Abstract
BackgroundThe COVID-19 pandemic poses new challenges to health care providers and the delivery of continuous care. Although many diabetes technologies, such as insulin pumps and continuous glucose monitors, have been established, the data from these devices are rarely assessed. Furthermore, telemedicine has not been sufficiently integrated into clinical workflows.ObjectiveWe sought to remotely support children with type 1 diabetes and their caregivers, enhance the clinical outcomes and quality of life of children with diabetes, increase multiple stakeholders’ engagement with digital care via a participatory approach, evaluate the feasibility of using an interoperable open-source platform in a university hospital setting, and analyze the success factors and barriers of transitioning from conventional care to digital care.MethodsService design methods were used to adapt clinical workflows. Remote consultations were performed on a monthly and on-demand basis. Diabetes device data were uploaded from patients’ homes to an open-source platform. Clinical and patient-reported outcomes were assessed before, during, and after the COVID-19 lockdown period in Germany.ResultsA total of 28 children with type 1 diabetes and their caregivers enrolled in this study and completed 6 months of remote visits. Of these 28 participants, 16 (57%) also opted to attend at least one of their regular visits remotely. After 3 months of remote visits, participants’ time in range (P=.001) and time in hyperglycemia (P=.004) significantly improved, and their time in hypoglycemia did not increase. These improvements were maintained during the COVID-19 lockdown period (ie, between months 3 and 6 of this study). Participants’ psychosocial health improved after 6 months.ConclusionsRemote consultations and commonly shared data access can improve the clinical outcomes and quality of life of children with type 1 diabetes, even during challenging circumstances. A service design approach helped with the delivery of comprehensive and holistic solutions that accounted for the needs of multiple stakeholders. Our findings can inform the future integration of digital tools into clinical care during and beyond the pandemic.Trial RegistrationGerman Clinical Trials Register DRKS00016170; https://tinyurl.com/skz4wdk5
Highlights
People’s interest in digital and remote care has been increasing worldwide
Health care professionals (HCPs) and public health institutions recommend that people who are at risk of SARS-CoV-2 infection should be protected from potential exposure to the virus
The service design activities involved 5 pediatric endocrinologists, 3 diabetes educators, 3 nurses, 3 psychologists/social workers, 1 resident physician, and 4 families that previously participated in telemedicine interventions
Summary
People’s interest in digital and remote care has been increasing worldwide. previous studies have demonstrated the effectiveness and increasing acceptability of telemedicine [1], knowledge on the implementation of digital care in health care settings and workflows remains limited.The COVID-19 pandemic has forced many health care teams to find alternative approaches for delivering care to patients with chronic conditions. The demand for acute and emergency care has dramatically increased, and other areas of health care have been considerably compromised [2] This is concerning, as people with chronic conditions may have a higher risk for hospitalization and morbidity when they contract COVID-19. Results: A total of 28 children with type 1 diabetes and their caregivers enrolled in this study and completed 6 months of remote visits. After 3 months of remote visits, participants’ time in range (P=.001) and time in hyperglycemia (P=.004) significantly improved, and their time in hypoglycemia did not increase These improvements were maintained during the COVID-19 lockdown period (ie, between months 3 and 6 of this study). Conclusions: Remote consultations and commonly shared data access can improve the clinical outcomes and quality of life of children with type 1 diabetes, even during challenging circumstances. Trial Registration: German Clinical Trials Register DRKS00016170; https://tinyurl.com/skz4wdk
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