930-P: Improving Access and Communication through Telehealth for Pediatric Type 1 Diabetes (T1D): Twelve-Month Outcomes

Abstract

Improving access for diabetes care may help youth with poor glycemic control. Telehealth can expand access to care. Youth with T1D, Medicaid, and initial A1c 9-12% had quarterly diabetes goal setting and monthly telehealth glucose review/goal reinforcement. Over 12 mo we measured A1c q 3mo and assessed diabetes empowerment (1-5; higher=greater self-efficacy), diabetes distress (1-6; higher=greater), and intervention satisfaction (1-5; higher=greater). Youth (N=32, 56% male, 53% AA), aged 5-22 yr, had T1D for 5.1±3.5 years, baseline mean A1c 10.7±1.5%; 19% on CSII and 34% on CGM. At baseline, participants reported low levels of distress (mean 1.9 youth, 2.1 parents) and high self-efficacy (mean 4.2). There were no effects of intervention on distress or self-efficacy at 12-months for youth (p=0.11) or parents (p=0.36). There was no correlation between youth/parent distress scores. Baseline A1c correlated positively with youth burden and negatively with motivation: “takes too much mental/physical energy”(r=0.65, p=0.02); “controls my life” (r=0.70, p=0.008); “I can find ways to feel better about diabetes” (r=-0.67, p<0.02); “I know what helps me stay motivated” (r=-0.69, p=0.01). In contrast, baseline A1c correlated negatively with parental frustration and worry: “I’m the only one who takes responsibility” (r=-0.46, p<0.05); “worrying others will blame me if diabetes not well-controlled” (r=-0.57, p=0.03). A1c did not change and there were no differences in ED/hospitalizations compared to 2 years prior. However, participants reported satisfaction with the intervention (mean 4.3). While well received by families, a monthly telehealth intervention failed to impact A1c. Parental worry and frustration was higher in children with better A1c levels. Identifying ways to maintain parent involvement in diabetes care and enhance mental health support may help diabetes control and burden of disease. Future work should explore the long-term impact of telehealth support. Disclosure L. E. Rasbach: None. L. C. Page: None. M. Freemark: Advisory Panel; Self; Rhythm Pharmaceuticals, Inc., Research Support; Self; Rhythm Pharmaceuticals, Inc. V. Purrington: None. M. Griffis: None. A. Annas: None. R. Hall: None. R. Benjamin: None. Funding Duke University School of Medicine