Impact of Telemedicine in Managing Type 1 Diabetes Among School-age Children and Adolescents: An Integrative Review

doi:10.1016/j.pedn.2013.10.013

Journal of Pediatric Nursing

Volume 29, Issue 3, May–June 2014, Pages 198-204

https://doi.org/10.1016/j.pedn.2013.10.013 Get rights and content

Patients with diabetes who have limited access to healthcare services are less likely to maintain adequate diabetes control. Telemedicine represents a useful solution to the strict follow up required in diabetes management. This review analyzes the impact that telemedicine has on the management of type 1 diabetes among school-age children and adolescents, as measured by compliance with blood glucose monitoring, glycemic control, satisfaction, and self management. In general, this review supports the use of telemedicine in maintaining glycemic control. Further studies are desired to observe the impact of telemedicine in managing type 1 diabetes in school-age children and adolescents.

Section snippets

Background

APPROXIMATELY 25.8 MILLION individuals in the United States have diabetes, roughly 215,000 of which are under the age of 20 years (American Diabetes Association [ADA], 2011). Each year more than 13,000 young people are diagnosed with type 1 diabetes (Centers for Disease Control and Prevention [CDC], 2012). Maintaining glycemic control is essential in diabetes management to prevent future complications (ADA, 2011). However, diabetes management is often difficult among children and adolescents due

Methods

A comprehensive literature search was conducted using the following databases: PubMed, Academic Search Premiere, CINAHL, and Health Source: Nursing/Academic Edition (Figure 1). Articles were retrieved from 1990–2013 using controlled vocabularies relevant to telemedicine, adolescents, children, and type 1 diabetes. Eighty-seven articles were retrieved. Eighty-two articles were excluded based on the following exclusion criteria: eight did not involve children or adolescents aged 8–20 years, five

Results

This search provided a total of eight articles to be included in this review (Table 1), including four randomized control trials, one feasibility study, one evaluation study, and two randomized crossover trials. The participants included in this review are children and adolescents aged 8 to 20 years with type 1 diabetes for a duration of at least 1 year. A variety of types of telemedicine were used in this review. Six studies utilized modems or mobile phones to transmit blood glucose data to the

Discussion

The results of this review suggest that telemedicine can play a role in managing type 1 diabetes in school-age children and adolescents. Due to the small number of studies in this review measuring compliance with blood glucose monitoring, there is limited evidence supporting the use of telemedicine for this purpose (Horan et al., 1990, Rosenfalck and Bendtson, 1993). The blood glucose testing requirements and availability of free supplies in one study of this review may have affected these

Conclusion

Telemedicine has the potential to improve access to healthcare for pediatric populations, which may improve diabetes management and encourage greater patient involvement in care, especially with the technological interests of the adolescent age group. This review provides some insight into telemedicine's potential impact in the management of type 1 diabetes. While findings of this review were varied, they generally support the use of telemedicine in management of glycemic control. Further

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Cited by (41)

Innovations: Using telemedicine to improve care of predominantly non-white youth with suboptimal insulin dependent diabetes control
2024, Diabetes Research and Clinical Practice
Despite advances in diabetes treatments, youth commonly fail to meet glucose targets. Telehealth support may help youth meet diabetes related goals. The objective of the project was to assess whether intensive telehealth support in a group of poorly controlled youth with diabetes would help improve glycated hemoglobin (HbA1c) levels and decrease hospitalization rates over a 12-month time frame.
This quality improvement project included youth aged 8–18 with suboptimal insulin dependent diabetes control and Medicaid insurance, who were willing to use continuous glucose monitoring (CGM). Participants received weekly contact (phone or video) with a certified diabetes educator and monthly video visits with a nurse practitioner.
Youth (N = 27, 63 % female, 89 % Non-Hispanic Black), diabetes duration 6.2 ± 4.3 years, had baseline mean HbA1c 12.4 ± 1.8 % (112 mmol/mol); 22 % were on pump therapy (majority were non-automated insulin delivery systems). There was a sustained improvement between baseline HbA1c (mean 12.4 %±1.8) (112 mmol/mol) and 3 months (mean 11.5 %±2.8) (102 mmol/mol) (p = 0.03), 6 months (mean 11.1 %±2.1) (98 mmol/mol) (p = 0.01), 9 months (mean 11.4 %±2.3) (101 mmol/mol) (p = 0.04) and 12 months (mean 10.8 %±2.2) (95 mmol/mol) (p = 0.02).
This intensive telehealth intervention provided interim glycemic improvement in a high-risk patient cohort. Further efforts to increase connection in vulnerable pediatric patient groups could help long-term diabetes management.
An Analysis of Self-Reported Barriers to Type 1 Diabetes Care in a Pediatric Population in British Columbia, Canada
2021, Canadian Journal of Diabetes
Citation Excerpt :
Although telehealth in pediatric diabetes had been growing over the past decade, the global COVID-19 pandemic has catapulted virtual medicine to the forefront as a primary means of delivering health care (46). Studies have demonstrated that telehealth for T1DM has the capability to support comprehensive access to care for patients in rural, remote and underserviced regions, including enabling regular contact with various specialists, such as endocrinologists, ophthalmologists, dietitians and other allied health professionals (47). Canada stands to benefit greatly from the expansion of telemedicine given the vast geography, where urban-focused health-care services are often far from remote and northern populations (48).
Our aim in this study was to identify patient-level barriers to attending pediatric type 1 diabetes mellitus (T1DM) clinic and to better understand the demographic and clinical characteristics of these reporting barriers.
Patients were recruited from pediatric T1DM clinics throughout British Columbia. Barriers to attending clinic were identified through a survey. Demographic and clinical characteristics of patients who reported difficulty attending clinic appointments were compared with those who did not.
Of the 197 study participants, 31% reported difficulty attending appointments. Commonly reported barriers were distance to clinic and missing work. Younger child age and residing in northern regions increased the odds of reporting a barrier, whereas residing on Vancouver Island decreased odds of reporting a barrier. There were no differences in glycated hemoglobin levels between the 2 groups.
Approximately 1 in 3 patients identified challenges in attending T1DM appointments in British Columbia. Further research is needed to determine whether similar challenges exist in other provinces.
L’objectif de notre étude était de déterminer les obstacles à la présence des patients à la clinique de pédiatrie spécialisée en diabète sucré de type 1 (DST1) et d’avoir une meilleure compréhension des caractéristiques démographiques et cliniques de ces obstacles.
Nous avons recruté les patients dans des cliniques de pédiatrie spécialisée en DST1 de la Colombie-Britannique. Une enquête nous a permis de déterminer les obstacles à la présence à la clinique. Nous avons comparé les caractéristiques démographiques et cliniques des patients qui faisaient état de la difficulté à se présenter aux rendez-vous à la clinique aux patients qui n’en faisaient pas état.
Parmi les 197 patients de l’étude, 31 % d’entre eux ont fait état des difficultés à se présenter aux rendez-vous. Les obstacles fréquemment rapportés étaient la distance de la clinique et l’absence au travail. Le fait d’être un enfant d’un plus jeune âge et d’habiter dans les régions septentrionales faisait augmenter la probabilité de rapporter un obstacle, alors que le fait d’habiter sur l’île de Vancouver faisait diminuer la probabilité de rapporter un obstacle. Il n’y avait aucune différence de l’hémoglobine glyquée entre les 2 groupes.
Approximativement 1 patient sur 3 a cerné les enjeux entourant leur présence aux rendez-vous de DST1 en Colombie-Britannique. D’autres recherches sont nécessaires pour déterminer si des enjeux similaires existent dans les autres provinces.
Patient-Driven Diabetes Care of the Future in the Technology Era
2019, Cell Metabolism
Citation Excerpt :
Although the pathophysiology of peripheral insulin resistance is not completely understood, the resulting hyperglycemia exacerbates pancreatic β cell aging and decline in function by increasing demand on β cells to produce and hypersecrete insulin (Aguayo-Mazzucato et al., 2017). Studies on telemedicine use among children and adolescent patients with diabetes are relatively limited, but they have generally demonstrated success in maintaining or improving health outcomes (Guljas et al., 2014). An observational study in rural Wyoming found that young T1D patients who replaced their quarterly clinic visits with remote telemedicine consultations maintained HbA1c levels after 12 months, improved adherence to scheduled visits, and reduced time lost from school (Wood et al., 2015).
The growing burden of diabetes is fueled by obesity-inducing lifestyle behaviors including high-calorie diets and lack of physical activity. Challenges in access to diabetes specialists and educators, low adherence to medications, and inadequate motivational support for proper disease self-management contribute to poor glycemic control in patients with diabetes. Simultaneously, high patient volumes and low reimbursement rates limit physicians' time spent on lifestyle behavior counseling. These barriers to efficient diabetes care lead to high rates of diabetes-related complications, driving healthcare costs up and reducing the quality of patients' lives. Considering recent advancements in healthcare delivery technologies such as smartphone applications, telemedicine, m-health, device connectivity, machine-learning technology, and artificial intelligence, there is significant opportunity to achieve better efficiency in diabetes care and increase patient involvement in diabetes self-management, which ultimately may put an end to soaring diabetes-related healthcare expenditures. This review explores the patient-driven diabetes care of the future in the technology era.
Telementoring and Telesurgery for Minimally Invasive Procedures
2018, Journal of Urology
Tremendous interest and need lie at the intersection of telemedicine and minimally invasive surgery. Robotics provides an ideal environment for surgical telementoring and telesurgery given its endoscopic optics and mechanized instrument movement. We review the present status, current challenges and future promise of telemedicine in endoscopic and minimally invasive surgery with a focus on urological applications.
Two paired investigators screened PubMed^®, Scopus^® and Web of Science^® databases for all full text English language articles published between 1995 and 2016 using the key words “telemedicine,” “minimally invasive surgical procedure,” “robotic surgical procedure,” “education” and “distance.” We categorized and included studies of level of interaction between proctors and trainees. Research design, special equipment, telecommunication network bandwidth and research outcomes of each study were ascertained and analyzed.
Of 65 identified reports 38 peer-reviewed studies qualified for inclusion. Series were categorized into 4 advancing levels, ie verbal guidance, guidance with telestration, guidance with tele-assist and telesurgery. More advanced levels of surgical telementoring provide more effective and experiential teaching but are associated with increased telecommunication network bandwidth requirements and expenses. Concerns regarding patient safety and legal, financial, economic and ethical issues remain to be reconciled.
Telementoring and telesurgery in minimally invasive surgery are becoming more practical and cost effective in facilitating teaching of advanced surgical skills worldwide and delivery of surgical care to underserved areas, yet many challenges remain. Maturity of these modalities depends on financial incentives, favorable legislation and collaboration with cybersecurity experts to ensure safety and cost-effectiveness.
Distal technologies and type 1 diabetes management
2018, The Lancet Diabetes and Endocrinology
Citation Excerpt :
Telehealth is an effective and viable alternative for delivery of clinic-based medical care and family-based behavioural interventions. This technology has been shown to result in significantly greater improvements in HbA1c compared with usual care and can provide outcomes equivalent to clinic-based services.19,56–58 Telehealth has begun to address important barriers to care of people with type 1 diabetes, including distance, time, and costs for families and health-care systems.
Type 1 diabetes requires intensive self-management to avoid acute and long-term health complications. In the past two decades, substantial advances in technology have enabled more effective and convenient self-management of type 1 diabetes. Although proximal technologies (eg, insulin pumps, continuous glucose monitors, closed-loop and artificial pancreas systems) have been the subject of frequent systematic and narrative reviews, distal technologies have received scant attention. Distal technologies refer to electronic systems designed to provide a service remotely and include heterogeneous systems such as telehealth, mobile health applications, game-based support, social platforms, and patient portals. In this Review, we summarise the empirical literature to provide current information about the effectiveness of available distal technologies to improve type 1 diabetes management. We also discuss privacy, ethics, and regulatory considerations, issues of global adoption, knowledge gaps in distal technology, and recommendations for future directions.
Greater Telehealth Use Results in Increased Visit Frequency and Lower Physician Related-Distress in Adolescents and Young Adults With Type 1 Diabetes
2023, Journal of Diabetes Science and Technology

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Impact of Telemedicine in Managing Type 1 Diabetes Among School-age Children and Adolescents: An Integrative Review

Section snippets

Background

Methods

Results

Discussion

Conclusion

Adherence challenges in the management of type 1 diabetes in adolescents: Prevention and intervention

Current Opinion in Pediatrics

Telecare for teenagers with type 1 diabetes: A trial

Minerva Pediatrica

Using a cell phone-based glucose monitoring system for adolescent diabetes management

The Diabetes Educator

Modem transmission of glucose values reduces the costs and need for clinic visits

Diabetes Care

Managing diabetes in childhood and adolescence

Canadian Family Physician

Telemedicine in the management of young patients with type 1 diabetes mellitus: A follow-up study

Acto Bio Medica

A systematic review of telemedicine interventions to support blood glucose self-monitoring in diabetes

Diabetic Medicine