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Teleassistance for Patients With Type 1 Diabetes During the COVID-19 Pandemic: Results of a Pilot Study.
Parise, Martina; Tartaglione, Linda; Cutruzzolà, Antonio; Maiorino, Maria Ida; Esposito, Katherine; Pitocco, Dario; Gnasso, Agostino; Irace, Concetta.
  • Parise M; Department of Experimental and Clinical Medicine, University Magna Graecia Catanzaro, Catanzaro, Italy.
  • Tartaglione L; IRCCS, University Agostino Gemelli, Rome, Italy.
  • Cutruzzolà A; Department of Experimental and Clinical Medicine, University Magna Graecia Catanzaro, Catanzaro, Italy.
  • Maiorino MI; Department of Advanced Medical and Surgical Science, University Vanvitelli, Napoli, Naples, Italy.
  • Esposito K; Department of Advanced Medical and Surgical Science, University Vanvitelli, Napoli, Naples, Italy.
  • Pitocco D; IRCCS, University Agostino Gemelli, Rome, Italy.
  • Gnasso A; Department of Advanced Medical and Surgical Science, University Magna Graecia Catanzaro, Naples, Italy.
  • Irace C; Department of Health Science, University Magna Graecia Catanzaro, Catanzaro, Italy.
J Med Internet Res ; 23(4): e24552, 2021 04 06.
Article in English | MEDLINE | ID: covidwho-1177923
ABSTRACT

BACKGROUND:

Telemedicine use in chronic disease management has markedly increased during health emergencies due to COVID-19. Diabetes and technologies supporting diabetes care, including glucose monitoring devices, software analyzing glucose data, and insulin delivering systems, would facilitate remote and structured disease management. Indeed, most of the currently available technologies to store and transfer web-based data to be shared with health care providers.

OBJECTIVE:

During the COVID-19 pandemic, we provided our patients the opportunity to manage their diabetes remotely by implementing technology. Therefore, this study aimed to evaluate the effectiveness of 2 virtual visits on glycemic control parameters among patients with type 1 diabetes (T1D) during the lockdown period.

METHODS:

This prospective observational study included T1D patients who completed 2 virtual visits during the lockdown period. The glucose outcomes that reflected the benefits of the virtual consultation were time in range (TIR), time above range, time below range, mean daily glucose, glucose management indicator (GMI), and glycemic variability. This metric was generated using specific computer programs that automatically upload data from the devices used to monitor blood or interstitial glucose levels. If needed, we changed the ongoing treatment at the first virtual visit.

RESULTS:

Among 209 eligible patients with T1D, 166 completed 2 virtual visits, 35 failed to download glucose data, and 8 declined the visit. Among the patients not included in the study, we observed a significantly lower proportion of continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) users (n=7/43, 16% vs n=155/166, 93.4% and n=9/43, 21% vs n=128/166, 77.1%, respectively; P<.001) compared to patients who completed the study. TIR significantly increased from the first (62%, SD 18%) to the second (65%, SD 16%) virtual visit (P=.02); this increase was more marked among patients using the traditional meter (n=11; baseline TIR=55%, SD 17% and follow-up TIR=66%, SD 13%; P=.01) than among those using CGM, and in those with a baseline GMI of ≥7.5% (n=46; baseline TIR=45%, SD 15% and follow-up TIR=53%, SD 18%; P<.001) than in those with a GMI of <7.5% (n=120; baseline TIR=68%, SD 15% and follow-up TIR=69%, SD 15%; P=.98). The only variable independently associated with TIR was the change of ongoing therapy. The unstandardized beta coefficient (B) and 95% CI were 5 (95% CI 0.7-8.0) (P=.02). The type of glucose monitoring device and insulin delivery systems did not influence glucometric parameters.

CONCLUSIONS:

These findings indicate that the structured virtual visits help maintain and improve glycemic control in situations where in-person visits are not feasible.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Blood Glucose Self-Monitoring / Telemedicine / Diabetes Mellitus, Type 1 / SARS-CoV-2 / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Adult / Female / Humans / Male Language: English Journal: J Med Internet Res Journal subject: Medical Informatics Year: 2021 Document Type: Article Affiliation country: 24552

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Blood Glucose Self-Monitoring / Telemedicine / Diabetes Mellitus, Type 1 / SARS-CoV-2 / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Limits: Adult / Female / Humans / Male Language: English Journal: J Med Internet Res Journal subject: Medical Informatics Year: 2021 Document Type: Article Affiliation country: 24552