO model allows for multiple patients to benefit simultaneously by building new expertise. We recently applied the ECHO model to improve health outcomes of patients with complex diabetes (Endo ECHO) living in rural New Mexico. We describe the design of the Endo ECHO intervention and a 4-year, prospective program evaluation assessing health outcomes, utilization patterns, and cost-effectiveness. The Endo ECHO evaluation will demonstrate whether and to what extent this intervention improves outcomes for patients with complex diabetes living in rural New Mexico, and will serve as proof-of-concept for academic medical centers wishing to replicate the model in underserved regions around the world.
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Affiliation(s)
- Matthew F Bouchonville
- Division of Endocrinology, Diabetes, and Metabolism, University of New Mexico School of Medicine, Albuquerque, NM, USA.
| | - Margaret M Paul
- Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - John Billings
- Wagner School of Public Service, New York University, New York, NY, USA
| | - Jessica B Kirk
- University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Sanjeev Arora
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
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85
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Raymond JK, Berget CL, Driscoll KA, Ketchum K, Cain C, “Fred” Thomas JF. CoYoT1 Clinic: Innovative Telemedicine Care Model for Young Adults with Type 1 Diabetes. Diabetes Technol Ther 2016; 18:385-90. [PMID: 27196443 PMCID: PMC5583551 DOI: 10.1089/dia.2015.0425] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Young adults with type 1 diabetes (T1D) face many challenges in managing their diabetes, resulting in suboptimal glycemic control and often loss to follow-up. Comprehensive strategies are needed to engage this population in diabetes care and improve outcomes. This pilot study investigated the feasibility and acceptability of the Colorado Young Adults with Type 1 Diabetes (CoYoT1) Clinic-an innovative clinical care model for young adults with T1D, incorporating telemedicine and peer interactions. SUBJECTS AND METHODS Forty-five patients with T1D, 18-25 years of age, participated in this study. Patients completed one routine, diabetes clinic appointment, using Health Insurance Portability and Accountability-approved, Web-based videoconferencing from a location of their choosing. The clinic visit consisted of an individual appointment with a diabetes provider and a group appointment with other young adults, facilitated by a certified diabetes educator. Patients completed a satisfaction survey and reported the time lost from school or work to complete the virtual appointment compared with time typically lost to complete a traditional, in-person, visit. RESULTS Patients reported high levels of satisfaction with the virtual clinic and high levels of perceived support from the peer interaction. Additionally, patients reported saving over 6 h from their work or school day when completing their diabetes clinic visit virtually instead of in-person. CONCLUSIONS In this cross-sectional pilot study, the CoYoT1 Clinic, incorporating Web-based videoconferencing and peer interactions, was feasible and acceptable for young adults with T1D. This model may potentially increase engagement with diabetes care in the young adult population. However, further research is needed to fully evaluate the intervention.
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Affiliation(s)
- Jennifer K. Raymond
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Cari L. Berget
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kimberly A. Driscoll
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kaitlin Ketchum
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Cynthia Cain
- Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - John F. “Fred” Thomas
- Department of Telehealth, Children's Hospital Colorado, Aurora, Colorado
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
- Department of Epidemiology, University of Colorado School of Public Health, Aurora, Colorado
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86
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Gur M, Nir V, Teleshov A, Bar-Yoseph R, Manor E, Diab G, Bentur L. The use of telehealth (text messaging and video communications) in patients with cystic fibrosis: A pilot study. J Telemed Telecare 2016; 23:489-493. [PMID: 27177869 DOI: 10.1177/1357633x16649532] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Poor communications between cystic fibrosis (CF) patients and health-care providers may result in gaps in knowledge and misconceptions about medication usage, and can lead to poor adherence. We aimed to assess the feasibility of using WhatsApp and Skype to improve communications. Methods This single-centre pilot study included CF patients who were older than eight years of age assigned to two groups: one without intervention (control group), and one with intervention. Each patient from the intervention group received Skype-based online video chats and WhatsApp messages from members of the multidisciplinary CF team. CF questionnaires, revised (CFQ-R) scores, knowledge and adherence based on CF My Way and patients satisfaction were evaluated before and after three months. Feasibility was assessed by session attendance, acceptability and satisfaction survey. Descriptive analysis and paired and non-paired t-tests were used as applicable. Results Eighteen patients were recruited to this feasibility study (nine in each group). Each intervention group participant had between four and six Skype video chats and received 22-45 WhatsApp messages. In this small study, CFQ-R scores, knowledge, adherence and patient satisfaction were similar in both groups before and after the three-month intervention. Conclusions A telehealth-based approach, using Skype video chats and WhatsApp messages, was feasible and acceptable in this pilot study. A larger and longer multi-centre study is warranted to examine the efficacy of these interventions to improve knowledge, adherence and communication.
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Affiliation(s)
- Michal Gur
- 1 Paediatric Pulmonary Institute and CF Centre, Rappaport Children's Hospital, Rambam Health Care Campus, Israel
| | - Vered Nir
- 1 Paediatric Pulmonary Institute and CF Centre, Rappaport Children's Hospital, Rambam Health Care Campus, Israel
| | - Anna Teleshov
- 1 Paediatric Pulmonary Institute and CF Centre, Rappaport Children's Hospital, Rambam Health Care Campus, Israel
| | - Ronen Bar-Yoseph
- 1 Paediatric Pulmonary Institute and CF Centre, Rappaport Children's Hospital, Rambam Health Care Campus, Israel
| | - Eynav Manor
- 1 Paediatric Pulmonary Institute and CF Centre, Rappaport Children's Hospital, Rambam Health Care Campus, Israel
| | - Gizelle Diab
- 1 Paediatric Pulmonary Institute and CF Centre, Rappaport Children's Hospital, Rambam Health Care Campus, Israel
| | - Lea Bentur
- 1 Paediatric Pulmonary Institute and CF Centre, Rappaport Children's Hospital, Rambam Health Care Campus, Israel.,2 Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Israel
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Giani E, Laffel L. Opportunities and Challenges of Telemedicine: Observations from the Wild West in Pediatric Type 1 Diabetes. Diabetes Technol Ther 2016; 18:1-3. [PMID: 26756102 PMCID: PMC5248506 DOI: 10.1089/dia.2015.0360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Elisa Giani
- Pediatric, Adolescent and Young Adult, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
- Genetics and Epidemiology Sections, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Lori Laffel
- Pediatric, Adolescent and Young Adult, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
- Genetics and Epidemiology Sections, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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