Background and Aims

The coronavirus disease-2019 (COVID-19) pandemic has forced rapid reconsideration as to the way in which healthcare is delivered. This study aimed to gather information on the use and perception of telemedicine in people living with type 1 diabetes (T1D) during the COVID-19 pandemic.

Methods

An anonymous questionnaire was widely distributed using an open-access web-based platform. Data were analysed descriptively and results were stratified according to age, sex and HbA_1c.

Results

There were 7477 responses from individuals in 89 countries. Globally, 30% reported that the pandemic had affected their healthcare access due to cancelled physical appointments with their healthcare providers. Thirty-two percent reported no fundamental change in their medical follow-up during this period, with 9% stating that no personal contact was established with their doctors during the study. Twenty-eight percent received remote care through telephone (72%) or video-calls (28%). Of these, 86% found remote appointments useful and 75% plan to have remote appointments in the future. Glucose control, indicated by HbA_1c, was positively associated with positive perception of telemedicine. In males, 45% of respondents with an HbA_1c >9% rated telemedicine not useful compared to those with lower HbA_1c, while 20% of females with an HbA_1c >9% rated it not useful (c₂=14.2, p=0.0016).

Conclusions

Remote appointments have largely been perceived as positive in people with T1D with the majority (75%) stating that they would consider remote appointments beyond the pandemic. Age and level of education do not appear to influence perception of telemedicine, whereas poor glucose control, particularly in males, seems to negatively affect perception.

Background and Aims

Siri (Apple, Inc., Cupertino, CA) allows for voice control of compatible apps, including the "G6" app for a continuous glucose monitoring (CGM) system (Dexcom, Inc., San Diego, CA). A customizable voice command (by default, "Hey Siri what's my glucose?") is sufficient to generate a spoken response that includes the user's current sensor glucose value (SGV) and trend (e.g., "You're 134 and steady"). G6/Siri integration may simplify diabetes management, especially for patients with limited vision or dexterity. We examined patterns and potential implications of invoking the feature.

Methods

Data were from US-based anonymized G6 customers who invoked the feature in December 2019 and uploaded ≥30 days of CGM data in the first half of 2020 (1H2020). Non-users and routine users were defined as those with zero and those with an average of ≥1 feature invocation per day of CGM use in 1H2020. Feature invocations were analyzed for routine users; summary statistics of glycemic metrics were calculated for both groups.

Results

Of the 34,572 customers who used the feature in December 2019, 6,847 were non-users and 2,282 were routine users in 1H2020. Among routine users, the median number of daily invocations was 1.84 (IQR, 1.29-3.29) and the feature was most commonly invoked between 4PM and 6PM (Figure). Time in range (70-180 mg/dL) was lower for non-users than for routine users (57±20 vs. 62±20%, respectivey); mean±SD SGVs were 177±39 and 169±36 mg/dL, respectively.

Conclusions

Routine use of the G6/Siri integration feature may contribute to appropriate diabetes management decisions.

Background and Aims

While registries are fundamental for planning and delivering high quality care for chronic diseases, the number of people living with type 1 diabetes (T1D) in Canada is unknown. The decentralized administrative data available, which captures people living with all types of diabetes, is not able to accurately identify the unique needs related to the daily management, preferences, and well being of people living with T1D (PWD). The aim of this project was to co-design and develop a patient-centered national registry that could enable PWDs to drive future priorities in research, policy, and clinical care.

Methods

The conceptualization of Connect1d occurred in three phases; 1) iterative co-design with PWDs (n=30), 2) a pan-Canada validation study with clinicians, researchers, and PWDs (n=125), and 3) a critical assessment of the patient-centricity of existing T1D registries.

Results

The co-design process identified several gaps and needs in the experience of PWDs, specifically highlighting the hands-off experience they have with research and the lack of accurate data to enable policy change. The resulting solution, Connect1d, aims to improve accessibility and recruitment into clinical trials, and collect data directly from patients to create a national T1D registry. Furthermore, the validation study to date has demonstrated slight variations in perspectives depending on regionality and access.

Conclusions

Connect1d has the potential to overcome the challenges associated with harmonizing data for disparate systems, while simultaneously bridging gaps that exist in conducting patient-oriented research. This project is funded by JDRF and the Canadian Institutes for Health Research, and a part of Diabetes Action Canada.

Background and Aims

The ETAPES trial, initiated in 2018 by the French Health ministry, aims at evaluating a business model for telemonitoring of patients with diabetes. Launched in April 2015, the myDiabby telemedicine software allows HCPs to monitor their patients remotely, in particular in the context of this national trial.

The goal of our study is to evaluate patients’ A1c in order to analyse the impact of the ETAPES telemedicine trial on their glycemic control.

Methods

Patients with type 1 and type 2 diabetes were included according to the ETAPES criteria (T1D: A1c ≥ 8% & T2D with insulin: A1c ≥ 9%) and followed remotely via myDiabby during at least 6 month. Each patient benefited from a weekly monitoring plus a monthly therapeutic coaching from their healthcare providers. The A1Cs were collected via blood tests and reported on myDiabby at the beginning and after several months of telemonitoring.

Results

The average patients’ A1c was 10.12 ± 0.11 % at the beginning of the telemonitoring, and 7.90 ± 0.13 % after 6 months of telemonitoring. This decrease of 2% of the A1C is significant (p<0,0001) and associated with a small sample variation.

Conclusions

Our study highlights the positive outcomes of telemonitoring for patients with diabetes. This new way of treating patients has a highly significant impact on their blood glucose control. In order to reinforce these first results, the Time in Range (TIR), which is becoming a mainstream glucose metric, is also collected on myDiabby for further analysis.

Background and Aims

The aim of this study was to evaluate effectiveness of remote initiation of Hybrid Closed Loop (HCL) System on glycemic control in patients with Type 1 Diabetes (T1D) on Multiple Daily Injections (MDI).

Methods

Individuals with T1D (7 to 18 years old) initiated the MiniMed 670G HCL system using Skype Meet Now with the following program: introduction session, pre-course and technical requirements session, one face to face practical session for sensor insertion and four consecutive online sessions: Day 1- Manual Mode, bolus wizard use, basal rates, Auto Mode and readiness; Day 2- Infusion set and reservoir change; Day 3- hypoglycemia, hyperglycemia, exercise and travel management; Day 4- Evaluation to initiate HCL system. HbA1c, Time in Range, HCL system characteristics were analyzed after 3-month of HCL initiation.

Results

A total of 14, patients (age 11.4±2.8 years) and their caregivers commenced MiniMed 670G using the remote initiation program and used the system for 3 months. Sensor wear of 89.1±8.2% and Auto Mode usage of 86.8±6.8% was noted after 3 months of HCL initiation. Time in Range (70-180mg/dL) increased from 45.4±9.2% at baseline to 74.6±8.2% at the end of the study (p<0.001). There was no severe hypoglycemia nor DKA during the study.

Conclusions

Remote initiation program in individuals with T1D on MDI, can be an effective tool to initiate an HCL system and to improve glycemic control in a safe manner. Technical assessment (basic computer skills and internet connection), as well as educators’ skills on remote teaching are crucial factors in successful initiation of HCL system.

Background and Aims

The clinical significance of HbA1c in critically ill patients, particularly those with previously undiagnosed Diabetes Mellitus (DM), has not been adequately explored. This study investigated the clinical significance of HbA1c levels on admission in the intensive care unit (ICU) as a prognostic marker for mortality in critically ill patients.

Methods

We performed a retrospective cohort study using the Medical Information Mart for Intensive Care III v1.4 open access, anonymised database (MIMIC-III), based on the data of 23620 ICU admissions between 2008 and 2012 at Beth Israel Deaconess Medical Center, USA. Logistic regression was performed, using age, sex, SOFA, OASIS and HbA1c levels on admission (thresholded at 6.5%) as predictors, and death in ICU as the target. The study protocol was approved by the respective Institutional Review Boards.

Results

The results of the analysis:

Conclusions

When patients of medical ICUs with no known diagnosis of diabetes are considered, high HbA1c is a significant (p < 0.03) predictor of death in ICU, after adjusting for age, gender, SOFA and OASIS scores. However, this association ceases to be significant if other types of ICU (surgical, cardiac) are included, or when patients with known diagnosis of diabetes are included in the sample.

Acknowledgements:“This research is co-financed by Greece and the European Union (European Social Fund-ESF) through the Operational Programme «Human Resources Development, Education and Lifelong Learning 2014-2020» in the context of the project "A retrospective, real world data based study, on the impact of glycemic control on mortality and morbidity of critically ill patients in ICU" (MIS 5050694)."

Background and Aims

Digital health solutions that facilitate self-tracking and offer coaching hold great promise to help users manage their diabetes. Establishing patterns of good Digital Health Habits, in which users engage with app features frequently for a sustained period of time, may be a critical foundation of success. The aim of this research was to identify digital health habits correlated with improvements in blood glucose (BG), focusing on early engagement patterns.

Methods

Data from a sample of 48,368 users of a digital health solution were analyzed. Our primary outcome of interest was a clinically significant improvement in BG from month 1 to month 6 of using the digital health solution. This was defined as a 14 mg/dL drop of either max or average BG in that period. To identify correlates of BG success, we included the first 4 week of engagement data and user demographics as predictor variables in a logistic regression model.

Results

Results of a logistic regression indicated that, in order of effect size, logging blood glucose, food, medications, sleep, and labs were significant predictors (p<0.05) of an improvement in BG. In contrast, logging exercise, weight, steps and blood pressure (BP) were not significant predictors.

Conclusions

Our results indicate that certain Digital Health Habits are better predictors of overall improvements in diabetes status. Specifically, habits more closely linked to daily diabetes disease management (medications, BG, food) translate better to clinical improvements in BG than those less relevant (steps, BP, weight).

Background and Aims

During COVID-19 pandemic, access to medicines and healthcare professionals (HCPs) was damaged in Brazil. Although telemedicine and teleconsultations were authorized during the crisis, people did not always find these services available. For this reason, the quick response from not-for-profit organizations (NGOs) was vital to the most vulnerable people with diabetes (PwD).

Methods

ADJ Diabetes Brasil started teleconsultations through voice-calls or WhatsApp video-calls with dietitians, psychologists and physicians, in addition to online support groups. Trained volunteers triaged PwD and scheduled the consultations.

Results

Between May 8th and September 25th, 204 first time consultations had been offered, and 30 returning consultations; while 122 were with dietitians, 74 with physicians, 8 with psychologists, all the returning consultations were with physicians. Among the main challenges identified by PwD were: 1) unavailability of medical appointments at the public health system, as a consequence lack of medicine adjustments and directions for healthy choices in the new routine; 2) no diabetes education on carbohydrate counting, insulin action and injection sites; 3) difficulties for obtaining prescription to receive medicines.

Conclusions

The pandemic crisis threatened the health systems worldwide. In Brazil, the public health system was not able to fully assist individuals with noncommunicable diseases such as diabetes, since the efforts were mostly directed to equip hospitals and relocate HCP to emergency care. In this environment the ability of NGOs to adapt and offer services to complement the public health services was fundamental to guarantee, at least in part, the continuity of care for underserved individuals.

Background and Aims

During COVID-19, countless healthcare professionals (HCPs) have turned to telemedicine as their only means of reaching patients with diabetes. The present study sought to assess how HCPs were adapting to virtual visits, with a focus on 1) use of audiovisual conferencing tools and 2) software and data management.

Methods

From June-July 2020, a mixed-methods approach was used to investigate HCPs’ telemedicine experience in the US. Virtual interviews were conducted with 8 endocrinologists, 8 primary care providers (PCPs), and 8 diabetes educators (DEs). An online questionnaire was completed by 105 endocrinologists, 110 PCPs, and 103 DEs.

Results

Qualitative insights revealed that most HCPs were new to telemedicine, initially considered virtual visits more burdensome than in-person ones, and felt frustrated by the lack of an integrated conferencing and data management platform.

In the quantitative phase, the majority of HCPs reported never implementing telemedicine before the pandemic (67%), but hosting daily (60%) or weekly (31%) virtual visits since its onset. On average, HCPs used 2 platforms to communicate with patients, with many relying on audio calls (36%) and/or Facetime (22%). Those who reviewed diabetes data (94%) typically used 3 different methods of gathering data, with the most popular being patients’ verbal descriptions of trends (63%). Four in ten received photos (42%) or faxes (39%) of paper logs.

Conclusions

Despite widespread adoption of telemedicine, many HCPs remain reliant on older forms of communication and data exchange. Going forward, the development of simple, integrated telemedicine platforms can facilitate and improve the virtual care experience.