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Zhang K, Huang Q, Wang Q, Li C, Zheng Q, Li Z, Xu D, Xie C, Zhang M, Lin R. Telemedicine in Improving Glycemic Control Among Children and Adolescents With Type 1 Diabetes Mellitus: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e51538. [PMID: 38981114 PMCID: PMC11267117 DOI: 10.2196/51538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/28/2024] [Accepted: 05/21/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) is the most common chronic autoimmune disease among children and adolescents. Telemedicine has been widely used in the field of chronic disease management and can benefit patients with T1DM. However, existing studies lack high-level evidence related to the effectiveness of telemedicine for glycemic control in children and adolescents with T1DM. OBJECTIVE This study aims to systematically review the evidence on the effectiveness of telemedicine interventions compared with usual care on glycemic control among children and adolescents with T1DM. METHODS In this systematic review and meta-analysis, we searched PubMed, Cochrane Library, Embase, Web of Science (all databases), and CINAHL Complete from database inception to May 2023. We included randomized controlled trials (RCTs) that evaluated the effectiveness of a telemedicine intervention on glycemic control in children and adolescents with T1DM. In total, 2 independent reviewers performed the study selection and data extraction. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Our primary outcome was glycated hemoglobin (HbA1c) levels. Secondary outcomes were quality of life, self-monitoring of blood glucose, the incidence of hypoglycemia, and cost-effectiveness. A random-effects model was used for this meta-analysis. RESULTS Overall, 20 RCTs (1704 participants from 12 countries) were included in the meta-analysis. Only 5% (1/20) of the studies were at high risk of bias. Compared to usual care, telemedicine was found to reduce HbA1c levels by 0.22 (95% CI -0.33 to -0.10; P<.001; I2=35%). There was an improvement in self-monitoring of blood glucose (mean difference [MD] 0.54, 95% CI -0.72 to 1.80; P=.40; I2=67.8%) and the incidence of hypoglycemia (MD -0.15, 95% CI -0.57 to 0.27; P=.49; I2=70.7%), although this was not statistically significant. Moreover, telemedicine had no convincing effect on the Diabetes Quality of Life for Youth score (impact of diabetes: P=.59; worries about diabetes: P=.71; satisfaction with diabetes: P=.68), but there was a statistically significant improvement in non-youth-specific quality of life (MD -0.24, 95% CI -0.45 to -0.02; P=.04; I2=0%). Subgroup analyses revealed that the effect of telemedicine on HbA1c levels appeared to be greater in studies involving children (MD -0.41, 95% CI -0.62 to -0.20; P<.001), studies that lasted <6 months (MD -0.32, 95% CI -0.48 to -0.17; P<.001), studies where providers used smartphone apps to communicate with patients (MD -0.37, 95% CI -0.53 to -0.21; P<.001), and studies with medication dose adjustment (MD -0.25, 95% CI -0.37 to -0.12; P<.001). CONCLUSIONS Telemedicine can reduce HbA1c levels and improve quality of life in children and adolescents with T1DM. Telemedicine should be regarded as a useful supplement to usual care to control HbA1c levels and a potentially cost-effective mode. Meanwhile, researchers should develop higher-quality RCTs using large samples that focus on hard clinical outcomes, cost-effectiveness, and quality of life.
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Affiliation(s)
- Kun Zhang
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Qiyuan Huang
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Qiaosong Wang
- School of Nursing, Fujian Medical University, Fuzhou, China
- Department of Nursing, The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, China
| | - Chengyang Li
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Qirong Zheng
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Zhuoyue Li
- Department of Infectious diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Dan Xu
- Foreign Language Department, Xuzhou Medical University, Xuzhou, China
| | - Cuiling Xie
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Mingqi Zhang
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Rongjin Lin
- School of Nursing, Fujian Medical University, Fuzhou, China
- Department of Nursing, The First Affiliated Hospital of Fujian Medical University, Fujian Medical University, Fuzhou, China
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Giammarino F, Senanayake R, Prahalad P, Maahs DM, Scheinker D. A Machine Learning Model for Week-Ahead Hypoglycemia Prediction From Continuous Glucose Monitoring Data. J Diabetes Sci Technol 2024:19322968241236208. [PMID: 38445628 DOI: 10.1177/19322968241236208] [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] [Indexed: 03/07/2024]
Abstract
BACKGROUND Remote patient monitoring (RPM) programs augment type 1 diabetes (T1D) care based on retrospective continuous glucose monitoring (CGM) data. Few methods are available to estimate the likelihood of a patient experiencing clinically significant hypoglycemia within one week. METHODS We developed a machine learning model to estimate the probability that a patient will experience a clinically significant hypoglycemic event, defined as CGM readings below 54 mg/dL for at least 15 consecutive minutes, within one week. The model takes as input the patient's CGM time series over a given week, and outputs the predicted probability of a clinically significant hypoglycemic event the following week. We used 10-fold cross-validation and external validation (testing on cohorts different from the training cohort) to evaluate performance. We used CGM data from three different cohorts of patients with T1D: REPLACE-BG (226 patients), Juvenile Diabetes Research Foundation (JDRF; 355 patients) and Tidepool (120 patients). RESULTS In 10-fold cross-validation, the average area under the receiver operating characteristic curve (ROC-AUC) was 0.77 (standard deviation [SD]: 0.0233) on the REPLACE-BG cohort, 0.74 (SD: 0.0188) on the JDRF cohort, and 0.76 (SD: 0.02) on the Tidepool cohort. In external validation, the average ROC-AUC across the three cohorts was 0.74 (SD: 0.0262). CONCLUSIONS We developed a machine learning algorithm to estimate the probability of a clinically significant hypoglycemic event within one week. Predictive algorithms may provide diabetes care providers using RPM with additional context when prioritizing T1D patients for review.
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Affiliation(s)
| | | | - Priya Prahalad
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Children's Health, Lucile Packard Children's Hospital, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Children's Health, Lucile Packard Children's Hospital, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA
| | - David Scheinker
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
- Stanford Children's Health, Lucile Packard Children's Hospital, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA
- Department of Management Science and Engineering, School of Engineering, Stanford University, Stanford, CA, USA
- Clinical Excellence Research Center, School of Medicine, Stanford University, Stanford, CA, USA
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Breidbart E, Gallagher MP. Type 1 and Covid-19: Diagnosis, Clinical Care, and Health Outcomes during the Pandemic. Endocrinol Metab Clin North Am 2024; 53:135-149. [PMID: 38272592 DOI: 10.1016/j.ecl.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic disrupted health care, creating challenges for people with diabetes and health care systems. Diabetes was recognized as a risk factor for severe disease early in the pandemic. Subsequently, risk factors specific for people with type 1 diabetes were identified, including age, hemoglobin A1c level, and lack of continuous glucose monitoring . Telemedicine, especially when accompanied by diabetes data, allowed effective remote care delivery. However, pre-existing racial disparities in access to diabetes technology persisted and were associated with worse outcomes. Events of the COVID-19 pandemic underscore the importance of continuing to develop flexible and more equitable health care delivery systems.
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Affiliation(s)
- Emily Breidbart
- Department of Pediatrics, Division of Pediatric Endocrinology, NYU Grossman School of Medicine, Hassenfeld Children's Hospital at NYU Langone Health, 135 East 31st Street, Level 2, New York, NY 10016, USA.
| | - Mary Pat Gallagher
- Department of Pediatrics, Division of Pediatric Endocrinology, NYU Grossman School of Medicine, Hassenfeld Children's Hospital at NYU Langone Health, 135 East 31st Street, Level 2, New York, NY 10016, USA
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4
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Holm TF, Udsen FW, Færch K, Jensen MH, von Scholten BJ, Hejlesen OK, Hangaard S. The Effectiveness of Digital Health Lifestyle Interventions on People With Prediabetes: Protocol for a Systematic Review, Meta-Analysis, and Meta-Regression. JMIR Res Protoc 2024; 13:e50340. [PMID: 38335018 PMCID: PMC10891485 DOI: 10.2196/50340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/15/2023] [Accepted: 12/17/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND There has been an increasing interest in the use of digital health lifestyle interventions for people with prediabetes, as these interventions may offer a scalable approach to preventing type 2 diabetes. Previous systematic reviews on digital health lifestyle interventions for people with prediabetes had limitations, such as a narrow focus on certain types of interventions, a lack of statistical pooling, and no broader subgroup analysis of intervention characteristics. The identified limitations observed in previous systematic reviews substantiate the necessity of conducting a comprehensive review to address these gaps within the field. This will enable a comprehensive understanding of the effectiveness of digital health lifestyle interventions for people with prediabetes. OBJECTIVE The objective of this systematic review, meta-analysis, and meta-regression is to systematically investigate the effectiveness of digital health lifestyle interventions on prediabetes-related outcomes in comparison with any comparator without a digital component among adults with prediabetes. METHODS This systematic review will include randomized controlled trials that investigate the effectiveness of digital health lifestyle interventions on adults (aged 18 years or older) with prediabetes and compare the digital interventions with nondigital interventions. The primary outcome will be change in body weight (kg). Secondary outcomes include, among others, change in glycemic status, markers of cardiometabolic health, feasibility outcomes, and incidence of type 2 diabetes. Embase, PubMed, CINAHL, and CENTRAL (Cochrane Central Register of Controlled Trials) will be systematically searched. The data items to be extracted include study characteristics, participant characteristics, intervention characteristics, and relevant outcomes. To estimate the overall effect size, a meta-analysis will be conducted using the mean difference. Additionally, if feasible, meta-regression on study, intervention, and participant characteristics will be performed. The Cochrane risk of bias tool will be applied to assess study quality, and the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach will be used to assess the certainty of evidence. RESULTS The results are projected to yield an overall estimate of the effectiveness of digital health lifestyle interventions on adults with prediabetes and elucidate the characteristics that contribute to their effectiveness. CONCLUSIONS The insights gained from this study may help clarify the potential of digital health lifestyle interventions for people with prediabetes and guide the decision-making regarding future intervention components. TRIAL REGISTRATION PROSPERO CRD42023426919; http://tinyurl.com/d3enrw9j. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50340.
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Affiliation(s)
- Tanja Fredensborg Holm
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
| | - Flemming Witt Udsen
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
| | - Kristine Færch
- Data Science, Novo Nordisk A/S, Søborg, Denmark
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Morten Hasselstrøm Jensen
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
- Data Science, Novo Nordisk A/S, Søborg, Denmark
| | | | | | - Stine Hangaard
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
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Franceschi R, Tornese G. Sustaining telehealth in pediatric diabetology beyond COVID-19: How to set the tone. Digit Health 2024; 10:20552076241249272. [PMID: 39156051 PMCID: PMC11329951 DOI: 10.1177/20552076241249272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/08/2024] [Indexed: 08/20/2024] Open
Abstract
In the post-COVID-19 era, telehealth experience and knowledge must be structured to deliver high-quality care. Type 1 diabetes is a chronic disease that lends itself to being a model for telehealth diffusion, especially in the pediatric setting where the use of cloud-connected technologies is widespread. Here, we present "how to set the tone" and manage a telemedicine session according to our experiences and those reported in the literature, according to the health professional perspective. A practical workflow on how healthcare professionals can structure a virtual diabetes clinic is reported, as well as critical issues related to limits in physical examination, communication registers, relationships, and visit settings. A proactive virtual visit model could be feasible, stratifying patients according to continuous glucose monitoring metrics, and personalized interventions can be provided to each patient. Analysis of benefits and hassles due to telehealth for each patient has to be considered, as well as their personal perspective, expectations, and reported barriers, mainly related to connection issues and digital literacy.
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Affiliation(s)
| | - Gianluca Tornese
- Pediatric Department, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
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6
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Shao Y, Shi L, Nauman E, Price-Haywood E, Stoecker C. Telehealth use and its impact on clinical outcomes in patients with type 2 diabetes during the COVID-19 pandemic. Diabetes Obes Metab 2024; 26:118-125. [PMID: 37726978 DOI: 10.1111/dom.15293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
AIM To evaluate the impact of telehealth use during the COVID-19 pandemic on glycaemic control and other clinical outcomes among patients with type 2 diabetes. METHODS We used electronic health records from the Research Action for Health Network (REACHnet) database for patients with type 2 diabetes who had telehealth visits and those who only received in-person care during the pandemic. A quasi-experimental method of difference-in-difference with propensity-score weighting was implemented to mitigate selection bias and to control for observed factors related to telehealth use. Outcomes included glycated haemoglobin (HbA1c) and other clinical measures (low-density lipoprotein [LDL] cholesterol, blood pressure [BP], and body mass index [BMI]). RESULTS Patients using telehealth had better HbA1c control compared to those receiving in-person care only during the pandemic. The telehealth group saw a significant average decrease of 0.146% (95% confidence interval [CI] -0.178% to -0.1145%; P < 0.001) in HbA1c levels over time. The proportion of patients with average HbA1c levels >7% decreased by 0.023 (95% CI -0.034, -0.011; P < 0.001) in the treatment group relative to the comparison group. Modest benefits in the control of LDL cholesterol levels, diastolic BP, and BMI were found in association with telehealth use. CONCLUSIONS Our findings suggest that telehealth services contributed to better glycaemic control and management of other clinical outcomes in patients with type 2 diabetes during the pandemic. Factors unmeasured in this study would need to be further explored to better understand the impact of telehealth.
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Affiliation(s)
- Yixue Shao
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Lizheng Shi
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | | | | | - Charles Stoecker
- Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Sińska BI, Kucharska A, Rzońca E, Wronka L, Bączek G, Gałązkowski R, Olejniczak D, Rzońca P. What Differentiates Rural and Urban Patients with Type 1 Diabetes-A Pilot Study. Nutrients 2023; 16:22. [PMID: 38201852 PMCID: PMC10780946 DOI: 10.3390/nu16010022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
The effective management of diabetes is a complex issue and may be determined according to numerous patient-dependent and patient-independent factors. This study aimed to analyze the relationship between the place of residence and selected sociodemographic, psychological and diabetes-related parameters in people with type 1 diabetes (T1D). This study was conducted on 419 adults with T1D using nonprobability sampling. The following questionnaires were used: the Diabetes Dietary Guidelines Adherence Index, the Acceptance of Illness Scale, the Sense of Responsibility for Health Scale, the Diabetes Eating Problem Survey-Revised scale, the Eating Attitudes Test and questions on sociodemographic and diabetes-related parameters. People living in rural areas were characterized by a significantly lower age and level of education, a higher incidence of being overweight, a higher glycated hemoglobin concentration, a lower number of glucose measurements during the day and a higher level of acceptance of the disease compared to urban residents. The degree of adherence to dietary recommendations and the sense of responsibility for one's own health were significantly higher among urban residents. It is necessary to assess barriers to a proper diet and to increase the effectiveness in managing the disease in rural communities. Targeted actions promoting the health of type 1 diabetics need to be developed with particular emphasis on patients from rural areas.
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Affiliation(s)
- Beata I. Sińska
- Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland; (A.K.); (L.W.)
| | - Alicja Kucharska
- Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland; (A.K.); (L.W.)
| | - Ewa Rzońca
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 00-575 Warsaw, Poland; (E.R.); (G.B.)
| | - Leszek Wronka
- Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland; (A.K.); (L.W.)
| | - Grażyna Bączek
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 00-575 Warsaw, Poland; (E.R.); (G.B.)
| | - Robert Gałązkowski
- Department of Emergency Medical Services, Faculty of Health Sciences, Medical University of Warsaw, 00-575 Warsaw, Poland;
| | - Dominik Olejniczak
- Department of Public Health, Faculty of Health Sciences, Medical University of Warsaw, 02-007 Warsaw, Poland;
| | - Patryk Rzońca
- Department of Human Anatomy, Faculty of Health Sciences, Medical University of Warsaw, 02-004 Warsaw, Poland;
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8
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Snoswell CL, Chelberg G, De Guzman KR, Haydon HH, Thomas EE, Caffery LJ, Smith AC. The clinical effectiveness of telehealth: A systematic review of meta-analyses from 2010 to 2019. J Telemed Telecare 2023; 29:669-684. [PMID: 34184580 DOI: 10.1177/1357633x211022907] [Citation(s) in RCA: 136] [Impact Index Per Article: 136.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION To promote telehealth implementation and uptake, it is important to assess overall clinical effectiveness to ensure any changes will not adversely affect patient outcomes. The last systematic literature review examining telehealth effectiveness was conducted in 2010. Given the increasing use of telehealth and technological developments in the field, a more contemporary review has been carried out. The aim of this review was to synthesise recent evidence associated with the clinical effectiveness of telehealth services. METHODS A systematic search of 'Pretty Darn Quick'-Evidence portal was carried out in November 2020 for systematic reviews on telehealth, where the primary outcome measure reported was clinical effectiveness. Due to the volume of telehealth articles, only systematic reviews with meta-analyses published between 2010 and 2019 were included in the analysis. RESULTS We found 38 meta-analyses, covering 10 medical disciplines: cardiovascular disease (n = 3), dermatology (n = 1), endocrinology (n = 13), neurology (n = 4), nephrology (n = 2), obstetrics (n = 1), ophthalmology (n = 1), psychiatry and psychology (n = 7), pulmonary (n = 4) and multidisciplinary care (n = 2). The evidence showed that for all disciplines, telehealth across a range of modalities was as effective, if not more, than usual care. DISCUSSION This review demonstrates that telehealth can be equivalent or more clinically effective when compared to usual care. However, the available evidence is very discipline specific, which highlights the need for more clinical effectiveness studies involving telehealth across a wider spectrum of clinical health services. The findings from this review support the view that in the right context, telehealth will not compromise the effectiveness of clinical care when compared with conventional forms of health service delivery.
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Affiliation(s)
- Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Georgina Chelberg
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
- Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Australia
| | - Keshia R De Guzman
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Helen H Haydon
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Emma E Thomas
- Centre for Online Health, The University of Queensland, Australia
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Australia
- University of Southern Denmark, Denmark
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Lee S, Kim K, Kim JE, Hyun Y, Lee M, Hahm MI, Lee SG, Kang ES. Clinical Effects of a Home Care Pilot Program for Patients with Type 1 Diabetes Mellitus: A Retrospective Cohort Study. Diabetes Metab J 2023; 47:693-702. [PMID: 37349080 PMCID: PMC10555540 DOI: 10.4093/dmj.2022.0170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/29/2022] [Indexed: 06/24/2023] Open
Abstract
BACKGRUOUND Given the importance of continuous self-care for people with type 1 diabetes mellitus (T1DM), the Ministry of Health and Welfare of Korea launched a pilot program for chronic disease management. Herein, we applied a home care pilot program to people with T1DM to investigate its effects. METHODS This retrospective cohort study was conducted at a single tertiary hospital (January 2019 to October 2021). A multidisciplinary team comprising doctors, nurses, and clinical nutritionists provided specialized education and periodically assessed patients' health status through phone calls or text messages. A linear mixed model adjusting for age, sex, and body mass index was used to analyze the glycemic control changes before and after implementing the program between the intervention and control groups. RESULTS Among 408 people with T1DM, 196 were enrolled in the intervention group and 212 in the control group. The reduction in glycosylated hemoglobin (HbA1c) after the program was significantly greater in the intervention group than in the control group (estimated marginal mean, -0.57% vs. -0.23%, P=0.008); the same trend was confirmed for glycoalbumin (GA) (-3.2% vs. -0.39%, P<0.001). More patients achieved the target values of HbA1c (<7.0%) and GA (<20%) in the intervention group than in the control group at the 9-month follow-up (34.5% vs. 19.6% and 46.7% vs. 28.0%, respectively). CONCLUSION The home care program for T1DM was clinically effective in improving glycemic control and may provide an efficient care option for people with T1DM, and positive outcomes are expected to expand the program to include more patients.
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Affiliation(s)
- Sejeong Lee
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - KyungYi Kim
- Department of Medical Device Engineering and Management, Yonsei University Graduate School, Seoul, Korea
| | - Ji Eun Kim
- Department of Medical Science, Soonchunhyang University Graduate School, Asan, Korea
| | - Yura Hyun
- Diabetes Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Minyoung Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Myung-Il Hahm
- Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Korea
| | - Sang Gyu Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Herber E, Bondar A, Hockings J, Hermiller T, Russo-Alvarez G, Wang L, Schulz L. Evaluation of pharmacist impact on diabetes outcomes for telehealth and hybrid care delivery versus in-office visits. J Am Pharm Assoc (2003) 2023; 63:1175-1179. [PMID: 37116796 PMCID: PMC10131742 DOI: 10.1016/j.japh.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Few studies have examined the effect of pharmacist-led telemanagement on diabetes outcomes during the COVID-19 pandemic. OBJECTIVES Assess for noninferiority for the absolute change in mean A1C between telehealth and hybrid groups versus the in-office group during the COVID-19 pandemic. Secondary objectives were to compare the percentage of patients achieving population health A1C goals and patient no-show rates between study groups. METHODS A retrospective, noninferiority analysis was conducted for patients seen by a primary care pharmacist from November 1, 2020 to May 31, 2021 across 17 primary care clinics in the Northeast Ohio region of Cleveland Clinic. The noninferiority margin was prespecified at > 0.3% A1C reduction. Patients with a baseline A1C of 8% or greater were included. Patients were separated into 3 study groups (telehealth, in-office, and hybrid) based on the visit types that were conducted by the pharmacist during the study period. RESULTS Hybrid care delivery (N = 366) was noninferior to in-office care delivery (N = 180), with regards to absolute change in mean A1C reduction (0.24% [95% CI: -0.13, 0.61], P = 0.002). Similar results were shown when comparing the telehealth group (N = 691) to the in-office group (0.04 [95% CI: -0.28, 0.36], P = 0.02). The mean A1C reduction in the in-office (1.36 ± 1.9), hybrid (1.60 ± 2.2), and telehealth (1.40 ± 2.0) groups were not significantly different (P = 0.23). Subgroup analyses showed that newly consulted patients had a larger reduction in A1C compared to the overall population, in all groups. No-show rates and percentage of patients achieving population health A1C goals were not significantly different based on visit type. CONCLUSION Telehealth and hybrid visit types were noninferior to in-office visits with regards to mean change in A1C reduction. Results demonstrate the importance of primary care pharmacists continuing to offer diverse visit types based on patient preference.
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11
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Eiland L, Datta P, Samson K, Anzalone J, Donovan A, McAdam-Marx C. In-Person and Telehealth Provider Access and Glycemic Control for People With Diabetes During the COVID-19 Pandemic. J Diabetes Sci Technol 2023; 17:895-900. [PMID: 36999204 PMCID: PMC10067707 DOI: 10.1177/19322968231162866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
BACKGROUND Ambulatory care underwent rapid changes at the onset of the COVID-19 pandemic. Care for people with diabetes shifted from an almost exclusively in-person model to a hybrid model consisting of in-person visits, telehealth visits, phone calls, and asynchronous messaging. METHODS We analyzed data for all patients with diabetes and established with a provider at a large academic medical center to identify in-person and telehealth ambulatory provider visits over two periods of time (a "pre-COVID" and "COVID" period). RESULTS While the number of people with diabetes and any ambulatory provider visit decreased during the COVID period, telehealth saw massive growth. Per Hemoglobin A1c, glycemic control remained stable from the pre-COVID to COVID time periods. CONCLUSIONS Findings support continued use of telehealth, and we anticipate hybrid models of care will be utilized for people with diabetes beyond the pandemic.
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Affiliation(s)
- Leslie Eiland
- Division of Diabetes, Endocrinology and Metabolism, University of Nebraska Medical Center, Omaha, NE, USA
| | - Proleta Datta
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Kaeli Samson
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jerrod Anzalone
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Carrie McAdam-Marx
- Department of Pharmacy Practice and Science, University of Nebraska Medical Center, Omaha, NE, USA
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12
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Ballesta S, Chillarón JJ, Inglada Y, Climent E, Llauradó G, Pedro-Botet J, Cots F, Camell H, Flores JA, Benaiges D. Telehealth model versus in-person standard care for persons with type 1 diabetes treated with multiple daily injections: an open-label randomized controlled trial. Front Endocrinol (Lausanne) 2023; 14:1176765. [PMID: 37441496 PMCID: PMC10333924 DOI: 10.3389/fendo.2023.1176765] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/06/2023] [Indexed: 07/15/2023] Open
Abstract
Objective Increasing evidence indicates that the telehealth (TH) model is noninferior to the in-person approach regarding metabolic control in type 1 diabetes (T1D) and offers advantages such as a decrease in travel time and increased accessibility for shorter/frequent visits. The primary aim of this study was to compare the change in glycated hemoglobin (HbA1c) at 6 months in T1D care in a rural area between TH and in-person visits. Research design and methods Randomized controlled, open-label, parallel-arm study among adults with T1D. Participants were submitted to in-person visits at baseline and at months 3 and 6 (conventional group) or teleconsultation in months 1 to 4 plus 2 in-person visits (baseline and 6 months) (TH group). Mixed effects models estimated differences in HbA1c changes. Results Fifty-five participants were included (29 conventional/26 TH). No significant differences in HbA1c between groups were found. Significant improvement in time in range (5.40, 95% confidence interval (CI): 0.43-10.38; p < 0.05) and in time above range (-6.34, 95% CI: -12.13- -0.55;p < 0.05) in the TH group and an improvement in the Diabetes Quality of Life questionnaire (EsDQoL) score (-7.65, 95% CI: -14.67 - -0.63; p < 0.05) were observed. In TH, the costs for the participants were lower. Conclusions The TH model is comparable to in-person visits regarding HbA1c levels at the 6-month follow-up, with significant improvement in some glucose metrics and health-related quality of life. Further studies are necessary to evaluate a more efficient timing of the TH visits.
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Affiliation(s)
- Sílvia Ballesta
- Endocrinology and Nutrition, Consorci Sanitari de l’Alt Penedès Garraf, Vilafranca del Penedès, Spain
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Universitari Mar, Barcelona, Spain
| | - Juan J. Chillarón
- Endocrinology and Nutrition, Consorci Sanitari de l’Alt Penedès Garraf, Vilafranca del Penedès, Spain
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
| | - Yolanda Inglada
- Endocrinology and Nutrition, Consorci Sanitari de l’Alt Penedès Garraf, Vilafranca del Penedès, Spain
| | - Elisenda Climent
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
| | - Gemma Llauradó
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Pedro-Botet
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Universitari Mar, Barcelona, Spain
| | - Francesc Cots
- Management Control Department, Hospital del Mar, Barcelona, Spain
| | - Helena Camell
- Internal Medicine, Hospital Comarcal de l´Alt Penedès, Vilafranca del Penedès, Spain
| | - Juana A. Flores
- Endocrinology and Nutrition, Consorci Sanitari de l’Alt Penedès Garraf, Vilafranca del Penedès, Spain
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
| | - David Benaiges
- Endocrinology and Nutrition, Consorci Sanitari de l’Alt Penedès Garraf, Vilafranca del Penedès, Spain
- Endocrinology and Nutrition, Hospital del Mar, Barcelona, Spain
- Cardiovascular Risk and Nutrition Research Group (CARIN-ULEC), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Barcelona Biomedical Research Park (PRBB), Barcelona, Spain
- Department of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
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13
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Hangaard S, Laursen SH, Andersen JD, Kronborg T, Vestergaard P, Hejlesen O, Udsen FW. The Effectiveness of Telemedicine Solutions for the Management of Type 2 Diabetes: A Systematic Review, Meta-Analysis, and Meta-Regression. J Diabetes Sci Technol 2023; 17:794-825. [PMID: 34957864 PMCID: PMC10210100 DOI: 10.1177/19322968211064633] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous systematic reviews have aimed to clarify the effect of telemedicine on diabetes. However, such reviews often have a narrow focus, which calls for a more comprehensive systematic review within the field. Hence, the objective of the present systematic review, meta-analysis, and meta-regression is to evaluate the effectiveness of telemedicine solutions versus any comparator without the use of telemedicine on diabetes-related outcomes among adult patients with type 2 diabetes (T2D). METHODS This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We considered telemedicine randomized controlled trials (RCT) including adults (≥18 years) diagnosed with T2D. Change in glycated hemoglobin (HbA1c, %) was the primary outcome. PubMed, EMBASE, and the Cochrane Library Central Register of Controlled Trials (CENTRAL) were searched on October 14, 2020. An overall treatment effect was estimated using a meta-analysis performed on the pool of included studies based on the mean difference (MD). The revised Cochrane risk-of-bias tool was applied and the certainty of evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS The final sample of papers included a total of 246, of which 168 had sufficient information to calculate the effect of HbA1c%. The results favored telemedicine, with an MD of -0.415% (95% confidence interval [CI] = -0.482% to -0.348%). The heterogeneity was great (I2 = 93.05%). A monitoring component gave rise to the higher effects of telemedicine. CONCLUSIONS In conclusion, telemedicine may serve as a valuable supplement to usual care for patients with T2D. The inclusion of a telemonitoring component seems to increase the effect of telemedicine.
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Affiliation(s)
- Stine Hangaard
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark,
Aalborg, Denmark
| | - Sisse H. Laursen
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
- Department of Nursing, University
College of Northern Denmark, Aalborg, Denmark
| | - Jonas D. Andersen
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Kronborg
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark,
Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark,
Aalborg, Denmark
- Department of Endocrinology, Aalborg
University Hospital, Aalborg, Denmark
- Department of Clinical Medicine,
Aalborg University, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
| | - Flemming W. Udsen
- Department of Health Science and
Technology, Aalborg University, Aalborg, Denmark
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14
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Wu Y, Zhang YY, Zhang YT, Zhang HJ, Long TX, Zhang Q, Huang J, Li MZ. Effectiveness of resilience-promoting interventions in adolescents with diabetes mellitus: a systematic review and meta-analysis. World J Pediatr 2023; 19:323-339. [PMID: 36534296 PMCID: PMC9761642 DOI: 10.1007/s12519-022-00666-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study aimed to analyze the efficacy of resilience-promoting interventions among adolescents and youth aged 10-24 years with any type of diabetes. METHODS A systematic literature search was performed using the PubMed, Web of Science, Embase, Cochrane Library, CINAHL, and PsycINFO databases from inception to May 25, 2022. The Cochrane risk of bias tool (version 2) was used to assess the quality of the included studies. A meta-analysis was performed to calculate the pooled effects of resilience-promoting interventions. RESULTS Nineteen articles were included covering an overall sample of 2048 adolescents with diabetes. When analyzing the effectiveness of resilience-promoting interventions, hemoglobin A1c (HbA1c) at six months [mean difference = - 0.47, 95% confidence interval (CI) = - 0.83 to - 0.12, P = 0.009] after the intervention was improved. However, long-term (≥ 12 months) improvement in HbA1c was not significant. In addition, comparing the control group, there were significant differences in the effect size for stress [standardized mean difference (SMD) = - 0.87, 95% CI = - 1.25 to -0.48, P < 0.05], self-efficacy (SMD = 0.50, 95% CI = 0.02-0.98, P = 0.04) and quality of life (SMD = 0.27, 95% CI = 0.03-0.51, P = 0.03). CONCLUSIONS Resilience-promoting intervention is a promising way for adolescent diabetes management to improve HbA1c, stress, self-efficacy, and quality of life. Incorporating resilience-promoting components into diabetes education and re-enforcing these contents every six months are recommended for implementation in clinical practice.
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Affiliation(s)
- Yi Wu
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing, 100191, China
- School of Nursing, Peking University, Beijing, China
- Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Yi-Yun Zhang
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing, 100191, China
- School of Nursing, Peking University, Beijing, China
- Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Ya-Ting Zhang
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing, 100191, China
- School of Nursing, Peking University, Beijing, China
- Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | | | - Tian-Xue Long
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing, 100191, China
- School of Nursing, Peking University, Beijing, China
- Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Qi Zhang
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing, 100191, China
- School of Nursing, Peking University, Beijing, China
- Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Jing Huang
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing, 100191, China
- School of Nursing, Peking University, Beijing, China
- Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Ming-Zi Li
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing, 100191, China.
- School of Nursing, Peking University, Beijing, China.
- Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China.
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15
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Greeviroj P, Thavaraputta S, Buranasupkajorn P, Laichuthai N. The Impact of Telemedicine-Augmented Integrated Personalized Diabetes Management on Glycemic Control in Adults With Diabetes Mellitus During the COVID-19 Pandemic: A Retrospective Study. Asia Pac J Public Health 2023; 35:194-196. [PMID: 36840347 PMCID: PMC9969184 DOI: 10.1177/10105395231158458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Primploy Greeviroj
- Division of Endocrinology and
Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand,Excellence Center in Diabetes, Hormone,
and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society,
Bangkok, Thailand
| | - Subhanudh Thavaraputta
- Division of Endocrinology and
Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand,Excellence Center in Diabetes, Hormone,
and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society,
Bangkok, Thailand
| | - Patinut Buranasupkajorn
- Division of Endocrinology and
Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand,Excellence Center in Diabetes, Hormone,
and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society,
Bangkok, Thailand
| | - Nitchakarn Laichuthai
- Division of Endocrinology and
Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University,
Bangkok, Thailand,Excellence Center in Diabetes, Hormone,
and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society,
Bangkok, Thailand,Nitchakarn Laichuthai, Division of
Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine,
Chulalongkorn University, Bangkok 10330, Thailand.
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16
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Mizokami-Stout K, Presseau J, Booth GL, Lipscombe LL, Perkins I, Perkins BA, Shulman R, Lakhanpal G, Ivers N. Implementation Plan for a High-Frequency, Low-Touch Care Model at Specialized Type 1 Diabetes Clinics: Model Development. JMIR Diabetes 2022; 7:e37715. [PMID: 36480257 PMCID: PMC9782362 DOI: 10.2196/37715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/05/2022] [Accepted: 09/01/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Individuals with type 1 diabetes (T1D) are more likely to achieve optimal glycemic management when they have frequent visits with their health care team. There is a potential benefit of frequent, telemedicine interventions as an effective strategy to lower hemoglobin A1c (HbA1c). OBJECTIVE The objective is this study was to understand the provider- and system-level factors affecting the successful implementation of a virtual care intervention in type 1 diabetes (T1D) clinics. METHODS Semistructured interviews were conducted with managers and certified diabetes educators (CDEs) at diabetes clinics across Southern Ontario before the COVID-19 pandemic. Deductive analysis was carried out using the Theoretical Domains Framework, followed by mapping to behavior change techniques to inform potential implementation strategies for high-frequency virtual care for T1D. RESULTS There was considerable intention to deliver high-frequency virtual care to patients with T1D. Participants believed that this model of care could lead to improved patient outcomes and engagement but would likely increase the workload of CDEs. Some felt there were insufficient resources at their site to enable them to participate in the program. Member checking conducted during the pandemic revealed that clinics and staff had already developed strategies to overcome resource barriers to the adoption of virtual care during the pandemic. CONCLUSIONS Existing enablers for high-frequency virtual care for T1D can be leveraged, and barriers can be overcome with targeted clinical incentives and support.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Noah Ivers
- Women's College Hospital, Toronto, ON, Canada
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17
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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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18
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Russo GT, Andreozzi F, Calabrese M, Di Bartolo P, Di Cianni G, Bruno Giorda C, Lapice E, Manicardi E, Giandalia A, Lucisano G, Nicolucci A, Rocca A, Rossi MC, Spreafico E, Vespasiani G, Manicardi V. Role of telemedicine during COVID-19 pandemic in type 2 diabetes outpatients: The AMD annals initiative. Diabetes Res Clin Pract 2022; 194:110158. [PMID: 36400169 PMCID: PMC9663380 DOI: 10.1016/j.diabres.2022.110158] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/13/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Abstract
AIMS Telemedicine is advocated as a fundamental tool in modern clinical management. However, data on the effects of telemedicine vs face-to-face consultation on clinical outcomes in type 2 diabetes (T2DM) are still uncertain. This paper describes the use of telemedicine during the 2020 COVID-19 emergency and compares volume activity and quality indicators of diabetes care between face-to-face vs telemedicine counseling in the large cohort of T2DM patients from the AMD Annals Initiative. METHODS Demographic and clinical characteristics, including laboratory parameters, rate of the screening of long-term complications, current therapies and the Q-score, a validated score that measures the overall quality of care, were compared between 364,898 patients attending face-to-face consultation and 46,424 on telemedicine, during the COVID-19 pandemic. RESULTS Patients on telemedicine showed lower HbA1c levels (7.1 ± 1.2 % vs 7.3 ± 1.3 %, p < 0.0001), and they were less frequently treated with metformin, GLP1-RAs and SGLT2i and more frequently with DPP4i. The telemedicine group showed reduced monitoring of the various parameters considered as process indicators, especially, eye and foot examination. The proportion of patients with a good quality of care (Q score > 25) was higher among those receiving face-to-face consultation. Moreover, in the telemedicine group, all major clinical outcomes remained stable when further compared to those collected in the year 2019, when the same patients underwent a regular face-to-face consultation, suggesting that the care provided through telemedicine did not negatively affect the most important parameters. CONCLUSIONS During the COVID-19 pandemic, telemedicine provided an acceptable quality of diabetes care, comparable to that of patients attending face-to-face consultation, although a less frequent screening of complications seems to have occurred in subjects consulted by telemedicine.
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Affiliation(s)
- Giuseppina T Russo
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Italy.
| | | | - Paolo Di Bartolo
- Ravenna Diabetes Center, Dept of Specialist Medicine, Romagna Local Health Authority, Italy
| | | | | | | | | | - Annalisa Giandalia
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Giuseppe Lucisano
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Antonio Nicolucci
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Alberto Rocca
- Diabetology and Metabolic Diseases UOS, "G.Segalini", H.Bassini Cinisello Balsamo, ASST Nord Milan, Italy
| | - Maria Chiara Rossi
- CORESEARCH - Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Emanuele Spreafico
- UOSD of Endocrine and Metabolic Disease and Nutrition, ASST Brianza, Pio XI Hospital, Desio, (MB), Italy
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19
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Patient Satisfaction with Telemedicine in Adults with Diabetes: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10091677. [PMID: 36141289 PMCID: PMC9498402 DOI: 10.3390/healthcare10091677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 08/24/2022] [Accepted: 09/01/2022] [Indexed: 12/04/2022] Open
Abstract
Patient satisfaction assessment is essential for improving the quality of healthcare. Diabetes management using telemedicine technology is promising in the 21st century. However, the number of randomised controlled trials (RCTs) examining the effect of telemedicine on satisfaction in patients with diabetes is limited. This systematic review aimed to summarise the current evidence on patient satisfaction with telemedicine in adults with diabetes and discuss related issues and future directions of telemedicine in patients with diabetes. The author systematically searched PubMed/MEDLINE, Embase and The Cochrane Library, and a total of six RCTs were eligible for this review. Patient satisfaction with telemedicine was as high as conventional face-to-face care; however, telemedicine appeared not to significantly increase patient satisfaction compared with conventional face-to-face care in the included studies. Significant heterogeneity was noted between the studies, including participants’ age, study duration, the method of assessing patient satisfaction and types of telemedicine. Further studies are required to provide firm evidence to healthcare providers who are willing to use telemedicine in diabetes management. Telemedicine technology has been advancing and is a key tool in providing high-quality healthcare to patients with diabetes in the 21st century.
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20
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Calikoglu F, Bagdemir E, Celik S, Idiz C, Ozsarı H, Issever H, Satman I. Telemedicine as a Motivational Tool to Optimize Metabolic Control in Patients with Diabetes in Turkey: A Prospective, Randomized, Controlled TeleDiab Trial. Telemed J E Health 2022; 29:518-530. [PMID: 36067018 DOI: 10.1089/tmj.2022.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Telemedicine is a follow-up system that can improve the quality of management and cost-effectiveness of rapidly increasing diabetes patients. Methods: Two hundred adult patients with diabetes were enrolled in this prospective, randomized study. Consecutive patients were divided equally into two groups. Both groups received routine care visits quarterly. TeleDiab group also sent self-monitoring of blood glucose data and received short message service over the transmission system for 12 months. After the study was completed, all patients continued their routine care visits, and their data were evaluated for another 12 months. Six years after the initial study, patients were contacted by phone during the Covid-19 lockdown, and their status was assessed. Results: At the end of the study, glycemic control, kidney function, and lipid parameters of the TeleDiab group were statistically significantly better than the Usual Care group. There was no significant change in the weights of the patients. It was observed that this state of wellbeing continued both at the end of the second year and during the Covid-19 lockdown. Individuals with type 2 diabetes were found to benefit more from telemedicine. Discussion: It has been beneficial to guide patients with applications such as TeleDiab in diseases such as diabetes that require lifelong follow-up. On the other hand, the importance of telemedicine programs in the management of chronic diseases in the current pandemic conditions has come to the fore even more. Telemedicine is an effective motivational tool to ensure optimal control not only of glycemic but also of kidney and lipid parameters.
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Affiliation(s)
- Fulya Calikoglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| | - Elif Bagdemir
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| | - Selda Celik
- Hamidiye Faculty of Nursing, Department of Internal Medicine, Nursing University of Health Sciences Turkey, Istanbul, Turkey
| | - Cemile Idiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| | - Haluk Ozsarı
- Department of Healthcare Management, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Halim Issever
- Division of Medical Sciences, Department of Public Health, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| | - Ilhan Satman
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey
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21
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Abstract
INTRODUCTION Despite advances in and increased adoption of technology, glycemic outcomes for individuals with type 1 diabetes (T1D) have not improved. Access to care is limited for many, in part due to a shortage of endocrinologists and their concentration in urban areas. Managing T1D via telehealth has potential to improve glycemic outcomes, as the barriers of travel-related time and cost are mitigated. METHODS Our endocrine telehealth program started in 2013 and currently provides care to nine rural community hospitals in Nebraska and Iowa. A retrospective cohort study was performed to evaluate glycemic outcomes in people with T1D who received care at these telehealth clinics from 2013-2019. Data were collected on age, race, gender, prior diabetes provider, use of diabetes technology, and A1c values over time. RESULTS One hundred thirty-nine individuals were followed for an average duration of 32 months (range 4-69 months). Sixty-six percent of people were previously under the care of an endocrinologist. The most common therapeutic action, in addition to insulin adjustment, was addition of a CGM (52%). Each year in telemedicine care was associated with a decline of 0.13% in A1c (95% CI: -0.20, -0.06). There was no association between A1c and age or gender. When stratifying by previous diabetes provider, all groups had a statistically significant decline in A1c, even those with a previous endocrine provider. There was no statistically significant decline in A1c based on addition of technology. CONCLUSION We have shown that traditional telehealth visits are an effective way to provide care for people with T1D long-term and may provide distinct advantages to home telehealth visits.
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Affiliation(s)
- Leslie A Eiland
- Division of Diabetes, Endocrinology
& Metabolism, University of Nebraska Medical Center, Omaha, NE, USA
- Leslie A Eiland, MD, Division of Diabetes,
Endocrinology & Metabolism, University of Nebraska Medical Center, 984130
Nebraska Medical Center, Omaha, NE 68198-4130, USA.
| | - Andjela Drincic
- Division of Diabetes, Endocrinology
& Metabolism, University of Nebraska Medical Center, Omaha, NE, USA
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22
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Greenwood DA, Litchman ML, Isaacs D, Blanchette JE, Dickinson JK, Hughes A, Colicchio VD, Ye J, Yehl K, Todd A, Peeples MM. A New Taxonomy for Technology-Enabled Diabetes Self-Management Interventions: Results of an Umbrella Review. J Diabetes Sci Technol 2022; 16:812-824. [PMID: 34378424 PMCID: PMC9264439 DOI: 10.1177/19322968211036430] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND A 2017 umbrella review defined the technology-enabled self-management (TES) feedback loop associated with a significant reduction in A1C. The purpose of this 2021 review was to develop a taxonomy of intervention attributes in technology-enabled interventions; review recent, high-quality systematic reviews and meta-analyses to determine if the TES framework was described and if elements contribute to improved diabetes outcomes; and to identify gaps in the literature. METHODS We identified key technology attributes needed to describe the active ingredients of TES interventions. We searched multiple databases for English language reviews published between April 2017 and April 2020, focused on PwD (population) receiving diabetes care and education (intervention) using technology-enabled self-management (comparator) in a randomized controlled trial, that impact glycemic, behavioral/psychosocial, and other diabetes self-management outcomes. AMSTAR-2 guidelines were used to assess 50 studies for methodological quality including risk of bias. RESULTS The TES Taxonomy was developed to standardize the description of technology-enabled interventions; and ensure research uses the taxonomy for replication and evaluation. Of the 26 included reviews, most evaluated smartphones, mobile applications, texting, internet, and telehealth. Twenty-one meta-analyses with the TES feedback loop significantly lowered A1C. CONCLUSIONS Technology-enabled diabetes self-management interventions continue to be associated with improved clinical outcomes. The ongoing rapid adoption and engagement of technology makes it important to focus on uniform measures for behavioral/psychosocial outcomes to highlight healthy coping. Using the TES Taxonomy as a standard approach to describe technology-enabled interventions will support understanding of the impact technology has on diabetes outcomes.
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Affiliation(s)
- Deborah A. Greenwood
- School of Nursing, UT Health San
Antonio, TX, USA
- Deborah A. Greenwood, PhD, RN, BC-ADM,
CDCES, FADCES, School of Nursing, UT Health San Antonio, 7703 Floyd Curl Dr, San
Antonio, TX 78229 USA.
| | | | - Diana Isaacs
- Cleveland Clinic Diabetes Center,
Cleveland, OH, USA
| | | | | | | | | | - Jiancheng Ye
- Northwestern University Feinberg School
of Medicine, Chicago, IL, USA
| | - Kirsten Yehl
- Association of Diabetes Care &
Education Specialists, Chicago, IL, USA
| | - Andrew Todd
- University of Central Florida, College
of Nursing, University Tower, Orlando, FL, USA
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23
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Video Telehealth Access and Changes in HbA1c Among People With Diabetes. Am J Prev Med 2022; 62:782-785. [PMID: 34893386 PMCID: PMC9035032 DOI: 10.1016/j.amepre.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/01/2021] [Accepted: 10/18/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Video telehealth can offer people convenient, real-time access to clinicians without arranging transportation or time off work. Among people with diabetes, this study examines the association between video telehealth access and changes in HbA1c. METHODS This longitudinal cohort study (2016-2019) used linear regression with person-level fixed effects, stratified by baseline HbA1c (last value in 2015), to examine the association between video visit access and changes in HbA1c. HbA1c values were categorized into 3 periods of video visit exposure: (1) before any video visit, (2) during video visit transition year (calendar year of the first video visit), and (3) after video visits. The model compared changes in HbA1c values collected before the patient had any video visits with those collected after the transition year. Analyses were conducted in September 2020. RESULTS Among 204,301 people with diabetes, video visit access was associated with a statistically significant reduction of 0.15 (95% CI= -0.19, -0.11) percentage points in HbA1c, with greater reductions among patients with an elevated baseline HbA1c value (-0.22 percentage points, 95% CI= -0.32, -0.11) and with no baseline HbA1c measurement (-0.39 percentage points, 95% CI= -0.71, -0.07). CONCLUSIONS Gaining access to video telehealth was associated with reductions in HbA1c among people with diabetes. Video telehealth offers people with chronic conditions a new, convenient way to access health care, is not associated with worsening HbA1c, and may support better disease management, particularly among patients with higher baseline HbA1c.
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24
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Cao DX, Tran RJC, Yamzon J, Stewart TL, Hernandez EA. Effectiveness of telepharmacy diabetes services: A systematic review and meta-analysis. Am J Health Syst Pharm 2022; 79:860-872. [PMID: 35235950 DOI: 10.1093/ajhp/zxac070] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Although pharmacist-provided diabetes services have been shown to be effective, the effectiveness of telepharmacy (TP) in diabetes management has not been clearly established. This systematic review and meta-analysis aims to evaluate the effectiveness of diabetes TP services. METHODS PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched (from inception through September 2021) to identify published studies that evaluated the effect of TP services in patients with diabetes mellitus and reported either glycosylated hemoglobin (HbA1c) or fasting blood glucose (FBG) outcomes. Mean difference (MD), weighted mean difference (WMD), relative risk (RR), and 95% confidence intervals were calculated using the DerSimonian and Laird random-effects model. RESULTS 36 studies involving 13,773 patients were included in the systematic review, and 23 studies were included in the meta-analysis. TP was associated with a statistically significant decrease in HbA1c (MD, -1.26%; 95% CI, -1.69 to -0.84) from baseline. FBG was not significantly affected (MD, -25.32 mg/dL; 95% CI, -57.62 to 6.98). Compared to non-TP service, TP was associated with a lower risk of hypoglycemia (RR, 0.48; 95% CI, 0.30-0.76). In a subset of studies that compared TP to face-to-face (FTF) pharmacy services, no significant difference in HbA1c lowering was seen between the 2 groups (WMD, -0.09%; 95% CI, -1.07 to 0.90). CONCLUSION Use of TP was associated with reduction of HbA1c and the risk of hypoglycemia in patients with diabetes mellitus. High-quality randomized controlled trials are needed to validate the effectiveness of diabetes TP services relative to FTF services.
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Affiliation(s)
- Diana X Cao
- Department of Pharmacy Practice, Marshall B. Ketchum University College of Pharmacy, Fullerton, CA, USA
| | - Rebecca J C Tran
- Department of Clinical and Administrative Sciences, Keck Graduate Institute School of Pharmacy and Health Sciences, Claremont, CA, USA
| | - Joycelyn Yamzon
- Department of Pharmacy Practice, Marshall B. Ketchum University College of Pharmacy, Fullerton, CA, USA
| | - Tania L Stewart
- Department of Clinical and Administrative Sciences, Keck Graduate Institute School of Pharmacy and Health Sciences, Claremont, CA, USA
| | - Elvin A Hernandez
- Department of Pharmacy Practice, Marshall B. Ketchum University College of Pharmacy, Fullerton, CA, USA
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25
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Dhediya R, Chadha M, Bhattacharya AD, Godbole S, Godbole S. Role of Telemedicine in Diabetes Management. J Diabetes Sci Technol 2022; 17:775-781. [PMID: 35227105 DOI: 10.1177/19322968221081133] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Telemedicine is a growing arena that may increase access to care for patients with diabetes. It has more relevance for rural populations or those with limited physical access to health care, for improving diabetes care. Telemedicine can also be used to offer diabetes self-education and transportation barriers for patients living in under-resourced areas or with disabilities. METHOD "This review explores the landscape of telemedicine approaches and evidence for incorporation into general practice. RESULTS & DISCUSSION Telehealth platforms have been shown to be both feasible and effective for health care delivery in diabetes, although there are many caveats that require tailoring to the institution, clinician, and patient population. Research in diabetes telehealth should focus next on how to increase access to patients who are known to be marginalized from traditional models of health care.
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Affiliation(s)
- Rajnish Dhediya
- Department of Medical Affairs, Dr. Reddy's Laboratories Limited, Hyderabad, India
| | - Manoj Chadha
- Department of Endocrinology, P.D. Hinduja Hospital, Mumbai, India
| | | | - Shreerang Godbole
- Institute for Treatment and Research in Diabetes and Endocrinology, Pune, India
| | - Shreeharsh Godbole
- Institute for Treatment and Research in Diabetes and Endocrinology, Pune, India
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26
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Udsen FW, Hangaard S, Bender C, Andersen J, Kronborg T, Vestergaard P, Hejlesen O, Laursen S. The Effectiveness of Telemedicine Solutions in Type 1 Diabetes Management: A Systematic Review and Meta-analysis. J Diabetes Sci Technol 2022; 17:782-793. [PMID: 35135365 DOI: 10.1177/19322968221076874] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Telemedicine holds a potential to strengthen self-management support outside health care settings in the everyday management of type 1 diabetes (T1D). However, existing effectiveness reviews are older or include a relatively narrow focus on specific definitions of telemedicine or included databases. OBJECTIVE To conduct a systematic review of the effectiveness of telemedicine solutions versus any comparator on diabetes-related outcomes among people with T1D. METHODS Studies including adults (≥18 years) with T1D published before October 14, 2020, were eligible. Primary outcome was glycated hemoglobin (HbA1c, %). The Cochrane Library, PubMed, EMBASE, and CINAHL were searched. Meta-analysis based on the mean difference in HbA1c% was used to pool effects. The Cochrane tool was applied to assess risk-of-bias, and the certainty of evidence was graded using the GRADE approach. RESULTS A total of 22 studies were included (with 1615 participants). Treatment effect for HbA1c% favored telemedicine (mean difference of -0.26% [95% confidence interval:-0.37% to -0.15%]) with moderate effect certainty. Heterogeneity was moderate (I2 = 33.30%). Although not significant, secondary outcomes were all in favor of telemedicine except number of severe hypoglycemic events and diabetes knowledge, but the certainty of the evidence for those outcomes was all low or very low. DISCUSSION Reducing average HbA1c% levels are important to combat the risk of diabetic complications and premature death. However, the evidence mostly consist of small studies with a relative short duration and the estimated pooled effect is smaller than could be expected from quality improvement strategies in general for diabetes management. PROSPERO NUMBER CRD42020123565.
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Affiliation(s)
- Flemming Witt Udsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Stine Hangaard
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Clara Bender
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jonas Andersen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Thomas Kronborg
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Sisse Laursen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Aalborg, Denmark
- Department of Nursing, University College Nordjylland, Aalborg, Denmark
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27
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Almasi S, Shahbodaghi A, Asadi F. Efficacy of Telemedicine for the Management of Asthma: A Systematic Review. TANAFFOS 2022; 21:132-145. [PMID: 36879729 PMCID: PMC9985125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/15/2021] [Indexed: 03/08/2023]
Abstract
Background Considering the increased prevalence of asthma and its consequences for individuals and society, its effective management and close monitoring is essential. Awareness of the effects of telemedicine can improve asthma management. The present study aimed to systematically review articles examining the effect of telemedicine on the management of asthma, including control of the symptom, patients' quality of life, costs, and adherence to treatment programs. Materials and Methods A systematic search was performed on four databases: PubMed, Web of Science, Embase, and Scopus. English language clinical trials investigating the effectiveness of telemedicine in asthma management published from 2005 to 2018 were selected and retrieved. The present study was designed and conducted based on the PRISMA guidelines. Results Out of 33 articles included in this research, telemedicine was employed by 23 studies for the promotion of patient adherence to treatment in the form of reminders and feedback, by 18 for telemonitoring and communicating with healthcare providers, by six for offering remote patient education, and by five for counseling. The most frequently used telemedicine approach was asynchronous (used in 21 articles), and the most commonly utilized tool was Web-based (utilized in 11 articles). Conclusion Telemedicine can improve symptom control, patients' quality of life, and adherence to treatment programs. However, little evidence exists confirming the effectiveness of telemedicine in decreasing costs.
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Affiliation(s)
- Sohrab Almasi
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azam Shahbodaghi
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Medical Library and Information Science, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farkhondeh Asadi
- Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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28
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Leblalta B, Kebaili H, Sim R, Lee SWH. Digital health interventions for gestational diabetes mellitus: A systematic review and meta-analysis of randomised controlled trials. PLOS DIGITAL HEALTH 2022; 1:e0000015. [PMID: 36812531 PMCID: PMC9931335 DOI: 10.1371/journal.pdig.0000015] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/21/2021] [Indexed: 12/29/2022]
Abstract
Good blood glucose control is important to reduce the risk of adverse effects on mothers and their offspring in women with gestational diabetes (GDM). This review examined the impact of using digital health interventions on reported glycaemic control among pregnant women with GDM and its impact on maternal and foetal outcomes. Seven databases were searched from database inception to October 31st, 2021 for randomised controlled trials that examined digital health interventions to provide services remotely for women with GDM. Two authors independently screened and assessed the studies for eligibility for inclusion. Risk of bias was independently assessed using the Cochrane Collaboration's tool. Studies were pooled using random effects model and presented as risk ratio or mean difference with 95% confidence intervals. Quality of evidence was assessed using GRADE framework. Twenty-eight randomised controlled trials that examined digital health interventions in 3,228 pregnant women with GDM were included. Moderate certainty of evidence showed that digital health interventions improved glycaemic control among pregnant women, with lower fasting plasma glucose (mean difference -0.33 mmol/L; 95% CI: -0.59 to -0.07), 2-hour post-prandial glucose (-0.49 mmol/L; -0.83 to -0.15) and HbA1c (-0.36%; -0.65 to -0.07). Among those randomised to digital health interventions, there was a lower need for caesarean delivery (Relative risk: 0.81; 0.69 to 0.95; high certainty) and foetal macrosomia (0.67; 0.48 to 0.95; high certainty). Other maternal and foetal outcomes were not significantly different between both groups. Moderate to high certainty evidence support the use of digital health interventions, as these appear to improve glycaemic control and reduce the need for caesarean delivery. However, more robust evidence is needed before it can be offered as a choice to supplement or replace clinic follow up. Systematic review registration: PROSPERO: CRD42016043009.
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Affiliation(s)
- Boutheina Leblalta
- Faculty of Medicine, Department of Pharmacy, University of Salah Boubnider Constantine, Algeria
| | - Hanane Kebaili
- Faculty of Médecine, Département of Pharmacy, Benboulaid University of Batna, Algeria
| | - Ruth Sim
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Selangor, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Selangor, Malaysia
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Selangor, Malaysia
- Center for Public Health, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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29
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Evin F, Er E, Ata A, Jalilova A, Demir G, Atik Altınok Y, Özen S, Darcan Ş, Gökşen D. The Value of Telemedicine for the Follow-up of Patients with New Onset Type 1 Diabetes Mellitus During COVID-19 Pandemic in Turkey: A Report of Eight Cases. J Clin Res Pediatr Endocrinol 2021; 13:468-472. [PMID: 33084289 PMCID: PMC8638622 DOI: 10.4274/jcrpe.galenos.2020.2020.0160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The current Coronavirus disease-2019 (COVID-19) pandemic has forced health care teams to look for alternative approaches to manage a great number of children with diabetes, not only in rural but also in urban locations. The aim was to assess the provision of information about follow-up of new-onset pediatric type 1 diabetes (T1D) patients, and to investigate the integration of telemedicine into routine clinical care in the long term. The changes in coefficient of variation (CV), standard deviation and percentages of time in range (TIR), time below range (TBR) and time above range were evaluated in eight children with new-onset T1D, diagnosed during the COVID-19 pandemic. The study period was two-months of follow-up using a telemedicine system. Median follow-up time was 51 (24-66) days. Two of the patients were using low glucose suspend system and six were on multiple daily injection therapy. Target TIR values were achieved in seven patients in the last televisit and, in line with recent guidelines, a TBR <70 mg/dL (<3.9 mmol/L) (level 1 hypoglycemia) of <4% and a TBR <54 mg/dL (<3.0 mmol/L) (level 2 hypoglycemia) of <1% were achieved in all patients. Seven patients achieved a CV of <36% at their last televisit. Telemedicine as an alternative follow-up tool during unusual circumstances such pandemics, even in countries where it is not routinely used, could be beneficial to achieve optimum glycemic control in patients with new-onset T1D.
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Affiliation(s)
- Ferda Evin
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey,* Address for Correspondence: Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey Phone: +90 232 390 12 30 E-mail:
| | - Eren Er
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Aysun Ata
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Arzu Jalilova
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Günay Demir
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Yasemin Atik Altınok
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Samim Özen
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Şükran Darcan
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
| | - Damla Gökşen
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, İzmir, Turkey
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30
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Muller AE, Berg RC, Jardim PSJ, Johansen TB, Ormstad SS. Can Remote Patient Monitoring Be the New Standard in Primary Care of Chronic Diseases, Post-COVID-19? Telemed J E Health 2021; 28:942-969. [PMID: 34665645 DOI: 10.1089/tmj.2021.0399] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: One lesson from the current COVID-19 pandemic is the need to optimize health care provision outside of traditional settings, and potentially over longer periods of time. An important strategy is remote patient monitoring (RPM), allowing patients to remain at home, while they transmit health data and receive follow-up services. Materials and Methods: We conducted an overview of the latest systematic reviews that had included randomized controlled trials with adult patients with chronic diseases. We summarized results and displayed these in forest plots, and used GRADE (Grading of Recommendations Assessment, Development, and Evaluation) to assess our certainty of the evidence. Results: We included 4 systematic reviews that together reported on 11 trials that met our definition of RPM, each including patients with diabetes and/or hypertension. RPM probably makes little to no difference on HbA1c levels. RPM probably leads to a slight reduction in systolic blood pressure, with questionable clinical meaningfulness. RPM probably has a small negative effect on the physical component of health-related quality of life, but the clinical significance of this reduction is uncertain. We have low confidence in the finding that RPM makes no difference to the remaining five primary outcomes. Conclusion: Most of our findings are consistent with reviews of other, broader definitions of RPM. The type of RPM examined in this review is as effective as standard treatment for patients with diabetes/hypertension. If this or other types of RPM are to be used for "long covid" patients or for other chronic disease groups post-pandemic, we need to understand why RPM may negatively affect quality of life.
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Affiliation(s)
- Ashley Elizabeth Muller
- Department of Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
| | - Rigmor C Berg
- Department of Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway.,Department of Community Medicine, The Arctic University of Norway, University of Tromsø, Tromsø, Norway
| | | | - Trine Bjerke Johansen
- Department of Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
| | - Sari Susanna Ormstad
- Department of Reviews and Health Technology Assessments, Norwegian Institute of Public Health, Oslo, Norway
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Efficacy of eHealth Interventions for Adults with Diabetes: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178982. [PMID: 34501572 PMCID: PMC8431552 DOI: 10.3390/ijerph18178982] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/19/2022]
Abstract
The aim is to provide meta-analytical evidence on eHealth interventions’ efficacy in supporting the psychosocial and physical well-being of adults with type 1 or type 2 Diabetes Mellitus (DM), and to investigate differences in interventions primarily targeted at providing glycemic control vs. psychosocial support. A PRISMA-guided systematic search was conducted. Randomized Controlled Trials (RCTs) regarding eHealth interventions for adults (18–65 years) with DM were included. Data were pooled using Standard Mean Difference (SMD); sub-group analysis and meta-regressions were performed when appropriate. Outcomes were Hemoglobin A1c (HbA1c), diabetes distress, quality of life, anxiety, stress, and depression. Intervention acceptability was assessed performing the Odds Ratio (OR) of drop-out rates. Thirteen RCTs comprising 1315 participants were included (52.09% females; Mage = 46.18, SD = 9.98). Analyses showed intervention efficacy on HbA1c (SMD = −0.40; 95% CI = −0.70, −0.12; k = 13) and depressive symptoms (SMD = −0.18; 95% CI = −0.33, −0.02; k = 6) at RCTs endpoint and were well accepted (OR = 1.43; 95% CI = 0.72, 2.81; k = 10). However, efficacy on HbA1c was not maintained at follow-up (SMD = −0.13; 95% CI = −0.31, 0.05; k = 6). eHealth interventions providing medical support were acceptable and effective in fostering glycemic control and decreasing depressive symptoms in the short-term only. Digital solutions should be developed on multiple levels to fully support the psychophysical well-being of people with DM.
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32
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A Review of Prenatal Care Delivery to Inform the Michigan Plan for Appropriate Tailored Health Care in Pregnancy Panel. Obstet Gynecol 2021; 138:603-615. [PMID: 34352841 DOI: 10.1097/aog.0000000000004535] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To perform a literature review of key aspects of prenatal care delivery to inform new guidelines. DATA SOURCES A comprehensive review of Ovid MEDLINE, Elsevier's Scopus, Google Scholar, and ClinicalTrials.gov. METHODS OF STUDY SELECTION We included studies addressing components of prenatal care delivery (visit frequency, routine pregnancy assessments, and telemedicine) that assessed maternal and neonatal health outcomes, patient experience, or care utilization in pregnant individuals with and without medical conditions. Quality was assessed using the RAND/UCLA Appropriateness Methodology approach. Articles were independently reviewed by at least two members of the study team for inclusion and data abstraction. TABULATION, INTEGRATION, AND RESULTS Of the 4,105 published abstracts identified, 53 studies met inclusion criteria, totaling 140,150 participants. There were no differences in maternal and neonatal outcomes among patients without medical conditions with reduced visit frequency schedules. For patients at risk of preterm birth, increased visit frequency with enhanced prenatal services was inconsistently associated with improved outcomes. Home monitoring of blood pressure and weight was feasible, but home monitoring of fetal heart tones and fundal height were not assessed. More frequent weight measurement did not lower rates of excessive weight gain. Home monitoring of blood pressure for individuals with medical conditions was feasible, accurate, and associated with lower clinic utilization. There were no differences in health outcomes for patients without medical conditions who received telemedicine visits for routine prenatal care, and patients had decreased care utilization. Telemedicine was a successful strategy for consultations among individuals with medical conditions; resulted in improved outcomes for patients with depression, diabetes, and hypertension; and had inconsistent results for patients with obesity and those at risk of preterm birth. CONCLUSION Existing evidence for many components of prenatal care delivery, including visit frequency, routine pregnancy assessments, and telemedicine, is limited.
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Rohilla L, Kaur S, Duggal M, Malhi P, Bharti B, Dayal D. Diabetes Self-Management Education and Support to Improve Outcomes for Children and Young Adults With Type 1 Diabetes: An Umbrella Review of Systematic Reviews. Sci Diabetes Self Manag Care 2021; 47:332-345. [PMID: 34338051 DOI: 10.1177/26350106211031809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE The objectives of this umbrella review were to describe various aspects of diabetes self-management education and support (DSMES)-related interventions and their effect on clinical, behavioral, and psychosocial outcomes among children and young adults with type 1 diabetes (T1DM) and identify gaps in current DSMES-related research. METHODS An umbrella review of systematic reviews on DSMES interventions was conducted in accordance with the PRISMA 2009 statement. Four international medical databases were searched for eligible review articles published in English in the last 10 years that dealt with children and youths with T1DM and were conducted in accordance with a priori protocol. RESULTS Out of the 234 citations screened, only 8 systematic reviews representing 166 studies were considered eligible for further analysis. Glycemic management (A1C) is the most common outcome variable (108 studies). Common behavioral and psychosocial outcome variables examined are episodes of hypoglycemia (27 studies) and diabetic ketoacidosis (21 studies) and self-care behavior and generic quality of life (20 studies each). Several gaps in DSMES-related research studies are identified, including uneven geographical distribution of study population, methodological weaknesses in study designs, missing important outcome variables, use of nonstandardized assessment tools, and lack of assessment of the sustainability of effects. CONCLUSION The effects of DSMES interventions on clinical, behavioral, and psychosocial outcomes are varied. The heterogeneity of implementation and evaluation makes it difficult to draw clear conclusions about elements of DSMES that are most effective. There is a need for long-term assessment of the psychosocial and behavioral outcomes using validated and generalizable instruments.
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Affiliation(s)
- Latika Rohilla
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sukhpal Kaur
- National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mona Duggal
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prahbhjot Malhi
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhavneet Bharti
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Devi Dayal
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Telemedicine in the Time of the COVID-19 Pandemic: Results from the First Survey among Italian Pediatric Diabetes Centers. Healthcare (Basel) 2021; 9:healthcare9070815. [PMID: 34203306 PMCID: PMC8304480 DOI: 10.3390/healthcare9070815] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Use of telemedicine for children and adolescents with type 1 diabetes at the beginning of the COVID-19 pandemic was investigated. Method: 68 Italian pediatric diabetes centers were invited to complete a survey about telemedicine usage in their pediatric patients, allocated to the no-tech group (multiple daily injections and self-monitoring blood glucose) and the tech group (insulin pump and/or flash- or continuous-glucose monitoring). Results: 60.3% of the centers completed the survey. In both the no-tech and tech groups, the most used ways of communication were generic download portals, instant messaging with personal physicians’ mobiles, working emails, and phone calls to physicians’ mobiles, with no difference, except for the use of email being higher in the no-tech group (p = 0.03). Seventy-four percent of the centers did not have any systematization and/or reimbursement, with significant differences among regions (p = 0.03). Conclusions: Almost all Italian pediatric diabetes centers use telemedicine in a semi-volunteering manner, lacking proper codification, reimbursement system, legal traceability, and accreditation system.
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Rachmiel M, Lebenthal Y, Mazor-Aronovitch K, Brener A, Levek N, Levran N, Chorna E, Dekel M, Barash G, Landau Z, Pinhas-Hamiel O. Glycaemic control in the paediatric and young adult population with type 1 diabetes following a single telehealth visit - what have we learned from the COVID-19 lockdown? Acta Diabetol 2021; 58:697-705. [PMID: 33511493 PMCID: PMC7842171 DOI: 10.1007/s00592-021-01673-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 01/07/2021] [Indexed: 02/08/2023]
Abstract
AIMS Children with chronic diseases were unable to receive their usual care during COVID-19 lockdown. We assessed the feasibility and impact of telehealth visits on the time-in-range (TIR) of paediatric individuals with type 1 diabetes (T1D). METHODS An observational multicentre real-life study. Patients scheduled for an in-clinic visit during the lockdown were offered to participate in a telehealth visit. Sociodemographic, clinical, continuous glucose monitor and pump data were recorded 2 weeks prior and 2 weeks after telehealth visit. The primary endpoint was change in relative-TIR, i.e. change in TIR divided by the percent of possible change (∆TIR/(100-TIRbefore)*100). RESULTS The study group comprised 195 individuals with T1D (47.7% males), mean±SD age 14.6 ± 5.3 years, and diabetes duration 6.0 ± 4.6 years. Telehealth was accomplished with 121 patients and their parents (62.0%); 74 (38.0%) did not transfer complete data. Mean TIR was significantly higher for the two-week period after the telehealth visit than for the two-week period prior the visit (62.9 ± 16.0, p < 0.001 vs. 59.0 ± 17.2); the improvement in relative-TIR was 5.7±26.1%. Initial higher mean glucose level, lower TIR, less time spent at <54 mg/dl range, longer time spent at 180-250 mg/dl range, higher daily insulin dose, and single-parent household were associated with improved relative-TIR. Multiple regression logistic analysis demonstrated only initial lower TIR and single-parent household were significant, odds ratio: -0.506, (95%CI -0.99,-0.023), p=0.04 and 13.82, (95%CI 0.621, 27.016), p=0.04, respectively. CONCLUSIONS Paediatric and young adult patients with T1D benefited from a telehealth visit during COVID-19. However, this modality is not yet suitable for a considerable proportion of patients.
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Affiliation(s)
- Marianna Rachmiel
- Pediatric Endocrinology Unit, Shamir (Assaf Harofeh) Medical Center, Tzrifin, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yael Lebenthal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Kineret Mazor-Aronovitch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
- Pediatric Endocrine and Diabetes Unit, Chaim Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat-Gan, Israel
| | - Avivit Brener
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Noa Levek
- National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
- Pediatric Endocrine and Diabetes Unit, Chaim Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat-Gan, Israel
| | - Neria Levran
- National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
- Pediatric Endocrine and Diabetes Unit, Chaim Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat-Gan, Israel
| | - Efrat Chorna
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Michal Dekel
- Pediatric Endocrinology Unit, Shamir (Assaf Harofeh) Medical Center, Tzrifin, Israel
| | - Galia Barash
- Pediatric Endocrinology Unit, Shamir (Assaf Harofeh) Medical Center, Tzrifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zohar Landau
- National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
- Pediatrics Department, Barzilai Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Orit Pinhas-Hamiel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel
- Pediatric Endocrine and Diabetes Unit, Chaim Sheba Medical Center, Edmond and Lily Safra Children's Hospital, Ramat-Gan, Israel
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Mumford B, Oldham V, Lee D, Jones J, Das G. The effectiveness of running virtual clinics as part of insulin pump services for patients with type 1 diabetes. ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Eberle C, Stichling S. Telemetric Interventions Offer New Opportunities for Managing Type 1 Diabetes Mellitus: Systematic Meta-review. JMIR Diabetes 2021; 6:e20270. [PMID: 33724201 PMCID: PMC8080418 DOI: 10.2196/20270] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/20/2020] [Accepted: 02/16/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The prevalence of diabetes mellitus (DM) is increasing rapidly worldwide. Simultaneously, technological advances are offering new opportunities for better management of type 1 diabetes mellitus (T1DM). Telemetry, the remote acquisition of patient data via a telecommunication system, is a promising field of application in eHealth and is rapidly gaining importance. OBJECTIVE The aim of this study was to summarize the current evidences available on the effectiveness of telemetric approaches in T1DM management. This systematic meta-review examined different types of interventions of the technologies used in communication between health care professionals and patients as well as the key outcomes. METHODS We performed a systematic search in Web of Science Core Collection, EMBASE, Cochrane Library, MEDLINE via PubMed, and CINAHL databases in April 2020 with regard to the effectiveness of telemetric interventions for T1DM. We classified the interventions into 4 categories according to the technology used: (1) real-time video communication, (2) real-time audio communication, (3) asynchronous communication, and (4) combined forms of communication (real-time and asynchronous). We considered various study designs such as systematic reviews, clinical trials, meta-analyses, and randomized controlled trials and focused on the key outcomes. Additionally, a funnel plot based on hemoglobin A1c (HbA1c) values and different quality assessments were performed. RESULTS We identified 17 (6 high quality and 9 moderate quality) eligible publications: randomized controlled trials (n=9), systematic reviews and meta-analyses (n=5), cohort studies (n=2), and qualitative publications (n=1). Of 12 studies, 8 (67%) indicated a (significant or nonsignificant) reduction in HbA1c levels; 65% (11/17) of the studies reported overall (mildly) positive effects of telemetric interventions by addressing all the measured outcomes. Asynchronous interventions were the most successful for patients diagnosed with T1DM, but no technology was clearly superior. However, there were many nonsignificant results and not sustained effects, and in some studies, the control group benefited from telemetric support or increased frequency of contacts. CONCLUSIONS Based on the currently available literature, this systematic meta-review shows that telemetric interventions cause significant reduction in HbA1c levels and result in overall positive effects in T1DM management. However, more specified effects of telemetric approaches in T1DM management should be analyzed in detail in larger cohorts.
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Affiliation(s)
- Claudia Eberle
- Medicine with Specialization in Internal Medicine and General Medicine, Hochschule Fulda - University of Applied Sciences, Fulda, Germany
| | - Stefanie Stichling
- Medicine with Specialization in Internal Medicine and General Medicine, Hochschule Fulda - University of Applied Sciences, Fulda, Germany
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Chan CB, Popeski N, Hassanabad MF, Sigal RJ, O'Connell P, Sargious P. Use of Virtual Care for Glycemic Management in People With Types 1 and 2 Diabetes and Diabetes in Pregnancy: A Rapid Review. Can J Diabetes 2021; 45:677-688.e2. [PMID: 34045146 DOI: 10.1016/j.jcjd.2021.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/18/2021] [Accepted: 02/28/2021] [Indexed: 11/26/2022]
Abstract
Our objective in this study was to answer the main research question: In patients with diabetes, does virtual care vs face-to-face care provide different clinical, patient and practitioner experience or quality outcomes? Articles (2012 to 2020) describing interventions using virtual care with the capability for 2-way, individualized interactions compared with usual care were included. Studies involving any patients with diabetes and outcomes of glycated hemoglobin (A1C), quality of care and/or patient or health-care practitioner experience were included. Systematic reviews, randomized controlled studies, quasi-experimental trials, implementation trials, observational studies and qualitative analyses were reviewed. MEDLINE and McMaster Health Evidence databases searched in June 2020 identified 59 articles. Virtual care, in particular telemonitoring, combined with a means of 2-way communications provided improvement in A1C similar or superior to usual care, with the strongest evidence for type 2 diabetes. Virtual care was generally acceptable to patients, who expressed satisfaction with their care. Health-care providers recognized benefits but raised issues of technical support, workflow and compensation.
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Affiliation(s)
- Catherine B Chan
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada; Department of Agricultural, Food and Nutritional Sciences, Li Ka Shing Centre for Health Innovation Research, University of Alberta, Edmonton, Alberta, Canada; Department of Physiology, University of Alberta, Edmonton, Alberta, Canada.
| | - Naomi Popeski
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mortaza Fatehi Hassanabad
- Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada; Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ronald J Sigal
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Petra O'Connell
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Peter Sargious
- Diabetes, Obesity and Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada; Department of Medicine, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
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Sim R, Lee SWH. Patient Preference and Satisfaction with the Use of Telemedicine for Glycemic Control in Patients with Type 2 Diabetes: A Review. Patient Prefer Adherence 2021; 15:283-298. [PMID: 33603347 PMCID: PMC7882448 DOI: 10.2147/ppa.s271449] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/21/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Telemedicine has the potential to improve patient care and management for various chronic diseases such as type 2 diabetes. To ensure the success of any telemedicine program, there is a need to understand the patients' satisfaction and their preferences. This review aims to collate and provide evidence related to practices that may influence the performance of telemedicine for patients with type 2 diabetes. METHODS We searched three electronic databases for studies examining patients' satisfaction and preferences for using telemedicine in type 2 diabetes. An evaluation matrix was developed to collect the data from the included articles. A total of 20 articles were identified and data on the key outcomes identified were narratively synthesized. RESULTS Patients were generally satisfied with the use of telemedicine for management of type 2 diabetes. Users reported that telemedicine was beneficial as it provided constant monitoring, improved access to healthcare providers, and reduced waiting time. When adopting a telemedicine platform, most patients expressed preference for mobile health (mHealth) as the telemedicine modality, especially if it has been endorsed by their physician. To improve usability and sustainability, patients suggested that modules related to diabetes education be enhanced, together with sufficient technical and physician support when adopting telemedicine. Patients also expressed the importance of having a sufficiently flexible platform that could be adapted to their needs. CONCLUSION Personalized telemedicine strategies coupled with appropriate physician endorsement greatly influences a patient's decision to undertake telemedicine. Future work should focus on improving telemedicine infrastructure and increasing physician's involvement, especially during the implementation phase.
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Affiliation(s)
- Ruth Sim
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Selangor, Malaysia
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-Being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
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Tejera-Perez C, Moreno-Pérez Ó, Rios J, Reyes-García R. People living with type 1 diabetes point of view in COVID-19 times (COVIDT1 study): Disease impact, health system pitfalls and lessons for the future. Diabetes Res Clin Pract 2021; 171:108547. [PMID: 33278422 PMCID: PMC7711176 DOI: 10.1016/j.diabres.2020.108547] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/29/2020] [Accepted: 11/06/2020] [Indexed: 12/15/2022]
Abstract
AIMS To analyse the effects of confinement among people with type 1 diabetes (T1D) and their caregivers over the course of the COVID-19 crisis and to evaluate contemporary changes in medical assistance and patient preferences. METHODS An observational cross-sectional study designed as a self-reported web-based survey was conducted over the course of the COVID-19 pandemic. RESULTS A total of 769 subjects participated in the survey (603 people with T1D and 166 caregivers). Changes in glycaemic control were reported in 66% of cases, weight gain in 40.4% of cases and decreased exercise levels in 65.4% of cases. Of the cohort, 53% maintained contact with the healthcare team, and 23% received specific information related to COVID-19. Emotional support was requested by 17% of respondents. Regarding telemedicine, 97.9% agreed with its use with the following preferences regarding the future: telephone call (84.5%), video-call (60.6%) and platform devices (39.7%). CONCLUSIONS Over the course of the COVID-19 pandemic, at least two-thirds of people with T1D underwent changes in the management of their condition. Almost all participants agreed with the concept of telemedicine, favouring telephone and video calls as their preferred means of communication.
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Affiliation(s)
- Cristina Tejera-Perez
- Unidad de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Ferrol, Spain.
| | - Óscar Moreno-Pérez
- Endocrinology and Nutrition department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine department, Miguel Hernández University, Elche, Spain.
| | - Jose Rios
- Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic, Barcelona, Spain. Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona.
| | - Rebeca Reyes-García
- Unidad de Endocrinología y Nutrición. Hospital Universitario Torrecárdenas, Almería, Spain. CIBERFES, Instituto de Salud Carlos III.
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Minuto N, Bassi M, Montobbio C, Vinci F, Mercuri C, Perri FN, Cabri M, Calevo MG, d’Annunzio G, Maghnie M. The Effect of Lockdown and Physical Activity on Glycemic Control in Italian Children and Young Patients With Type 1 Diabetes. Front Endocrinol (Lausanne) 2021; 12:690222. [PMID: 34326814 PMCID: PMC8315148 DOI: 10.3389/fendo.2021.690222] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/24/2021] [Indexed: 12/23/2022] Open
Abstract
AIMS The purpose of the study was to evaluate the impact of the lockdown established by the Italian government to limit the spread of Coronavirus disease (COVID-19) on glycemic control in a large sample of patients with type 1 diabetes (T1D) based on age, type of insulin therapy, number of telemedicine visits and physical activity. MATERIAL AND METHODS We retrospectively evaluated glycemic control in young T1D patients using the DexcomG6® system before the Italian lockdown (February 10-23, 2020-Time 0) and during lockdown (April 17-30, 2020-Time 1). Data on age, type of insulin therapy, number of telemedicine visits and physical activity of 202 patients with T1D and a median age of 18.2 years (range: 6-39) were collected. RESULTS Data showed a significant improvement of TIR from 54.58% at T0 to 59.09% at T1 (p ≤0.0001). Glycemic control improved significantly in patients ≥14 years old, showing the best outcome in the "university students and young adults" group (55.40% at T0 and 61.37% at T1, p ≤0.001). All patients reduced physical activity during lockdown; in the 56 patients of "intense physical activity" group both at T0 and T1 TIR increased from ±56.91 to 64.11% (p ≤0.0001). CONCLUSIONS Overall, the lockdown led to an unexpected improvement in glycemic control of young patients with T1D. A healthier and stressless lifestyle changes in association with the maintenance of physical activity resulted in a significant age-proportional improvement in glycemic control.
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Affiliation(s)
- Nicola Minuto
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Marta Bassi
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
- *Correspondence: Marta Bassi,
| | - Carolina Montobbio
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Francesco Vinci
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Claudia Mercuri
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Francesca Nastasia Perri
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Mara Cabri
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | | | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini, University of Genova, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
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Ruddy KJ, Patel SR, Higgins AS, Armenian SH, Herrmann J. Cardiovascular Health during and after Cancer Therapy. Cancers (Basel) 2020; 12:E3737. [PMID: 33322622 PMCID: PMC7763346 DOI: 10.3390/cancers12123737] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 01/22/2023] Open
Abstract
Certain cancer treatments have been linked to specific cardiovascular toxicities, including (but not limited to) cardiomyopathy, atrial fibrillation, arterial hypertension, and myocarditis. Radiation, anthracyclines, human epidermal growth factor receptor 2 (Her2)-directed therapies, fluoropyrimidines, platinums, tyrosine kinase inhibitors and proteasome inhibitors, immune checkpoint inhibitors, and chimeric antigen-presenting (CAR)-T cell therapy can all cause cardiovascular side effects. Management of cardiovascular dysfunction that occurs during cancer therapy often requires temporary or permanent cessation of the risk-potentiating anti-neoplastic drug as well as optimization of medical management from a cardiovascular standpoint. Stem cell or bone marrow transplant recipients face unique cardiovascular challenges, as do patients at extremes of age.
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Affiliation(s)
| | - Shruti R. Patel
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| | | | - Saro H. Armenian
- Department of Population Sciences, City of Hope, Duarte, CA 91010, USA;
| | - Joerg Herrmann
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN 55905, USA;
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Chakranon P, Lai YK, Tang YW, Choudhary P, Khunti K, Lee SWH. Distal technology interventions in people with diabetes: an umbrella review of multiple health outcomes. Diabet Med 2020; 37:1966-1976. [PMID: 31631398 DOI: 10.1111/dme.14156] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2019] [Indexed: 12/15/2022]
Abstract
AIM To summarize and evaluate the existing evidence on the effectiveness of distal technology with regard to multiple health outcomes in people with diabetes. METHODS We searched PubMed, EMBASE and the Cochrane Database of Systematic Reviews from database inception to 31 August 2018 for systematic reviews and/or meta-analyses of studies that examined the impact of distal technology and reported any clinical or patient-related outcomes among people with type 1 or type 2 diabetes. RESULTS The umbrella review identified 95 reviews, including 162 meta-analyses with 46 unique outcomes. Evidence from meta-analyses of randomized controlled studies supports the use of distal technology, especially telehealth and mHealth (healthcare delivered by mobile technology), in people with diabetes for improving HbA1c values by 2-4 mmol/mol (0.2-0.4%). For other health outcomes, such as changes in fasting plasma glucose levels, risk of diabetic ketoacidosis or frequency of severe hypoglycaemia, the evidence was weaker. No evidence was reported for most patient-reported outcomes including quality of life, self-efficacy and medication-taking. The evidence base was poor, with most studies rated as low to very low quality. CONCLUSION Distal technologies were associated with a modest improvement in glycaemic control, but it was unclear if they improved major clinical outcomes or were cost-effective in people with diabetes. More robust research to improve wider outcomes in people with diabetes is needed before such technologies can be recommended as part of routine care for any patient group.
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Affiliation(s)
- P Chakranon
- Faculty of Pharmacy, Silapakorn University, Pathom, Thailand
| | - Y K Lai
- Department of Pharmacy, Hospital Universiti Kebangsaan Malaysia, Cheras, Malaysia
| | - Y W Tang
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | - P Choudhary
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - S W H Lee
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Selangor, Malaysia
- School of Pharmacy, Taylor's University Lakeside Campus, Jalan Taylors, Selangor, Malaysia
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Ceconi V, Barbi E, Tornese G. Glycemic control in type 1 diabetes mellitus and COVID-19 lockdown: What comes after a "quarantine"? J Diabetes 2020; 12:946-948. [PMID: 32909344 DOI: 10.1111/1753-0407.13110] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/08/2020] [Accepted: 09/01/2020] [Indexed: 11/28/2022] Open
Abstract
Highlights A stable or even improved glycemic control was found in adolescents with T1DM using hybrid closed loop system not only during COVID-19 lockdown but also in the weeks after, when daily activities slowly resumed. Although the slowing down of routine daily activities might still have an influence, we believe that the continuation of the health care professional assistance through telemedicine during lockdown might have led to a "dragging effect" in these patients also after its suspension.
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Affiliation(s)
| | - Egidio Barbi
- University of Trieste, Trieste, Italy
- Institute for maternal and child health IRCCS Burlo Garofolo, Trieste, Italy
| | - Gianluca Tornese
- Institute for maternal and child health IRCCS Burlo Garofolo, Trieste, Italy
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March CA, Flint A, DeArment D, Gilliland A, Kelly K, Rizzitano E, Chrisman A, Muzumdar RH, Libman IM. Paediatric diabetes care during the COVID-19 pandemic: Lessons learned in scaling up telemedicine services. ENDOCRINOLOGY DIABETES & METABOLISM 2020; 4:e00202. [PMID: 33349799 PMCID: PMC7744857 DOI: 10.1002/edm2.202] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/14/2020] [Accepted: 10/13/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Christine A March
- Division of Pediatric Endocrinology, Metabolism, and Diabetes UPMC Children's Hospital of Pittsburgh Pittsburgh PA USA
| | - Amanda Flint
- Division of Pediatric Endocrinology, Metabolism, and Diabetes UPMC Children's Hospital of Pittsburgh Pittsburgh PA USA
| | - Diana DeArment
- Division of Pediatric Endocrinology, Metabolism, and Diabetes UPMC Children's Hospital of Pittsburgh Pittsburgh PA USA
| | - Amy Gilliland
- Division of Pediatric Endocrinology, Metabolism, and Diabetes UPMC Children's Hospital of Pittsburgh Pittsburgh PA USA
| | - Karen Kelly
- Division of Pediatric Endocrinology, Metabolism, and Diabetes UPMC Children's Hospital of Pittsburgh Pittsburgh PA USA
| | - Ernesto Rizzitano
- Division of Pediatric Endocrinology, Metabolism, and Diabetes UPMC Children's Hospital of Pittsburgh Pittsburgh PA USA
| | - Aaron Chrisman
- Division of Pediatric Endocrinology, Metabolism, and Diabetes UPMC Children's Hospital of Pittsburgh Pittsburgh PA USA
| | - Radhika H Muzumdar
- Division of Pediatric Endocrinology, Metabolism, and Diabetes UPMC Children's Hospital of Pittsburgh Pittsburgh PA USA
| | - Ingrid M Libman
- Division of Pediatric Endocrinology, Metabolism, and Diabetes UPMC Children's Hospital of Pittsburgh Pittsburgh PA USA
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46
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Laursen S, Hangaard S, Udsen F, Vestergaard P, Hejlesen O. Effectiveness of Telemedicine Solutions for the Management of Patients With Diabetes: Protocol for a Systematic Review and Meta-Analysis. JMIR Res Protoc 2020; 9:e22062. [PMID: 33141100 PMCID: PMC7671833 DOI: 10.2196/22062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 01/07/2023] Open
Abstract
Background Telemedicine is often suggested as a promising approach to support patients with diabetes. However, the effectiveness of diabetes-related telemedicine interventions in regard to patient-related outcomes requires further evaluation. Previous systematic reviews describing the effectiveness of telemedicine in diabetes management focus on a specific type of telemedicine, a specific type of diabetes, specific comparators, or specific outcomes. Moreover, the rapid development within telemedicine emphasizes the need for a new review. Objective The present review has a broad scope with an eye to performing an updated and exhaustive review within the field. The review aims to evaluate the effectiveness of existing telemedicine solutions versus any comparator without the use of telemedicine on diabetes-related outcomes among adult patients with diabetes. Methods The review will consider studies that include adult subjects with a diagnosis of diabetes (type 1, 2, or gestational), studies that evaluate various types of telemedicine interventions, and randomized controlled trials comparing a telemedicine intervention to any control that does not include telemedicine. Peer-reviewed full-text papers in English, Norwegian, Danish, and Swedish will be considered. A thorough search will be performed in the PubMed, CINAHL, EMBASE, and Cochrane Library Central Register of Controlled Trials (CENTRAL) databases. Data extraction will include details about the populations, study methods, interventions, and outcomes of significance based on the review objective. Results The results of the review are expected to provide an estimate of the treatment effect. The studies will be pooled via statistical meta-analysis and supplemented with narrative comparisons when necessary. Conclusions The review is important as it will inform clinicians and investigators about the effect of various telemedicine solutions within the field of diabetes. International Registered Report Identifier (IRRID) DERR1-10.2196/22062
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Affiliation(s)
- Sisse Laursen
- Department of Health Science and Technology, University of Aalborg, Aalborg Øst, Denmark.,University College Nordjylland, Aalborg Øst, Denmark
| | - Stine Hangaard
- Department of Health Science and Technology, University of Aalborg, Aalborg Øst, Denmark.,Steno Diabetes Center North Jutland, Aalborg Øst, Denmark
| | - Flemming Udsen
- Department of Health Science and Technology, University of Aalborg, Aalborg Øst, Denmark.,Steno Diabetes Center North Jutland, Aalborg Øst, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Jutland, Aalborg Øst, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg Øst, Denmark.,Department of Endocrinology, Aalborg University Hospital, Aalborg Øst, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, University of Aalborg, Aalborg Øst, Denmark
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47
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Lee JW, Theng YL, Lee SW. Health information seeking behaviour using mobile devices among people with diabetes: A comparison between Middle and high income country. Digit Health 2020; 6:2055207620956457. [PMID: 32963802 PMCID: PMC7488880 DOI: 10.1177/2055207620956457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/12/2020] [Indexed: 11/17/2022] Open
Abstract
Objective The internet has become a primary source of information for many individuals especially those with chronic diseases. This study aims to understand and compare the health seeking behaviour using mobile devices among individuals with diabetes and between a high (Singapore) and middle (Malaysia) income country. Methods A cross sectional survey was conducted among people with diabetes in Malaysia and Singapore. Participants attending the primary health clinic for the treatment of diabetes were approached to participate in this survey. Data on demographics, health status and beliefs to health were collected and compared. Results A total of 673 respondents were included in the study. Most of the respondents reported to have access to the Internet, with a high ownership of mobile phones (99.3%). However, only one in every three respondents sought information online. Younger individuals (≤50 years) and those with higher education more likely to seek information using mobile devices. Respondents in Singapore reported to be more likely to use mobile devices to monitor their health as compared to respondents in Malaysia. However, most respondents would seek health information from their healthcare professionals’ especially physicians. Conclusion There was limited differences in the health-seeking behaviour among the respondents from both countries, suggesting for a need to identify for more effective means of distribution of health related information.
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Affiliation(s)
- Jason Wy Lee
- Teaching, Learning and Pedagogy Division, Nanyang Technological University, Singapore, Singapore
| | - Yin-Leng Theng
- Office of Education, Duke-NUS Medical School, National University of Singapore, Singapore
| | - Shaun Wh Lee
- Ageing Research Institute for Society and Education, Nanyang Technological University, Singapore, Singapore.,School of Pharmacy, Monash University Malaysia, Selangor, Malaysia.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Selangor, Malaysia
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48
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Omboni S, McManus RJ, Bosworth HB, Chappell LC, Green BB, Kario K, Logan AG, Magid DJ, Mckinstry B, Margolis KL, Parati G, Wakefield BJ. Evidence and Recommendations on the Use of Telemedicine for the Management of Arterial Hypertension: An International Expert Position Paper. Hypertension 2020; 76:1368-1383. [PMID: 32921195 DOI: 10.1161/hypertensionaha.120.15873] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Telemedicine allows the remote exchange of medical data between patients and healthcare professionals. It is used to increase patients' access to care and provide effective healthcare services at a distance. During the recent coronavirus disease 2019 (COVID-19) pandemic, telemedicine has thrived and emerged worldwide as an indispensable resource to improve the management of isolated patients due to lockdown or shielding, including those with hypertension. The best proposed healthcare model for telemedicine in hypertension management should include remote monitoring and transmission of vital signs (notably blood pressure) and medication adherence plus education on lifestyle and risk factors, with video consultation as an option. The use of mixed automated feedback services with supervision of a multidisciplinary clinical team (physician, nurse, or pharmacist) is the ideal approach. The indications include screening for suspected hypertension, management of older adults, medically underserved people, high-risk hypertensive patients, patients with multiple diseases, and those isolated due to pandemics or national emergencies.
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Affiliation(s)
- Stefano Omboni
- From the Clinical Research Unit, Italian Institute of Telemedicine, Varese (S.O.).,Scientific Research Department of Cardiology, Science and Technology Park for Biomedicine, Sechenov First Moscow State Medical University, Russian Federation (S.O.)
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom (R.J.M.)
| | - Hayden B Bosworth
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, NC (H.B.B.).,Department of Psychiatry and Behavioral Sciences (H.B.B.), Duke University, Durham, NC.,Division of General Internal Medicine (H.B.B.), Duke University, Durham, NC.,Department of Population Health Sciences (H.B.B.), Duke University, Durham, NC
| | - Lucy C Chappell
- Women's Health Academic Centre, King's College London, United Kingdom (L.C.C.)
| | - Beverly B Green
- Kaiser Permanente Washington Health Research Institute, Seattle (B.B.G.)
| | - Kazuomi Kario
- Department of Cardiology, Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
| | - Alexander G Logan
- Department of Medicine, Mount Sinai Hospital, University Health Network and University of Toronto, ON, Canada (A.G.L.)
| | - David J Magid
- Colorado Permanente Medical Group, Denver and School of Public Health, University of Colorado, Aurora (D.J.M.)
| | - Brian Mckinstry
- Emeritus Professor of Primary Care eHealth, Usher Institute, The University of Edinburgh, United Kingdom (B.M.)
| | | | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Italy (G.P.).,Istituto Auxologico Italiano, IRCCS San Luca, Milano, Italy (G.P.)
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Feigerlová E, Oussalah A, Zuily S, Sordet S, Braun M, Guéant JL, Guerci B. E-health education interventions on HbA 1c in patients with type 1 diabetes on intensive insulin therapy: A systematic review and meta-analysis of randomized controlled trials. Diabetes Metab Res Rev 2020; 36:e3313. [PMID: 32212412 DOI: 10.1002/dmrr.3313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/09/2020] [Accepted: 03/17/2020] [Indexed: 02/03/2023]
Abstract
AIMS Patient-centered education improves glycemic control in subjects with type 1 diabetes (T1D). E-health technologies are widely used to support medical decision-making, patient advising or teleconsultations; however, the active participation of a patient is missing. Challenges remain whether e-health education can be effectively incorporated into clinical pathways. The purpose of the study was to examine the effects of e-health education, compared to standard care, on HbA1c. MATERIAL AND METHODS: We conducted a literature search (EMBASE, MEDLINE, The Cochrane Library and Web of Science) up to February 2018 for randomized controlled trials (RCTs) of Internet-/ mobile application-based educational interventions, with the active involvement of patients, provided in addition to, or substituting usual care in patients with T1D on intensive insulin therapy. The primary outcome was the standardized difference in means (SDM) of HbA1c change from baseline between intervention and comparator groups. RESULTS Eight RCTs involving 757 subjects were included on 6335 screened citations. After excluding two trials with a high risk of bias from the meta-analysis, the HbA1c change from baseline did not significantly differ between intervention and comparator groups (SDM = -0.154, 95% CI: -0.335 to 0.025; P = 0.01, random-effect model). The number of studies is limited with a relatively short duration. Reporting of educational outcomes was not rigorous. CONCLUSIONS The effect of e-health educational interventions on HbA1c in patients with T1D is comparable to the standard care. This review highlights the need for further well-designed RCTs that will investigate the opportunities of incorporating e-health education into clinical pathways.
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Affiliation(s)
- Eva Feigerlová
- Université de Lorraine, CHRU-Nancy, Department of Endocrinology, Diabetology and Nutrition, Nancy, France
- University Centre for Education by Medical Simulation (CUESiM), Virtual Hospital of Lorraine, Faculty of Medicine, Nancy, France
- Université de Lorraine, Inserm UMR_S 1116-DCAC, Nancy, France
| | - Abderrahim Oussalah
- Université de Lorraine, Inserm, NGERE, Nancy, France
- Université de Lorraine, CHRU-Nancy, Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, and Nutrition, Nancy, France
| | - Stéphane Zuily
- University Centre for Education by Medical Simulation (CUESiM), Virtual Hospital of Lorraine, Faculty of Medicine, Nancy, France
- Université de Lorraine, Inserm UMR_S 1116-DCAC, Nancy, France
- Université de Lorraine, CHRU-Nancy,Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy, France
| | - Stéphanie Sordet
- Department of Diabetology, Cochin University Hospital, Paris, France
| | - Marc Braun
- University Centre for Education by Medical Simulation (CUESiM), Virtual Hospital of Lorraine, Faculty of Medicine, Nancy, France
| | - Jean-Louis Guéant
- Université de Lorraine, Inserm, NGERE, Nancy, France
- Université de Lorraine, CHRU-Nancy, Department of Molecular Medicine, Division of Biochemistry, Molecular Biology, and Nutrition, Nancy, France
| | - Bruno Guerci
- Université de Lorraine, CHRU-Nancy, Department of Endocrinology, Diabetology and Nutrition, Nancy, France
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50
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Snoswell CL, Caffery LJ, Haydon HM, Wickramasinghe SI, Crumblin K, Smith AC. A cost-consequence analysis comparing patient travel, outreach, and telehealth clinic models for a specialist diabetes service to Indigenous people in Queensland. J Telemed Telecare 2020; 25:537-544. [PMID: 31631756 DOI: 10.1177/1357633x19873239] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The delivery of specialist health services to people living in Indigenous communities is an important challenge. Specialist diabetes outpatient clinics may be delivered via a patient travelling to a metropolitan hospital, during an outreach clinic, or by telehealth. The aim of this study was to compare the costs and consequences of different service models for delivering specialist diabetes clinics for a remote Indigenous community. METHOD Patient travel, outreach and telehealth clinic models were compared using a cost-consequence analysis principles. The setting was Cunnamulla, a remote Indigenous community in Western Queensland. Costs were calculated by quantifying the staff resources and travel costs for each clinic model. Costs were reported in Australian dollars and reported from the health service perspective. RESULTS The marginal cost per patient for each clinic were $692 for patient travel, $482 for the outreach and $284 for telehealth. If a patient travel appointment was replaced with telehealth, approximately $517 in costs for patient travel reimbursement would be avoided. While replacing an entire outreach clinic with a telehealth clinic would reduce costs by approximately $3961. CONCLUSION The marginal cost of patient travel to a metropolitan clinic and outreach clinic appointments was greater than telehealth. Telehealth is unlikely to completely replace the need for patient travel or outreach clinics. However, replacing a proportion of these appointments with telehealth may reduce the overall costs of providing specialist diabetes care in remote communities. Telehealth may have advantages beyond economic as it reduces the time away from usual activities for both the patient and endocrinologist.
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Affiliation(s)
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | - Helen M Haydon
- Centre for Online Health, The University of Queensland, Brisbane, Australia
| | | | - Kerry Crumblin
- Cunnamulla Aboriginal Corporation for Health, Cunnamulla, Queensland, Australia
| | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Brisbane, Australia.,University of Southern Denmark, Odense, Denmark
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