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Lindholm Olinder A, DeAbreu M, Greene S, Haugstvedt A, Lange K, Majaliwa ES, Pais V, Pelicand J, Town M, Mahmud FH. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes education in children and adolescents. Pediatr Diabetes 2022; 23:1229-1242. [PMID: 36120721 PMCID: PMC10107631 DOI: 10.1111/pedi.13418] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 12/29/2022] Open
Affiliation(s)
- Anna Lindholm Olinder
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden.,Sachs' Children and Youths Hospital, Södersjukhuset, Stockholm, Sverige
| | - Matthew DeAbreu
- Parent and Advocate of Child with Type One Diabetes, Toronto, Ontario, Canada
| | | | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Karin Lange
- Medical Psychology Unit, Hannover Medical School, Hannover, Germany
| | - Edna S Majaliwa
- Department of Paediatrics and child health, Muhimbili National Hospital, Dar es Salaam, Tanzania.,Departement of peadiatrics and child health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Vanita Pais
- Department of Endocrinology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julie Pelicand
- Pediatric Diabetology Unit, San Camilo Hospital, Medicine School, Universidad de Valparaiso, San Felipe, Chile.,Childhood, Adolescence & Diabetes, Toulouse Hospital, Toulouse, France
| | - Marissa Town
- Children with Diabetes and Department of Pediatric Endocrinology, Stanford University, California, USA
| | - Farid H Mahmud
- Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada
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2
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Limbert C, Tinti D, Malik F, Kosteria I, Messer L, Jalaludin MY, Benitez-Aguirre P, Biester S, Corathers S, von Sengbusch S, Marcovecchio ML. ISPAD Clinical Practice Consensus Guidelines 2022: The delivery of ambulatory diabetes care to children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1243-1269. [PMID: 36537530 DOI: 10.1111/pedi.13417] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Catarina Limbert
- Unit of Paediatric Endocrinology and Diabetes, Hospital Dona Estefânia, Lisbon, Portugal.,Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Davide Tinti
- Department of Pediatrics, University of Turin, Turin, Italy
| | - Faisal Malik
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Ioanna Kosteria
- Department of Endocrinology, Growth & Development, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Laurel Messer
- Barbara Davis Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Paul Benitez-Aguirre
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Biester
- Diabetes-Center for Children and Adolescents, Children's Hospital "Auf der Bult", Hannover, Germany
| | - Sarah Corathers
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Simone von Sengbusch
- Division of Pediatric Endocrinology and Diabetology, Campus Lübeck, University Medical Centre Schleswig-Holstein, Lübeck, Germany
| | - M Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Davis SA, Coyne I, Carpenter DM, Thomas KC, Lee C, Garcia N, Sleath B. Adolescent Preferences Regarding a Web Site to Empower Adolescents to Talk With Their Healthcare Providers. J Adolesc Health 2021; 68:629-631. [PMID: 32713739 DOI: 10.1016/j.jadohealth.2020.06.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/29/2020] [Accepted: 06/16/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE Adolescents experience challenges managing their chronic conditions, partly owing to limited involvement in medical visits. Because adolescents are "digital natives," providing a specific Web site with educational resources may support better adolescent-provider communication. Our purpose was to determine adolescents' opinions about a health communication-focused Web site. METHODS Sixty English-speaking adolescents aged 11-17 years with a chronic health condition (mean age: 13.3 years; SD 1.9) were enrolled at a pediatric clinic in rural North Carolina. RESULTS Adolescents most commonly accessed YouTube and Google for online health information. Nearly all adolescents supported the creation of a Web site and resources on how to communicate with their healthcare provider. Adolescents most often wanted to talk to specialists about their health and to pharmacists about their medications. CONCLUSIONS A Web site and educational resources are currently being codeveloped with adolescents. It is essential that we find ways to engage adolescents in their healthcare management.
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Affiliation(s)
- Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina.
| | - Imelda Coyne
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Kathleen C Thomas
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Research, University of North Carolina Health Sciences at Mountain Area Health Education Center, Asheville, North Carolina
| | | | - Nacire Garcia
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Betsy Sleath
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Smith MB, Albanese-O'Neill A, Yao Y, Wilkie DJ, Haller MJ, Keenan GM. Feasibility of the Web-Based Intervention Designed to Educate and Improve Adherence Through Learning to Use Continuous Glucose Monitor (IDEAL CGM) Training and Follow-Up Support Intervention: Randomized Controlled Pilot Study. JMIR Diabetes 2021; 6:e15410. [PMID: 33560234 PMCID: PMC7902192 DOI: 10.2196/15410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 07/11/2020] [Accepted: 07/23/2020] [Indexed: 01/29/2023] Open
Abstract
Background Proper training and follow-up for patients new to continuous glucose monitor (CGM) use are required to maintain adherence and achieve diabetes-related outcomes. However, CGM training is hampered by the lack of evidence-based standards and poor reimbursement. We hypothesized that web-based CGM training and education would be effective and could be provided with minimal burden to the health care team. Objective The aim of this study was to perform a pilot feasibility study testing a theory-driven, web-based intervention designed to provide extended training and follow-up support to adolescents and young adults newly implementing CGM and to describe CGM adherence, glycemic control, and CGM-specific psychosocial measures before and after the intervention. Methods The “Intervention Designed to Educate and improve Adherence through Learning to use CGM (IDEAL CGM)” web-based training intervention was based on supporting literature and theoretical concepts adapted from the health belief model and social cognitive theory. Patients new to CGM, who were aged 15-24 years with type 1 diabetes for more than 6 months were recruited from within a public university’s endocrinology clinic. Participants were randomized to enhanced standard care or enhanced standard care plus the IDEAL CGM intervention using a 1:3 randomization scheme. Hemoglobin A1c levels and psychosocial measures were assessed at baseline and 3 months after start of the intervention. Results Ten eligible subjects were approached for recruitment and 8 were randomized. Within the IDEAL CGM group, 4 of the 6 participants received exposure to the web-based training. Half of the participants completed at least 5 of the 7 modules; however, dosage of the intervention and level of engagement varied widely among the participants. This study provided proof of concept for use of a web-based intervention to deliver follow-up CGM training and support. However, revisions to the intervention are needed in order to improve engagement and determine feasibility. Conclusions This pilot study underscores the importance of continued research efforts to optimize the use of web-based intervention tools for their potential to improve adherence and glycemic control and the psychosocial impact of the use of diabetes technologies without adding significant burden to the health care team. Enhancements should be made to the intervention to increase engagement, maximize responsiveness, and ensure attainment of the skills necessary to achieve consistent use and improvements in glycemic control prior to the design of a larger well-powered clinical trial to establish feasibility. Trial Registration ClinicalTrials.gov NCT03367351, https://clinicaltrials.gov/ct2/show/NCT03367351.
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Affiliation(s)
- Madison B Smith
- College of Nursing, University of Florida, Gainesville, FL, United States
| | | | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, United States
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, United States
| | - Michael J Haller
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Gail M Keenan
- Department of Family, Community and Health Systems Science, College of Nursing, University of Florida, Gainesville, FL, United States
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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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Smartphone App as Motivational Intervention to Improve Glycemic Control in Adolescents with Type 1 Diabetes. Indian J Pediatr 2019; 86:1118-1123. [PMID: 31353430 DOI: 10.1007/s12098-019-03035-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 07/08/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Type 1 diabetes (T1D) adolescents often do not achieve good glycemic control. In the context of growing number of technologically savvy adolescents, this study was done to examine the effectiveness of a motivational smartphone app to improve their glycemic control. METHODS Eleven to eighteen year old adolescents, treated by Pediatric endocrine team of CMC, Vellore, who had T1D ≥ 1 y duration with poor glycemic control (mean HbA1c ≥ 8.5% in preceding 12 mo) were recruited. An app programmed to provide 3 reminders per day regarding insulin, meals and physical exercise was installed on their phone. Diabetes management was continued as per the standard of care. HbA1C was measured after 3 mo. RESULTS Thirty seven adolescents were recruited; 3 were excluded as the app became non-functional. Seventeen were boys, mean age was 13.8 y (11-18 y) and mean duration of diabetes was 4.9 y (0.8-16 y). The mean HbA1c levels over preceding 12 mo and at recruitment were 10.75% (1.88) and 10.6% (2.08) respectively. Twenty eight participants returned for repeat HbA1C after 3-4 mo. As compared to baseline there was significant reduction in HbA1c level: 10.6% (2.08) vs. 9.65% (1.6); p = 0.004. Twenty two of twenty eight participants showed reduction in HbA1c after app installation. The magnitude of change in HbA1c levels over a 3 mo period before and after the app use was analyzed. There was significant difference between mean HbA1c levels before and after app use; +0.28 (2.06) vs. -0.914 (1.52); p = 0.019. CONCLUSIONS Following usage of smartphone app as a motivational intervention in adolescents with Type 1 diabetes, there was significant reduction in HbA1c level after 3 mo. With continued use, this may benefit them to achieve target HbA1c levels. Use of mobile phone apps as motivational interventions is feasible in adolescents with Type 1 diabetes in India.
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Alhuwail D, Abduo H, Alqabandi N, Abu-Ghefreh A, Dawwas B, Halawa N. Engagement and Usage Patterns of a Diabetes Education Website Tailored for Arabic Speakers: A Case Study of a Diabetes Website from Kuwait. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2019. [DOI: 10.1080/15398285.2018.1547088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Dari Alhuwail
- Health Informatics Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
- College of Computing Sciences & Engineering, Kuwait University, Kuwait City, Kuwait
| | - Heba Abduo
- Pharmacotherapy Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Naeema Alqabandi
- Pharmacotherapy Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Ala’a Abu-Ghefreh
- Pharmacotherapy Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Basil Dawwas
- Pharmacotherapy Department, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Nadine Halawa
- Pharmacy Department, IWK Hospital, Halifax, Nova Scotia, Canada
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Knox ECL, Quirk H, Glazebrook C, Randell T, Blake H. Impact of technology-based interventions for children and young people with type 1 diabetes on key diabetes self-management behaviours and prerequisites: a systematic review. BMC Endocr Disord 2019; 19:7. [PMID: 30630442 PMCID: PMC6329145 DOI: 10.1186/s12902-018-0331-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/21/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The role of technology in the self-management of type 1 diabetes mellitus (T1DM) among children and young people is not well understood. Interventions should aim to improve key diabetes self-management behaviours (self-management of blood glucose, insulin administration, physical activity and dietary behaviours) and prerequisites (psychological outcomes and HbA1c) highlighted in the UK guidelines of the National Institute for Health and Care Excellence (NICE) for management of T1DM. The purpose was to identify evidence to assess the effectiveness of technological tools in promoting aspects of these guidelines amongst children and young people. METHODS A systematic review of English language articles was conducted using the following databases: Web of Science, PubMed, Scopus, NUSearch, SAGE Journals, SpringerLink, Google Scholar, Science Direct, Sport Discus, Embase, Psychinfo and Cochrane Trials. Search terms included paediatric, type one diabetes, technology, intervention and various synonyms. Included studies examined interventions which supplemented usual care with a health care strategy primarily delivered through a technology-based medium (e.g. mobile phone, website, activity monitor) with the aim of engaging children and young people with T1DM directly in their diabetes healthcare. Studies did not need to include a comparator condition and could be randomised, non-randomised or cohort studies but not single-case studies. RESULTS Of 30 included studies (21 RCTs), the majority measured self-monitoring of blood glucose monitoring (SMBG) frequency, clinical indicators of diabetes self-management (e.g. HbA1c) and/or psychological or cognitive outcomes. The most positive findings were associated with technology-based health interventions targeting SMBG as a behavioural outcome, with some benefits found for clinical and/or psychological diabetes self-management outcomes. Technological interventions were well accepted by children and young people. For the majority of included outcomes, clinical relevance was deemed to be little or none. CONCLUSIONS More research is required to assess which elements of interventions are most likely to produce beneficial behavioural outcomes. To produce clinically relevant outcomes, interventions may need to be delivered for at least 1 year and should consider targeting individuals with poorly managed diabetes. It is not possible to determine the impact of technology-based interventions on insulin administration, dietary habits and/or physical activity behaviour due to lack of evidence.
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Affiliation(s)
- Emily C. L. Knox
- University of Nottingham, School of Health Sciences, Nottingham, UK
| | - Helen Quirk
- Sheffield Hallam University, Centre for Sport and Exercise Science, Sheffield, UK
| | - Cris Glazebrook
- University of Nottingham, School of Medicine, Nottingham, UK
| | - Tabitha Randell
- Department of Paediatric Endocrinology and Diabetes, Nottingham Children’s Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Holly Blake
- University of Nottingham, School of Health Sciences, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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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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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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Griffiths FE, Armoiry X, Atherton H, Bryce C, Buckle A, Cave JAK, Court R, Hamilton K, Dliwayo TR, Dritsaki M, Elder P, Forjaz V, Fraser J, Goodwin R, Huxley C, Ignatowicz A, Karasouli E, Kim SW, Kimani P, Madan JJ, Matharu H, May M, Musumadi L, Paul M, Raut G, Sankaranarayanan S, Slowther AM, Sujan MA, Sutcliffe PA, Svahnstrom I, Taggart F, Uddin A, Verran A, Walker L, Sturt J. The role of digital communication in patient–clinician communication for NHS providers of specialist clinical services for young people [the Long-term conditions Young people Networked Communication (LYNC) study]: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BackgroundYoung people (aged 16–24 years) with long-term health conditions tend to disengage from health services, resulting in poor health outcomes. They are prolific users of digital communications. Innovative UK NHS clinicians use digital communication with these young people. The NHS plans to use digital communication with patients more widely.ObjectivesTo explore how health-care engagement can be improved using digital clinical communication (DCC); understand effects, impacts, costs and necessary safeguards; and provide critical analysis of its use, monitoring and evaluation.DesignObservational mixed-methods case studies; systematic scoping literature reviews; assessment of patient-reported outcome measures (PROMs); public and patient involvement; and consensus development through focus groups.SettingTwenty NHS specialist clinical teams from across England and Wales, providing care for 13 different long-term physical or mental health conditions.ParticipantsOne hundred and sixty-five young people aged 16–24 years living with a long-term health condition; 13 parents; 173 clinical team members; and 16 information governance specialists.InterventionsClinical teams and young people variously used mobile phone calls, text messages, e-mail and voice over internet protocol.Main outcome measuresEmpirical work – thematic and ethical analysis of qualitative data; annual direct costs; did not attend, accident and emergency attendance and hospital admission rates plus clinic-specific clinical outcomes. Scoping reviews–patient, health professional and service delivery outcomes and technical problems. PROMs: scale validity, relevance and credibility.Data sourcesObservation, interview, structured survey, routinely collected data, focus groups and peer-reviewed publications.ResultsDigital communication enables access for young people to the right clinician when it makes a difference for managing their health condition. This is valued as additional to traditional clinic appointments. This access challenges the nature and boundaries of therapeutic relationships, but can improve them, increase patient empowerment and enhance activation. Risks include increased dependence on clinicians, inadvertent disclosure of confidential information and communication failures, but clinicians and young people mitigate these risks. Workload increases and the main cost is staff time. Clinical teams had not evaluated the impact of their intervention and analysis of routinely collected data did not identify any impact. There are no currently used generic outcome measures, but the Patient Activation Measure and the Physicians’ Humanistic Behaviours Questionnaire are promising. Scoping reviews suggest DCC is acceptable to young people, but with no clear evidence of benefit except for mental health.LimitationsQualitative data were mostly from clinician enthusiasts. No interviews were achieved with young people who do not attend clinics. Clinicians struggled to estimate workload. Only eight full sets of routine data were available.ConclusionsTimely DCC is perceived as making a difference to health care and health outcomes for young people with long-term conditions, but this is not supported by evidence that measures health outcomes. Such communication is challenging and costly to provide, but valued by young people.Future workFuture development should distinguish digital communication replacing traditional clinic appointments and additional timely communication. Evaluation is needed that uses relevant generic outcomes.Study registrationTwo of the reviews in this study are registered as PROSPERO CRD42016035467 and CRD42016038792.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | - Xavier Armoiry
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Helen Atherton
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Carol Bryce
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Abigail Buckle
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Rachel Court
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Kathryn Hamilton
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Thandiwe R Dliwayo
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | | | - Patrick Elder
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Vera Forjaz
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Joe Fraser
- Patient and public involvement representative, London, UK
| | - Richard Goodwin
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | | | | | | | - Sung Wook Kim
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter Kimani
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jason J Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Harjit Matharu
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Mike May
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Moli Paul
- Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Gyanu Raut
- King’s College Hospital NHS Foundation Trust, London, UK
| | | | | | - Mark A Sujan
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | | | - Ayesha Uddin
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Alice Verran
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Leigh Walker
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
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Coyne I, Prizeman G, Sheehan A, Malone H, While AE. An e-health intervention to support the transition of young people with long-term illnesses to adult healthcare services: Design and early use. PATIENT EDUCATION AND COUNSELING 2016; 99:1496-1504. [PMID: 27372524 DOI: 10.1016/j.pec.2016.06.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/25/2016] [Accepted: 06/12/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Co-design information and website to support adolescents and young adults with long-term illnesses in their transition to adult healthcare. METHODS A participatory iterative process involving a survey (n=207), twenty-one interviews, six participatory workshops, six video recordings, two advisory groups, and a co-design group to identify needs and preferences for e-health and information provision, was used to develop an appropriate intervention. RESULTS Adolescents and young people expressed preferences for information that was trustworthy, empowering, colorful, easily downloaded online and written using non-patronizing language. They desired video testimonials of experiences from young adults who had transitioned to adult healthcare and wanted advice about becoming more independent, managing their condition, preparing for the transition, and information about medications and the differences between child and adult healthcare. They also wanted information about the location and configuration of adult healthcare, key hospital personnel, and frequently asked questions. CONCLUSION The participatory iterative process led to the development of an online resource specifically tailored to the adolescents and young people's transition needs and information preferences. Preliminary feedback indicates that it is a valued resource. PRACTICE IMPLICATIONS The www.SteppingUP.ie website has the potential to help prepare its target population group for the transition to adult healthcare.
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Affiliation(s)
- I Coyne
- Trinity College Dublin, School of Nursing & Midwifery, 24, D'Olier Street, Dublin 2, Ireland.
| | - G Prizeman
- Trinity College Dublin, School of Nursing & Midwifery, 24, D'Olier Street, Dublin 2, Ireland.
| | - A Sheehan
- Trinity College Dublin, School of Nursing & Midwifery, 24, D'Olier Street, Dublin 2, Ireland.
| | - H Malone
- Trinity College Dublin, School of Nursing & Midwifery, 24, D'Olier Street, Dublin 2, Ireland.
| | - A E While
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, United Kingdom.
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Huerta TR, Walker DM, Ford EW. An Evaluation and Ranking of Children's Hospital Websites in the United States. J Med Internet Res 2016; 18:e228. [PMID: 27549074 PMCID: PMC5011553 DOI: 10.2196/jmir.5799] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 07/13/2016] [Accepted: 08/03/2016] [Indexed: 11/24/2022] Open
Abstract
Background Children’s hospitals are faced with the rising need for technological innovation. Their prospective health care consumers, who increasingly depend on the Web and social media for communication and consumer engagement, drive this need. As patients and family members navigate the Web presence of hospitals, it is important for these specialized organizations to present themselves and their services efficiently. Objective The purpose of this study was to evaluate the website content of children’s hospitals in order to identify opportunities to improve website design and create benchmarks to judge improvement. Methods All websites associated with a children’s hospital were identified using a census list of all children’s hospitals in the United States. In March of 2014, each website and its social media were evaluated using a Web crawler that provided a 5-dimensional assessment that included website accessibility, marketing, content, technology, and usability. The 5-dimensional assessment was scored on a scale ranging from 0 to 10 with positive findings rated higher on the scale. Websites were ranked by individual dimensions as well as according to their average ranking across all dimensions. Results Mean scores of 153 websites ranged from 5.05 to 8.23 across all 5 dimensions. Results revealed that no website scored a perfect 10 on any dimension and that room exists for meaningful improvement. Conclusions Study findings allow for the establishment of baseline benchmarks for tracking future website and social media improvements and display the need for enhanced Web-based consumer engagement for children’s hospitals.
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Affiliation(s)
- Timothy R Huerta
- The Ohio State University, College of Medicine, Department of Family Medicine, Columbus, OH, United States.
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14
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Su D, McBride C, Zhou J, Kelley MS. Does nutritional counseling in telemedicine improve treatment outcomes for diabetes? A systematic review and meta-analysis of results from 92 studies. J Telemed Telecare 2015; 22:333-47. [PMID: 26442959 DOI: 10.1177/1357633x15608297] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 09/01/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND A growing number of studies and reviews have documented the impact of telemedicine on diabetes management. However, no meta-analysis has assessed whether including nutritional counseling as part of a telemedicine program has a significant impact on diabetes outcomes or what kind of nutritional counseling is most effective. METHODS Original research articles examining the effect of telemedicine interventions on HbA1c levels in patients with Type 1 or Type 2 diabetes were included in this study. A literature search was performed and 92 studies were retained for analysis. We examined stratified results by differentiating interventions using no nutritional counseling from those that used nutritional counseling. We further compared between nutritional counseling administered via short message systems (SMS) such as email and text messages, and nutritional counseling administered via telephone or videoconference. RESULTS Telemedicine programs that include a nutritional component show similar effect in diabetes management as those programs that do not. Furthermore, subgroup analysis reveals that nutritional intervention via SMS such as email and text messages is at least as equally effective in reducing HbA1c when compared to personal nutritional counseling with a practitioner over videoconference or telephone. CONCLUSION The inclusion of nutritional counseling as part of a telemedicine program does not make a significant difference to diabetes outcomes. Incorporating nutritional counseling into telemedicine programs via SMS is at least as effective as counseling via telephone or videoconference.
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Affiliation(s)
- Dejun Su
- Department of Health Promotion, Social & Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Junmin Zhou
- Department of Health Promotion, Social & Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Megan S Kelley
- Department of Nutrition and Health Sciences, College of Education and Human Sciences, University of Nebraska-Lincoln, USA
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15
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Schiaffini R, Tagliente I, Carducci C, Ullmann N, Ciampalini P, Lorubbio A, Cappa M. Impact of long-term use of eHealth systems in adolescents with type 1 diabetes treated with sensor-augmented pump therapy. J Telemed Telecare 2015; 22:277-81. [DOI: 10.1177/1357633x15598425] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/09/2015] [Indexed: 01/22/2023]
Abstract
Telemedicine in diabetes includes telemonitoring and transmission of important data (self monitoring of blood glucose data, insulin therapy, pump setting, etc.) from the patient s home to the diabetic unit, with a real-time health feedback. Moreover, an eHealth approach is thought to facilitate diabetes management and to improve compliance to CSII/SAP treatment in adolescents, but to date, limited literature related to this topic is available and long-term studies are still lacking. The main aim of this study was to compare the long-term effect on glycometabolic control of eHealth intervention and traditional care in T1DM SAP-treated adolescents. In our study we demonstrated a favorable impact of monthly teleassistance on treatment compliance. Adolescents receiving frequent feedback provided by the medicalmultidisciplinary team, due to the telemonitoring, resulted more compliant in self-management of diabetes. In particular, the medical team feedback resulted in interventions on behavioral errors and insulin therapy adjustments, leading to an improved glycometabolic control.
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Affiliation(s)
- R Schiaffini
- Unit of Endocrinology and Diabetes, Bambino Gesù Children's Hospital, Italy
| | - I Tagliente
- Technology, HTA and Safety Research Unit, Bambino Gesù Children's Hospital, Italy
| | - C Carducci
- Unit of Endocrinology and Diabetes, Bambino Gesù Children's Hospital, Italy
| | - N Ullmann
- Department of Pediatric Medicine, Bambino Gesù Children's Hospital, Rome, Italy
| | - P Ciampalini
- Unit of Endocrinology and Diabetes, Bambino Gesù Children's Hospital, Italy
| | - A Lorubbio
- Clinical Trial Center, Bambino Gesù Children's Hospital, Italy
| | - M Cappa
- Unit of Endocrinology and Diabetes, Bambino Gesù Children's Hospital, Italy
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16
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Riazi H, Larijani B, Langarizadeh M, Shahmoradi L. Managing diabetes mellitus using information technology: a systematic review. J Diabetes Metab Disord 2015; 14:49. [PMID: 26075190 PMCID: PMC4465147 DOI: 10.1186/s40200-015-0174-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/17/2015] [Indexed: 12/12/2022]
Abstract
Objective To review published evidences about using information technology interventions in diabetes care and determine their effects on managing diabetes. Design Systematic review of information technology based interventions. Research design and methods MEDLINE®/PubMed were electronically searched for articles published between 2004/07/01 and 2014/07/01. A comprehensive, electronic search strategy was used to identify eligible articles. Inclusion criteria were defined based on type of study and effect of information technology based intervention in relation to glucose control and other clinical outcomes in diabetic patients. Studies must have used a controlled design to evaluate an information technology based intervention. A total of 3613 articles were identified based on the searches conducted in MEDLINE from PubMed. After excluding duplicates (n = 6), we screened titles and abstracts of 3607 articles based on inclusion criteria. The remaining articles matched with inclusion criteria (n = 277) were reviewed in full text, and 210 articles were excluded based on exclusion criteria. Finally, 67 articles complied with our eligibility criteria and were included in this study. Results In this study, the effect of various information technology based interventions on clinical outcomes in diabetic patients extracted and measured from selected articles is described and compared to each other. Conclusion Information technology based interventions combined with the usual care are associated with improved glycemic control with different efficacy on various clinical outcomes in diabetic patients.
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Affiliation(s)
- H Riazi
- School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - B Larijani
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - M Langarizadeh
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - L Shahmoradi
- School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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17
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Shalitin S, Chase HP. Diabetes technology and therapy in the pediatric age group. Diabetes Technol Ther 2015; 17 Suppl 1:S96-S108. [PMID: 25679436 DOI: 10.1089/dia.2015.1512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Shlomit Shalitin
- 1 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
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18
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Pihoker C, Forsander G, Fantahun B, Virmani A, Luo X, Hallman M, Wolfsdorf J, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2014. The delivery of ambulatory diabetes care to children and adolescents with diabetes. Pediatr Diabetes 2014; 15 Suppl 20:86-101. [PMID: 25182310 DOI: 10.1111/pedi.12181] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/13/2014] [Indexed: 01/01/2023] Open
Affiliation(s)
- Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA, USA
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Abstract
This study aims to provide a better understanding of the ability of mobile health tools to offer glycemic control for patients with type 1 diabetes mellitus. Data gained from research articles searched in PubMed, Ovid (Medline), and CINAHL from 2005 to 2013 focused on interventions introduced to a type 1 diabetic population. Articles were screened to identify interventions that examined mobile health tools effect on glycemic control using %A1C as a proxy. Fourteen articles were included in this study. Descriptive data, %A1C difference, and statistical significance, if available, were extracted for comparison. Five major categories were identified across the spectrum of interventions, including "Internet," "Mobile," "Mobile and Internet," "Phone," and "Videoconference and phone." Seven of the 14 articles reported statistically significant decreases in measured outcomes. Seven studies examine a single cohort, and 7 examined a double cohort. Eleven of the 14 authors (79%) reported success with their intervention. Twelve studies reported a decrease in %A1C values in their intervention groups. Initial results for glycemic control through these tools appear promising, though inconclusive. Additional measures of mobile health tool efficacy should be assessed more directly. More rigorous study methods are also needed to improve the reliability of results.
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Affiliation(s)
- Adam Peterson
- Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia, MO, USA
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20
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Shalitin S, Ben-Ari T, Yackobovitch-Gavan M, Tenenbaum A, Lebenthal Y, de Vries L, Phillip M. Using the Internet-based upload blood glucose monitoring and therapy management system in patients with type 1 diabetes. Acta Diabetol 2014; 51:247-56. [PMID: 23982170 DOI: 10.1007/s00592-013-0510-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 08/12/2013] [Indexed: 01/13/2023]
Abstract
The aim of this study is to assess the impact of the internet-based upload blood glucose monitoring and therapy management system (Carelink(®)) in patients with type 1 diabetes. Diabetic patients treated with pump infusion for ≥3 months were prospectively randomized to use the CareLink(®) with (4 months) and without (4 months) diabetes-team initiated contact (n = 36, intervention group) or to continue standard care for 4 months and then transfer to the CareLink(®) without diabetes-team initiated contact (n = 34, control group). In the first 4 months, treatment was adjusted monthly by the same team in both groups. Main outcome measures were HbA1c level and scores on the Diabetes Treatment Satisfaction and Diabetes Quality of Life Questionnaires. Patients who submitted <3 times during each 4-month segment were considered noncompliant. Mean patient age was 14.02 ± 5.33 years; mean diabetes duration, 6.4 ± 4.7 years; median duration of pump treatment, 2.5 years. After 4 months, mean HbA1c level decreased from 8.75 ± 0.84 to 8.45 ± 0.90% in the intervention group (p = 0.013) and from 8.65 ± 0.57 to 8.37 ± 0.73% in the control group (p = 0.054). Within the intervention group, the difference in the change in HbA1c levels between compliant and noncompliant patients was significant (8.17 ± 0.81 vs. 8.99 ± 0.85%, p = 0.017). Only in the compliant subgroup was the decrease from baseline significant (p = 0.006). Similar findings were noted in the control group at 8 months (p < 0.05 and p = 0.018, respectively). There were no significant changes in questionnaire scores at 4 or 8 months in either group. Use of the CareLink(®) system is associated with significantly improved glycemic control in compliant patients, with no apparent effect on patient satisfaction or quality of life.
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Affiliation(s)
- S Shalitin
- The Jesse Z. and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, 14 Kaplan Street, 49202, Petach Tikva, Israel,
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21
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Jaacks LM, Bell RA, Dabelea D, D'Agostino RB, Dolan LM, Imperatore G, Klingensmith G, Lawrence JM, Saydah S, Yi-Frazier J, Mayer-Davis EJ. Diabetes self-management education patterns in a US population-based cohort of youth with type 1 diabetes. THE DIABETES EDUCATOR 2014; 40:29-39. [PMID: 24248833 PMCID: PMC4076934 DOI: 10.1177/0145721713512156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study is to describe (1) the receipt of diabetes self-management education (DSME) in a large, diverse cohort of US youth with type 1 diabetes (T1DM), (2) the segregation of self-reported DSME variables into domains, and (3) the demographic and clinical characteristics of youth who receive DSME. METHODS Data are from the US population-based cohort SEARCH for Diabetes in Youth. A cross-sectional analysis was employed using data from 1273 youth <20 years of age at the time of diagnosis of T1DM. Clusters of 19 self-reported DSME variables were derived using factor analysis, and their associations with demographic and clinical characteristics were evaluated using polytomous logistic regression. RESULTS Nearly all participants reported receiving DSME content consistent with "survival skills" (eg, target blood glucose and what to do for low or high blood glucose), yet gaps in continuing education were identified (eg, fewer than half of the participants reported receiving specific medical nutrition therapy recommendations). Five DSME clusters were explored: receipt of specific MNT recommendations, receipt of diabetes information resources, receipt of clinic visit information, receipt of specific diabetes information, and met with educator or nutritionist. Factor scores were significantly associated with demographic and clinical characteristics, including race/ethnicity, socioeconomic status, and diabetes self-management practices. CONCLUSIONS Health care providers should work together to address reported gaps in DSME to improve patient care.
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Affiliation(s)
- Lindsay M Jaacks
- the Department of Nutrition, University of North Carolina, Chapel Hill, NC (Ms Jaacks, Dr Mayer-Davis)
| | - Ronny A Bell
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (Dr Bell)
| | - Dana Dabelea
- Department of Pediatrics and Barbara Davis Center, University of Colorado, Denver, CO (Dr Dabelea, Dr Klingensmith)
| | - Ralph B D'Agostino
- Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, NC (Dr D’Agostino)
| | - Lawrence M Dolan
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH (Dr Dolan)
| | | | - Georgeanna Klingensmith
- Department of Pediatrics and Barbara Davis Center, University of Colorado, Denver, CO (Dr Dabelea, Dr Klingensmith)
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (Dr Lawrence)
| | - Sharon Saydah
- Centers for Disease Control and Prevention, Atlanta, GA (Dr Imperatore, Dr Saydah)
| | | | - Elizabeth J Mayer-Davis
- the Department of Nutrition, University of North Carolina, Chapel Hill, NC (Ms Jaacks, Dr Mayer-Davis)
- Department of Medicine, University of North Carolina, Chapel Hill, NC (Dr Mayer-Davis)
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Franklin BE, Crisler SC, Shappley R, Armour MM, McCommon DT, Ferry RJ. Real-time support of pediatric diabetes self-care by a transport team. Diabetes Care 2014; 37:81-7. [PMID: 23959568 PMCID: PMC3968448 DOI: 10.2337/dc13-1041] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The study seeks to improve access for underserved patients via novel integration of Pedi-Flite (a critical care transport team) and to validate whether this safely enhances diabetes care and effectively expands the endocrine workforce. RESEARCH DESIGN AND METHODS The study retrospectively analyzed pager service use in a cohort of established diabetic patients (n = 979) after inception of Pedi-Flite support. Outcomes included incidence and severity of recurrent diabetic ketoacidosis (DKA) and cost savings generated from reduced referrals to the emergency department (ED) and on-call endocrinologist. We generated descriptive statistics to characterize the study population and ED visits for DKA and constructed logistic regression models to examine associations of pager use and likelihood of ED visitation and nonelective inpatient admission from an ED for DKA. RESULTS Pager users comprised 30% of the patient population. They were younger but had more established diabetes than nonusers. While pager users were 2.75 times more likely than nonusers to visit the ED for DKA (P < 0.0001), their visits were less likely to lead to inpatient admissions (odds ratio 0.58; P < 0.02). More than half (n = 587) of all calls to the pager were resolved without need for further referral. Estimates suggest that 439 ED visits and 115 admissions were avoided at a potential cost savings exceeding 760,000 USD. CONCLUSIONS Integration of a transport service provides a novel, cost-effective approach to reduce disparities in diabetes care. Advantages include scalability, applicability to other disease areas and settings, and low added costs. These findings enrich an emerging evidence base for telephonic care-management models supported by allied health personnel.
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Choi YS, Berry-Cabán C, Nance J. Telemedicine in Paediatric Patients with Poorly Controlled Type 1 Diabetes. J Telemed Telecare 2013; 19:219-21. [DOI: 10.1258/jtt.2012.120506] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We conducted a retrospective study of a telemedicine clinic for paediatric patients with poorly controlled type 1 diabetes. Thirty-one patients (mean age 12 years) were enrolled into the clinic. After an initial visit, a group messaging system was provided to allow communication with the diabetic team which consisted of a diabetic provider, diabetic educator, insulin pump trainer and dietician. Patients and parents were encouraged to make all contacts by electronic means. For urgent matters, direct paging access was provided to the diabetic team. Adjustments in insulin dosing were accomplished via automated web-based communication or email between patient and provider. Compared to baseline, the HbA1c levels were significantly lower at 3 months (9.1% vs. 11.1%, P < 0.05) and 6.5 months (9.5% vs. 11.1%, P < 0.05). There were no significant differences in HbA1c levels for different age categories, insulin delivery methods or number of telemedicine encounters. The study showed that while telemedicine was effective in lowering HbA1c levels, it did not achieve optimum control.
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Affiliation(s)
- Y Sammy Choi
- Departments of Medicine and Pediatrics, Fort Bragg, North Carolina, USA
| | | | - Julie Nance
- Diabetes Education Program, Sentara Careplex Hospital, Hampton, Virginia, USA
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The role of continuous glucose monitoring in the care of children with type 1 diabetes. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2013; 2013:8. [PMID: 23531400 PMCID: PMC3630059 DOI: 10.1186/1687-9856-2013-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 03/20/2013] [Indexed: 11/10/2022]
Abstract
Continuous glucose monitoring (CGM), while a relatively new technology, has the potential to transform care for children with type 1 diabetes. Some, but not all studies, have shown that CGM can significantly improve hemoglobin A1c levels and reduce time spent in the hypoglycemic range in children, particularly when used as part of sensor-augmented pump (SAP) therapy. Despite the publication of recent clinical practice guidelines suggesting CGM be offered to all children 8 years of age or older who are likely to benefit, and studies showing that younger children can also benefit, this technology is not yet commonly used by children with type 1 diabetes. Effects of CGM are enhanced when used on a near-daily basis (a use-dependent effect) and with insulin pump therapy. Therefore, coordinated strategies are needed to help children and their families initiate and continue to use this resource for diabetes care. This review introduces CGM to pediatric endocrinologists who are not yet familiar with the finer details of this technology, summarizes current data showing the benefits and limitations of CGM use in children, reviews specific case examples demonstrating when CGM can be helpful, and shows the value of both retrospective and real-time CGM. It is hoped that this information leads to discussion of this technology in pediatric endocrinology clinics as an important next step in improving the care of children with type 1 diabetes.
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