ABSTRACT
Online credit recovery will likely expand in the coming years as school districts try to address increased course failure rates brought on by the coronavirus pandemic. Some researchers and policymakers, however, raise concerns over how much students learn in online courses, and there is limited evidence about the effectiveness of online credit recovery. This article presents findings from a multisite randomized study, conducted prior to the pandemic, to expand the field's understanding of online credit recovery's effectiveness. Within 24 high schools from a large urban district, the study randomly assigned 1,683 students who failed Algebra 1 or ninth grade English to a summer credit recovery class that either used an online curriculum with in-class teacher support or the school's business-as-usual teacher-directed class. The results suggest that online credit recovery had relatively insignificant effects on student course experiences and content knowledge, but significantly lower credit recovery rates for English. There was limited heterogeneity in effects across students and schools. Non-response on the study-administered student survey and test limit our confidence in the student experience and content knowledge results, but the findings are robust to different approaches to handling the missing data (multiple imputation or listwise deletion). We discuss how the findings add to the evidence base about online credit recovery and the implications for future research. © 2023 American Institutes for Research. Published with license by Taylor & Francis Group, LLC.
ABSTRACT
Background and Aims: COVID-19 created challenges to diabetes care and accelerated the need to optimize healthcare delivery outside of traditional settings. Due to subsequent stayat- home orders, many clinicians sought remote patient monitoring (RPM) solutions to remain engaged with their patients with diabetes (PWD) and to provide care. This study examined RPM uptake and diabetes-related outcomes during the COVID- 19 pandemic for PWD using a RPM solution. Method(s): The Glooko platform is used globally by millions of PWD and populates a real world data repository of 100+ billion data points. The analysis included diabetes device syncs from 100,000+ Glooko patient users during Year 2020. Descriptive statistics were used to evaluate trends in RPM usage and diabetes outcomes (glucose, self-monitoring, etc.). Result(s): RPM uploads increased by 36% during the "lockdown" and remained high even as clinics reopened. Five months into the pandemic, peak glucose levels on Sundays and Saturdays increased, but remained lower than pre-pandemic levels (-1.2% and -0.7%, respectively). Average glucose levels dropped early on and gradually increased over the year but with lower weekend and holiday spikes. Self-monitoring of blood glucose (SMBG) readings were within recommended range over 50% of the time and the average number of daily SMBG checks exceeded established clinical guidelines. Additional data will be presented. Conclusion(s): The Glooko RPM platform offered an important clinical tool to providers and patients during the pandemic which resulted in increased engagement, improved glucose trends, and increased self-monitoring. Remote care provided clinics and patients with necessary insights to collaborate and manage diabetes despite the lack of in-clinic visits.
ABSTRACT
Introduction: The use of continuous glucose monitors (CGM) and insulin pumps (PUMP) have been associated with improved outcomes in type 1 diabetes (T1D) care. Therefore, disengaging from these devices represents a risk for worsening health outcomes. Objective(s): We sought to evaluate the effect of the COVID-19 pandemic on device disengagement rates by race and ethnicity. Method(s): This retrospective cohort study Pre-COVID-19 [n = 15,838] + peri-COVID-19 ([n = 14,799]) used EMR data from 15 sites (i.e., 3 adult and 12 pediatric diabetes centers) within the T1D Exchange Quality Improvement Collaborative. We identified individuals using at least one Advanced Diabetes Technology (ADT [PUMP or CGM]) at their most recent visit. Individuals who continued to use that technology for at least two subsequent visits were classified as engaged. Those who reported not using ADT in two subsequent visits were classified as disengaged. Result(s): Comparing pre-COVID-19 (January 2017-March 2020) to peri-COVID-19 (April 2020-2021) time periods, we observed increases in disengagement among non-Hispanic White (NHW;42% to 45%, p = 0.03) and Hispanic (12% to 19%, p < 0.001) individuals. We found no difference among NH Black (NHB;61% to 62%, p = 0.7) individuals. Conclusion(s): The pandemic has presented self-care challenges for individuals with T1D, including continued use of ADT. NHB individuals exhibited the highest disengagement rates overall, while NHW/Hispanic individuals experienced significant pandemic-related increases in disengagement. Future research should evaluate the relative impact of intrinsic (i.e., patient-level) versus extrinsic (i.e., family-, environment-, and system-level) factors associated with race-/ethnicity- based differences in rate of disengagement.
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BACKGROUND: Childhood obesity rates continue to increase and have progressed with the COVID-19 pandemic. Obesity is associated with comorbidities, including prediabetes and type 2 diabetes mellitus (T2D). The frequency of HbA1c progression in overweight/obese children during the COVID-19 pandemic is not well reported.OBJECTIVES: To investigate the frequency of HbA1c and BMI increase in overweight/obese youth at risk of developing T2D during the COVID-19 pandemic.METHODOLOGY: A retrospective chart review of patients followed in a pediatric endocrinology clinic with overweight/obesity and concern of developing T2D was conducted. We included patients who were seen pre-pandemic (June 2019 to May 2020) and again after the pandemic onset (June 2020 to May 2021). We chose June 2020 as the pandemic onset since our clinic resumed in-person visits at this time. Demographic and clinical data, including BMI and HbA1c, were collected in the pre-pandemic and pandemic periods for each patient. We evaluated change in HbA1c using the following categories: Category 1: <5.7%, Category 2: 5.7-6%, Category 3: 6.1-6.4%, Category 4: 6.5-8.4%, and Category 5: >8.4%. HbA1c progression defined as increase in the HbA1c category. BMI progression defined as a z-score increase of at least 0.2 and we only included patients with 6-18 months between visits for this analysis. Chi-square or Fisher's exact test and t-test were used to evaluate HbA1c and BMI progression.RESULTS: A total of 64 patients (mean age 12.6 years, 58% female, 31% Black) were evaluated and had available HbA1c data. HbA1c progression was found in 18.8% (12 of 64) of patients during the pandemic. Based on pre-pandemic age, those with HbA1c progression had a mean (SD) age of 14.1 (2.3) years while those whose HbA1c did not progress had a mean (SD) age of 12.3 (2.7) years (p=0.04). Other characteristics including birth sex (p=0.18), race (p=0.54), and insurance (public/private/self-pay) (p=0.83) were not significantly different between those with and without HbA1c progression. We found that 9.1% of patients with HbA1c progression also had BMI progression compared to 6.7% without HbA1c progression (p= 1.0).SUMMARY: We found that 18.8% of overweight/obese youth with risk of developing T2D had HbA1c progression during the COVID-19 pandemic and that older age was a risk factor for HbA1c progression. Significant BMI increase was not associated with HbA1c progression. Further studies are needed to evaluate the impact of COVID-19 pandemic on HbA1c and BMI progression in youth at risk for T2D.Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.
ABSTRACT
Background and Aims: The burden of uploading diabetes device shifted from clinic staff to those living with T1D as a result of virtual encounters for COVID-19. Unfortunately, many patients were not familiar with the upload process, causing incomplete data availability. This study compared patients with device data available at the start of their routine virtual clinical visits vs. those that did not. Methods: Data was collected from individuals <23 years old, with T1D, who received virtual care at a network of tertiary pediatric diabetes clinics in the Midwest USA from 3/2020 to 11/ 2021. Successfully uploading any device data or having cloudconnected streaming data was defined as having engaged in data sharing. Results: Observations from 946 telehealth encounters were analyzed. Only 52.9% (n = 383) had device data uploaded before their visit. Mean HbA1c (9.5% vs 8.5%, p-value <0.001), and mean time in range (44.7% vs 35.7%, p-value <0.001) were lower in those that had uploaded/streamed their data before their clinic encounter. Those with a longer duration of diabetes, selfidentifying as Black or African American, and those with public insurance were less likely to have data available at the start of their visit. Conclusions: Data from diabetes devices are integral to routine, effective, and safe management of insulin therapy. Statistically significant differences in access to device data were noted in those with public insurance and those who self-identify as African American. HbA1c and TIR were also lower. This study highlights the importance of equitable access to diabetes devices and continued advancement in auto-data streaming technologies.
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Background: Patient outcomes of COVID-19 have improved throughout the pandemic. However, because it is not known whether outcomes of COVID-19 in the type 1 diabetes (T1D) population improved over time, we investigated differences in COVID-19 outcomes for patients with T1D in the United States. Methods: We analyzed data collected via a registry of patients with T1D and COVID-19 from 56 sites between April 2020 and January 2021. We grouped cases into first surge (April 9, 2020, to July 31, 2020, n = 188) and late surge (August 1, 2020, to January 31, 2021, n = 410), and then compared outcomes between both groups using descriptive statistics and logistic regression models. Results: Adverse outcomes were more frequent during the first surge, including diabetic ketoacidosis (32% vs 15%, P< .001), severe hypoglycemia (4% vs 1%, P= .04), and hospitalization (52% vs 22%, P< .001). Patients in the first surge were older (28 [SD,18.8] years vs 18.0 [SD, 11.1] years, P< .001), had higher median hemoglobin A1c levels (9.3 [interquartile range {IQR}, 4.0] vs 8.4 (IQR, 2.8), P< .001), and were more likely to use public insurance (107 [57%] vs 154 [38%], P< .001). The odds of hospitalization for adults in the first surge were 5 times higher compared to the late surge (odds ratio, 5.01;95% CI, 2.11-12.63). Conclusion: Patients with T1D who presented with COVID-19 during the first surge had a higher proportion of adverse outcomes than those who presented in a later surge.
ABSTRACT
Introduction: Considerable research has addressed the impact and increased severity of coronavirus disease 2019 (COVID-19) in adult patients with type 2 diabetes (T2D). However, findings from older adult patients cannot be generalized to affected children and young adults. Objectives: In this retrospective cohort study, we examine whether race/ethnicity and other factors are associated with hospitalization in pediatric and young adult patients with T2D and COVID-19 infection. Methods: The de-identified COVID-19 patient cohort from the December 2020 release of Cerner Real-World Data™ includes longitudinal data for patients who received care at 87 US-based health systems between December 2019 and September 2020. A rigorous, multi-step algorithm was used to identify patients with T2D (n=229). Analysis was limited to patients <27 years old with a positive laboratory test or billing code consistent with COVID-19 infection. A generalized linear mixed model was used to evaluate race/ethnicity, gender, HbA1c, body mass index (BMI), mean blood glucose, age, payer, and Elixhauser comorbidity score as correlates of hospital admission. Results: In this cohort, 204 (89.1%) patients were 18-26 years old, and 133 (58.1%) were female. Fifty-two percent were Hispanic, 27.1% were non-Hispanic Black, and 12.2% were non-Hispanic White. Median BMI was 37.9 kg/m2 (IQR 32.3-45.1 kg/m2);median HbA1c was 9.25% (IQR 7.2-12.3%). Ninety-four patients (41.0%), including all 21 patients in diabetic ketoacidosis (DKA;9.2%) were hospitalized. Male gender (OR 2.46 [CI 1.23-4.91], p=0.011), HbA1c (OR 1.29 [CI 1.10-1.52], p=0.001), and BMI (OR 1.44 [CI 1.02-2.03], p=0.040) were associated with hospitalization. Conclusions: Male gender, increased HbA1c, and increased BMI are associated with hospitalization in youths and young adults with T2D and COVID-19 infection. Further study is needed to identify targeted interventions to prevent hospitalization in youths and young adults with T2D.