Feasibility of Onboarding and Supporting Diabetes Technologies in Youth with Type 1 Diabetes during the COVID-19 Pandemic and Beyond

ABSTRACT

Background: Prior to COVID-19 lockdown, all new insulin pump training was done in house with the patient and families in attendance. However, the pandemic lockdown made it difficult for in-person education. Therefore, we embarked on virtual trainings as well as in-person training for new insulin pump starts. Aim: To evaluate the feasibility and effectiveness of remote and in-person trainings by comparing management metrics in the years of 2020 and 2021. Methods: We compared the age, race, sex, glycemic control at 6 months post insulin pump initiation, incidence of severe hypoglycemic episodes, and diabetic ketoacidosis (DKA) among the two training models. Results: There were 118 insulin pump starts during the study period, of which 73 (62%) were in-person (49 (67%) male, mean ± SD age was 10.6 ± 4.0 years, and 40 (55%) White, 11 (15%) Black and 22 (30%) other;and 39 (33%) were remote (19 (49%) male, mean ± SD age 11.6 ± 4.0 years, and 26 (67%) White, 4 (10%) Black, and 9 (23%) other race. There were no cases of severe hypoglycemia requiring a third-party assistance, hospitalizations, or DKA in the first 6 months after insulin pump initiation in either group. The proportion of subjects with optimal glycemic control (A1c of ≤7%) at 6 months following pump initiation was similar between the two training groups after adjusting for baseline A1c and BMI percentile group (p=0.35) . Conclusion: This study found no evidence that remote pump training was less safe than in-person training. Therefore, remote training could be an alternative method to promote health equity by increasing access to diabetes technology for youth with type 1 diabetes in whom in-person training may be a challenge. A larger study is warranted to further evaluate the safety and effectiveness of this alternative method.