Type 1 Diabetes Telemedicine Interventions and Glycemic Control: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Abstract

In the post-pandemic world, virtual care is playing a central role in type 1 diabetes (T1D) management. We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) to understand whether the frequency or type of T1D telemedicine intervention influences glycemic control to inform the design of the Type 1 diabetes self-Management Education and support (T1ME) Trial. We searched MEDLINE, Embase, Pubmed and CENTRAL for full-text RCTs published in English between January 1992 and April 2021. Reference lists of eligible studies were hand-searched to identify additional relevant studies. The main outcome was change in glycated hemoglobin (HbA1c) from baseline to study end (PROSPERO: CRD42021252859). Of 542 unique citations, we included 46 for full text review (AN, SdS, with inter-reviewer reliability (IRR) 94%) and 14 studies for meta-analysis (IRR 87%). Discrepancies were resolved through consensus (AN, SdS, GLB). Overall, synchronous (S: real-time telephone, videoconferencing) and asynchronous (AS: SMS text, email) interventions lasting ≤6 months resulted in improvements in glycemic control. Results were only significant for high frequency interventions (every 1-2 weeks), with an effect estimate of -0.48% (95% CI: -0.49 to -0.47) for S and -0.37% (95% CI: -0.38 to -0.36) for AS interventions. Less frequent interventions were not associated with a significant HbA1c reduction (S: +0.11 [95% CI: -0.22 to 0.43] and AS: -0.07 [95% CI: -0.07 to -0.06]). We conclude that telemedicine sessions, when performed frequently, improve glycemic control in people with type 1 diabetes.

The conference publication can be found here: https://www.canadianjournalofdiabetes.com/article/S1499-2671(21)00298-7/abstract

Implementation Plan for a High-Frequency, Low-Touch Care Model at Specialized Type 1 Diabetes Clinics: Model Development

Abstract

Background: Individuals with type 1 diabetes (T1D) are more likely to achieve optimal glycemic management when they have frequent visits with their health care team. There is a potential benefit of frequent, telemedicine interventions as an effective strategy to lower hemoglobin A1c (HbA1c).
Objective: The objective is this study was to understand the provider- and system-level factors affecting the successful
implementation of a virtual care intervention in type 1 diabetes (T1D) clinics.
Methods: Semistructured interviews were conducted with managers and certified diabetes educators (CDEs) at diabetes clinics across Southern Ontario before the COVID-19 pandemic. Deductive analysis was carried out using the Theoretical Domains Framework, followed by mapping to behavior change techniques to inform potential implementation strategies for high-frequency virtual care for T1D.
Results: There was considerable intention to deliver high-frequency virtual care to patients with T1D. Participants believed that this model of care could lead to improved patient outcomes and engagement but would likely increase the workload of CDEs. Some felt there were insufficient resources at their site to enable them to participate in the program. Member checking conducted during the pandemic revealed that clinics and staff had already developed strategies to overcome resource barriers to the adoption of virtual care during the pandemic.
Conclusions: Existing enablers for high-frequency virtual care for T1D can be leveraged, and barriers can be overcome with targeted clinical incentives and support.

The complete article can be found here: https://diabetes.jmir.org/2022/4/e37715/

Beyond Hemoglobin A1c—Outcomes That Matter to Individuals With Type 1 Diabetes in Adopting Digital Health Interventions for Self-Management Support: Qualitative Study

Abstract

Background: Type 1 diabetes is a demanding chronic condition that requires diligent blood glucose monitoring and timely insulin administration by patients who must integrate self-management into their daily lives.
Objective: This study aimed to better understand what outcome measures are important to individuals living with type 1 diabetes (T1D) in Ontario, Canada, to help inform the development of type 1 diabetes virtual self-management Education and support (T1ME) trial.
Methods: A qualitative approach was used, in which we conducted 6 focus groups with a total of 24 adult participants living with T1D (from age 18 to >65 years) in Ontario. Each focus group was semistructured in nature; participants were encouraged to talk openly about their experiences with T1D self-management and provide their perspectives on more focused topics such as technology and relationships with health care providers.
Results: An interpretive analysis helped us devise a framework for our results that centered around 6 main discussion themes: (1) adapting self-management to meet evolving needs, (2) looking “beyond A1c” toward more personalized indicators of glycemic management, (3) the benefits and challenges of adopting new T1D technology, (4) establishing trusting relationships with diabetes care providers, (5) perceived benefits of peer support, and (6) pre– and post–COVID-19 perspectives on virtual care.
Conclusions: Our goal is for these findings to help facilitate the development of patient-oriented outcome measures that are in line with the unique needs and preferences of T1D patients in this new, more virtual landscape of clinical care, education, and self-management support.

The complete article can be found here: https://diabetes.jmir.org/2024/1/e60190