This article was originally published here

J Med Internet Res. 2021 Mar 16. doi: 10.2196 / 24552. Online before going to press.


BACKGROUND: Telemedicine in chronic disease management has received a significant boost during the health emergency of COVID-19. Diabetes and technologies to support diabetes care as devices for monitoring glucose, software for analyzing glucose data, and systems for insulin delivery are examples of how remote and structured disease management can be developed. In fact, most of the technologies currently available store and transmit data on the Internet for distribution to healthcare providers.

OBJECTIVE: During this devastating pandemic, we decided to offer our patients the ability to remotely treat diabetes through the use of technology. Therefore, we designed our research to evaluate the effectiveness of two virtual visits to glycemic control parameters in patients with type 1 diabetes (T1D) during the lockout period.

METHODS: This is a prospective observational study that included T1D patients who completed two virtual visits during lockdown for COVID-19. The glucose results that assessed the benefit of virtual contact were time in range (TIR), time above and below range, mean daily glucose, glucose management indicator (GMI), and glycemic variability. This metric was generated by certain computer programs that automatically upload data from the devices used to monitor blood or interstitial glucose. If necessary, we have changed the current treatment during the first virtual visit.

RESULTS: Of 209 eligible T1D patients, 166 completed two virtual visits, 35 were unable to download glucose data, and 8 declined the visit. Among patients not included in the study, the prevalence of users of continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) was significantly lower (CGM 16 vs. 93%; CSII 21 vs. 77%; p = 0.0001) . compared to patients who completed the study. The TIR increased significantly from the first to the second virtual visit: first visit 62–18%, second visit 64–17% (p = 0.02). The increase in TIR was in patients with the conventional measuring device (N = 11, base TIR 55 ± 17% and follow-up TIR 66 ± 13%, p = 0.01) compared to patients with CGM and in patients with Baseline GMI more pronounced ~ 7.5% (N = 45, baseline TIR 45 ± 15% and follow-up TIR 53 ± 18%, p = 0.0001) compared to patients with GMI <7.5% . The only variable that was independently associated with TIR was change in ongoing therapy. The non-standardized beta coefficient and [95% CI] were 5 [0.7-8], p = 0.02. The type of glucose monitoring and insulin delivery systems did not affect the glucometric parameters.

CONCLUSIONS: These results show that the structured virtual visits allow the persistence and improvement of glycemic control in situations where the office visit is not possible.

PMID: 33769945 | DOI: 10.2196 / 24552