Assessing the benefits and challenges of video consultations for the treatment of children with type 1 diabetes – A qualitative study among diabetes professionals

Abstract Background Video consultations are promoted as a tool to effectively supplement paediatric diabetes outpatient care. However, knowledge about attitudes of diabetes professionals towards this new technology is lagging behind. Diabetologists and diabetes nurses participating in a controlled study (the VIDIKI study) with monthly video consultations for children with type 1 diabetes were interviewed about their experience with this type of communication. Research Design and Methods Guideline-based qualitative interviews with 9 telemedicine experts (7 paediatric diabetologists and 2 diabetes nurses) and 7 paediatric diabetologists who agreed to the telemedical co-treatment of their patients were analysed using qualitative content analysis, in particular inductive category formation. Results Diabetes experts reported generally positive attitudes towards video consultations. They identified a number of unique benefits of telemedical interventions, including higher frequency of contacts, greater sense of patient´s safety, ability to interact with patients in their own homes, more timely and accurate medical monitoring, and improved data management. Additionally, it was important to the experts to maintain regular face-to-face consultations and to ensure close communication between telemedicine and outpatient clinical experts. Conclusions Prerequisites for successful video consultations include a comprehensive initial technical training and an agreement on treatment responsibilities of all health care professionals involved in the patient’s care. Under these conditions, the experts reported significant advantages of video consultation in the treatment of children with type 1 diabetes.

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Video Consultation for Parents with a Child Newly Diagnosed with Type 1 Diabetes: A Qualitative Study

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-1655-5471 ◽

2021 ◽

Author(s):

Jana Doerdelmann ◽

Fabian-Simon Frielitz ◽

Karin Lange ◽

Tanja Meinsen ◽

Sandra Reimers ◽

...

Keyword(s):

Type 1 Diabetes ◽

High Frequency ◽

Standard Care ◽

Qualitative Content Analysis ◽

Qualitative Interviews ◽

Newly Diagnosed ◽

Supplementary Video ◽

One Year ◽

Families With Children

Abstract Aims With the exception of the coronavirus pandemic, video consultations have not been a part of the standard care for children with diabetes in Germany. The "Virtual Diabetes Outpatient Clinic for Children and Adolescents 2.0" (VIDIKI 2.0) study investigated the effect of monthly and supplementary video consultations on standard care over one year. The qualitative substudy investigated the experiences of families with a child newly diagnosed with type 1 diabetes mellitus (T1DM) who received at least four weekly supplementary video consultations. Methods Guideline-based qualitative interviews were conducted with seven families with children under the age of eight and T1DM onset shortly before study entry. The answers were analyzed using a qualitative content analysis approach, particularly inductive category formation. Results Families of patients with T1DM onset have questions, almost daily, concerning various aspects of insulin therapy. The offer of high-frequency video consultations can reduce the number of trips to the diabetes team, facilitate the organization of daily life and increase the sense of security. Conclusion Video consultations as a supplementary offer of health care, especially after diabetes onset, were considered very helpful by the affected families. High-frequency video consultations may provide a tool to overcome existing deficiencies in specialized diabetes care.

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The Role of Trust in the Care of Young Children with Type 1 Diabetes

Children ◽

10.3390/children8050383 ◽

2021 ◽

Vol 8 (5) ◽

pp. 383

Author(s):

Patricia DeCosta ◽

Timothy C. Skinner ◽

Dan Grabowski

Keyword(s):

Type 1 Diabetes ◽

Young Children ◽

Health Care Professionals ◽

Qualitative Interviews ◽

Psychosocial Care ◽

Psychosocial Needs ◽

Key Factor ◽

Trusting Relationships

Using the theoretical framework of Guido Möllering conceptualising trust as a mental process composed of three elements—expectation, interpretation and suspension—we examined the role of trust in relation to young children’s (age ≤7 years) psychosocial needs when diagnosed with type 1 diabetes. Based on qualitative interviews with health care professionals (HPCs) from paediatric diabetes clinics in all regions of Denmark, we identified four main themes: trust through meaningful interaction, trust as a key factor at the time of diagnosis, trust in a long-term perspective and caregivers as the bridge to trust. We conclude that trust between young children and HCPs is central to children’s psychosocial experience, as well as a primary need, when children are diagnosed with type 1 diabetes. Trusting relationships counteract children’s experience of fear, anxiety and needle phobia and reinforce HCPs’ experience of providing good psychosocial as well as medical care. The present study offers insights into how trust can positively affect young children’s experience of diagnosis. This study also points out some key barriers to and facilitators of creating trusting relationships. This research is a first step towards a greater understanding that can inform collective future guidelines on the psychosocial care of young children.

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A Decade of Disparities in Diabetes Technology Use and HbA1c in Pediatric Type 1 Diabetes: A Trans-Atlantic Comparison

10.2337/figshare.12808301 ◽

2020 ◽

Author(s):

Ananta Addala ◽

Marie Auzanneau ◽

Kellee Miller ◽

Werner Maier ◽

Nicole Foster ◽

...

Keyword(s):

Type 1 Diabetes ◽

Technology Use ◽

Hemoglobin A1c ◽

Diabetes Technology ◽

Design And Methods ◽

Relationship Of ◽

The Relationship ◽

Pediatric Type 1 Diabetes

Objective: As diabetes technology use in youth increases worldwide, inequalities in access may exacerbate disparities in hemoglobin A1c (HbA1c). We hypothesized an increasing gap in diabetes technology use by socioeconomic status (SES) would be associated with increased HbA1c disparities. Research Design and Methods: Participants aged <18 years with diabetes duration ≥1 year in the Type 1 Diabetes Exchange (T1DX, US, n=16,457) and Diabetes Prospective Follow-up (DPV, Germany, n=39,836) registries were categorized into lowest (Q1) to highest (Q5) SES quintiles. Multiple regression analyses compared the relationship of SES quintiles with diabetes technology use and HbA1c from 2010-2012 and 2016-2018. Results: HbA1c was higher in participants with lower SES (in 2010-2012 & 2016-2018, respectively: 8.0% & 7.8% in Q1 and 7.6% & 7.5% in Q5 for DPV; and 9.0% & 9.3% in Q1 and 7.8% & 8.0% in Q5 for T1DX). For DPV, the association between SES and HbA1c did not change between the two time periods, whereas for T1DX, disparities in HbA1c by SES increased significantly (p<0.001). After adjusting for technology use, results for DPV did not change whereas the increase in T1DX was no longer significant. Conclusions: Although causal conclusions cannot be drawn, diabetes technology use is lowest and HbA1c is highest in those of the lowest SES quintile in the T1DX and this difference for HbA1c broadened in the last decade. Associations of SES with technology use and HbA1c were weaker in the DPV registry.

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Increased stress, weight gain and less exercise in relation to glycemic control in people with type 1 and type 2 diabetes during the COVID-19 pandemic

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-002035 ◽

2021 ◽

Vol 9 (1) ◽

pp. e002035

Author(s):

Merel M Ruissen ◽

Hannah Regeer ◽

Cyril P Landstra ◽

Marielle Schroijen ◽

Ingrid Jazet ◽

...

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Weight Gain ◽

Glycemic Control ◽

Perceived Stress ◽

Medical Center ◽

Short Term ◽

Design And Methods

IntroductionLockdown measures have a profound effect on many aspects of daily life relevant for diabetes self-management. We assessed whether lockdown measures, in the context of the COVID-19 pandemic, differentially affect perceived stress, body weight, exercise and related this to glycemic control in people with type 1 and type 2 diabetes.Research design and methodsWe performed a short-term observational cohort study at the Leiden University Medical Center. People with type 1 and type 2 diabetes ≥18 years were eligible to participate. Participants filled out online questionnaires, sent in blood for hemoglobin A1c (HbA1c) analysis and shared data of their flash or continuous glucose sensors. HbA1c during the lockdown was compared with the last known HbA1c before the lockdown.ResultsIn total, 435 people were included (type 1 diabetes n=280, type 2 diabetes n=155). An increase in perceived stress and anxiety, weight gain and less exercise was observed in both groups. There was improvement in glycemic control in the group with the highest HbA1c tertile (type 1 diabetes: −0.39% (−4.3 mmol/mol) (p<0.0001 and type 2 diabetes: −0.62% (−6.8 mmol/mol) (p=0.0036). Perceived stress was associated with difficulty with glycemic control (p<0.0001).ConclusionsAn increase in perceived stress and anxiety, weight gain and less exercise but no deterioration of glycemic control occurs in both people with relatively well-controlled type 1 and type 2 diabetes during short-term lockdown measures. As perceived stress showed to be associated with glycemic control, this provides opportunities for healthcare professionals to put more emphasis on psychological aspects during diabetes care consultations.

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Can Innovative Technologies Overcome HbA1c Disparity for African-American Youth with Type 1 Diabetes?

Journal of Diabetes Science and Technology ◽

10.1177/19322968211021386 ◽

2021 ◽

pp. 193229682110213

Author(s):

Stuart Chalew ◽

Alan M. Delamater ◽

Sonja Washington ◽

Jayalakshmi Bhat ◽

Diane Franz ◽

...

Keyword(s):

Type 1 Diabetes ◽

Racial Disparity ◽

Diabetes Management ◽

New Technology ◽

African American Youth ◽

Glucose Monitoring ◽

Supportive Role

Achieving normal or near-normal glycemic control as reflected by HbA1c levels in patients with type 1 diabetes (T1D) is important for preventing the development and progression of chronic complications. Despite delineation and dissemination of HbA1c management targets and advances in insulin pharmacology, insulin delivery systems, and glucose monitoring, the majority of children with T1D do not achieve HbA1c goals. In particular, African Americans are more likely not to reach HbA1c goals and have persistently higher HbA1c than Non-Hispanic Whites. Availability of pumps and other technology has not eliminated the disparity in HbA1c. Multiple factors play a role in the persisting racial disparity in HbA1c outcome. The carefully designed application and deployment of new technology to help the patient/family and facilitate the supportive role of the diabetes management team may be able to overcome racial disparity in glycemic outcome and improve patient quality of life.

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Diabetes Technology Experiences Among Latinx and Non-Latinx Youth with Type 1 Diabetes

Journal of Diabetes Science and Technology ◽

10.1177/19322968211029260 ◽

2021 ◽

pp. 193229682110292

Author(s):

David Tsai ◽

Jaquelin Flores Garcia ◽

Jennifer L. Fogel ◽

Choo Phei Wee ◽

Mark W. Reid ◽

...

Keyword(s):

Type 1 Diabetes ◽

Young People ◽

Technology Use ◽

Private Insurance ◽

Spanish Speaking ◽

Positive Attitudes ◽

Diabetes Technology ◽

English Speaking ◽

Continuous Glucose Monitors

Background: Diabetes technologies, such as insulin pumps and continuous glucose monitors (CGM), have been associated with improved glycemic control and increased quality of life for young people with type 1 diabetes (T1D); however, few young people use these devices, especially those from minority ethnic groups. Current literature predominantly focuses on white patients with private insurance and does not report experiences of diverse pediatric patients with limited resources. Methods: To explore potential differences between Latinx and non-Latinx patients, English- and Spanish-speaking young people with T1D ( n = 173, ages 11-25 years) were surveyed to assess attitudes about and barriers to diabetes technologies using the Technology Use Attitudes and Barriers to Device Use questionnaires. Results: Both English- and Spanish-speaking participants who identified as Latinx were more likely to have public insurance ( P = .0001). English-speaking Latinx participants reported higher Hemoglobin A1c values ( P = .003), less CGM use ( P = .002), and more negative attitudes about technology (generally, P = .003; and diabetes-specific, P < .001) than either non-Latinx or Spanish-speaking Latinx participants. Barriers were encountered with equivalent frequency across groups. Conclusions: Latinx English-speaking participants had less positive attitudes toward general and diabetes technology than Latinx Spanish-speaking and non-Latinx English-speaking peers, and differences in CGM use were associated with socioeconomic status. Additional work is needed to design and deliver diabetes interventions that are of interest to and supportive of patients from diverse ethnic and language backgrounds.

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Evaluation of Vitamin D Metabolism in Patients with Type 1 Diabetes Mellitus in the Setting of Cholecalciferol Treatment

Nutrients ◽

10.3390/nu12123873 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3873

Author(s):

Alexandra Povaliaeva ◽

Ekaterina Pigarova ◽

Artem Zhukov ◽

Viktor Bogdanov ◽

Larisa Dzeranova ◽

...

Keyword(s):

Diabetes Mellitus ◽

Vitamin D ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Controlled Study ◽

Affinity Constant ◽

Vitamin D Metabolites ◽

Vitamin D Metabolism ◽

Vitamin D Levels

In this prospective controlled study, we examined 25 adults with adequately controlled (HbA1c level < 8.0%) type 1 diabetes mellitus (T1DM) and 49 conditionally healthy adults, intending to reveal the diversity of vitamin D metabolism in the setting of cholecalciferol intake at a therapeutic dose. All patients received a single dose (150,000 IU) of cholecalciferol aqueous solution orally. Laboratory assessments including serum vitamin D metabolites (25(OH)D3, 25(OH)D2, 1,25(OH)2D3, 3-epi-25(OH)D3 and 24,25(OH)2D3), free 25(OH)D, vitamin D-binding protein (DBP) and parathyroid hormone (PTH) as well as serum and urine biochemical parameters were performed before the intake and on Days 1, 3 and 7 after the administration. The studied groups had no significant differences in baseline parameters except that the patients with diabetes showed higher baseline levels of free 25(OH)D (p < 0.05). They also lacked a correlation between the measured and calculated free 25(OH)D in contrast to the patients from the control group (r = 0.41, p > 0.05 vs. r = 0.88, p < 0.05), possibly due to the glycosylation of binding proteins, which affects the affinity constant for 25(OH)D. The elevation of vitamin D levels after the administration of cholecalciferol was comparable in both groups, with slightly higher 25(OH)D3 levels observed in the diabetes group throughout the study since Day 1 (p < 0.05). Overall, our data indicate that in patients with adequately controlled T1DM 25(OH)D3 levels and the therapeutic response to cholecalciferol is similar to that in healthy individuals.

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An Age-Related Exponential Decline in the Risk of Multiple Islet Autoantibody Seroconversion During Childhood

10.2337/figshare.13643756 ◽

2021 ◽

Author(s):

Ezio Bonifacio ◽

Andreas Weiß ◽

Christiane Winkler ◽

Markus Hippich ◽

Marian J. Rewers ◽

...

Keyword(s):

Type 1 Diabetes ◽

Confidence Interval ◽

Islet Autoantibodies ◽

Islet Autoimmunity ◽

Islet Autoantibody ◽

Age Related ◽

At Risk Children ◽

Exponential Decline ◽

Design And Methods

Objective. Islet autoimmunity develops prior to clinical type 1 diabetes and includes multiple and single autoantibody phenotypes. The objective was to determine age-related risks of islet autoantibodies that reflect etiology and improve screening for pre-symptomatic type 1 diabetes. Research Design and Methods. The Environmental Determinants of Diabetes in the Young study prospectively followed 8,556 genetically at-risk children at 3–6-month intervals from birth for the development of islet autoantibodies and type 1 diabetes. The age-related change in the risk of developing islet autoantibodies was determined using landmark and regression models. Results. The 5-year risk of developing multiple islet autoantibodies was 4.3% (95% confidence interval, 3.8–4.7) at 7.5 months of age and declined to 1.1% (95% confidence interval, 0.8–1.3) at a landmark age of 6.25 years (P<0.0001). Risk decline was slight or absent in single insulin- and GAD-autoantibody phenotypes. The influence of sex, HLA and other susceptibility genes on risk subsided with increasing age and was abrogated by age six years. Highest sensitivity and positive predictive value of multiple islet autoantibody phenotypes for type 1 diabetes was achieved by autoantibody screening at 2 years and again at 5–7 years of age. Conclusions. The risk of developing islet autoimmunity declines exponentially with age and the influence of major genetic factors on this risk is limited to the first few years of life.

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The Rapid Transition to Telemedicine and Its Effect on Access to Care for Patients With Type 1 Diabetes During the COVID-19 Pandemic

10.2337/figshare.14207594 ◽

2021 ◽

Author(s):

Daniel R. Tilden ◽

Karishma A. Datye ◽

Daniel J. Moore ◽

Benjamin French ◽

Sarah S. Jaser

Keyword(s):

Type 1 Diabetes ◽

Access To Care ◽

Diabetes Care ◽

Demographic Groups ◽

Rapid Transition ◽

English Speaking ◽

Clinically Significant ◽

Design And Methods ◽

The Impact

Objective: We compared the uptake of telemedicine for diabetes care across multiple demographic groups during the COVID-19 pandemic to understand the impact of telemedicine adoption on access to care. Research Design and Methods: The study analyzed demographic information of patients with type 1 diabetes seen between 1/1/2018 and 6/30/2020 at a single center. We compared the odds of completing a visit via telemedicine across multiple demographic characteristics. Results: Among 28,977 patient-visits, the odds of completing a visit via telemedicine were lower among non-English-speaking (1.7% vs. 2.7%, aOR:0.45, 95% CI:0.26-0.79) and Medicaid-insured (32.0% vs. 35.9%, aOR:0.83, 95% CI:0.72-0.95) pediatric patients. No clinically significant differences were observed for other demographic factors. Conclusions: Rapid transition to telemedicine did not significantly impact access to diabetes care for most demographic groups. However, disparities in access to care for historically marginalized groups merit close attention to ensure use of telemedicine does not exacerbate these inequities.

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Carbohydrate Requirements for Prolonged, Fasted Exercise with and without Basal Rate Reductions in Adults with Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion (CSII)

10.2337/figshare.13247258.v1 ◽

2020 ◽

Author(s):

Sarah M McGaugh ◽

Dessi P Zaharieva ◽

Rubin Pooni ◽

Ninoschka C D’Souza ◽

Todd Vienneau ◽

...

Keyword(s):

Type 1 Diabetes ◽

Insulin Infusion ◽

Fat Oxidation ◽

Rate Reduction ◽

Basal Rate ◽

Carbohydrate Feeding ◽

Exercise Onset ◽

Design And Methods ◽

Better Than

Objective: Exercising while fasted in type 1 diabetes facilitates weight loss, however the best strategy to maintain glucose stability remains unclear. Research Design and Methods: Fifteen adults on CSII completed three sessions of fasted walking (120min at 45%VO2peak) in a randomized crossover design: 50% basal rate reduction set 90min pre-exercise (-90min50%BRR); usual basal rate with carbohydrate intake (0.3g/kg/hr; CHO-only); and combined 50% basal rate reduction set at exercise onset with carbohydrate (0.3g/kg/hr; Combo). Results: Combo had a smaller change in glucose (5±47mg/dL) vs CHO-only (-49±61mg/dL, P=0.03) or -90min50%BRR (-34±45mg/dL). -90min50%BRR produced higher b-hydroxybutyrate levels (0.4±0.3 vs 0.1±0.1mmol/L) and greater fat oxidation (0.51±0.2 vs 0.39±0.1g/min) than CHO-only (both P<0.05). Conclusions: All strategies examined produced stable glycemia for fasted exercise, but a 50% basal rate reduction set 90 min pre-exercise eliminates carbohydrate needs and enhances fat oxidation better than carbohydrate feeding with or without a basal rate reduction set at exercise onset.

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