Abstract
Purpose:
The purpose of the study was to evaluate the use of telemedicine for diabetes self-management education (DSME) for newly diagnosed youth and adolescents with type 1 diabetes on glycemic outcomes and health care utilization.
Methods:
A retrospective study of youth <18 years old receiving new-onset DSME between January 1, 2020, and September 30, 2022, was conducted. New-onset DSME includes teaching survival skills at diagnosis and advanced skills 7 to 10 days later, either in person or via telemedicine. A1C levels, readmission rates, emergency department (ED) visits, diabetes clinic visit attendance, and the probability of utilizing telemedicine for outpatient visits in the first year following diagnosis were compared between the in-person and hybrid groups using generalized linear models, adjusted by distance to the hospital.
Results:
Groups included 296 in-person and 246 hybrid participants. Baseline mean A1C improved 1-year post-diagnosis from 11.7% ± 2.1% (15.77 ± 3.27 mmol/l) and 11.8% ± 1.8% (15.93 ± 2.8 mmol/l) to 7.8% ± 1.7% (9.71 ± 2.64 mmol/l) and 7.8% ± 1.3% (9.71 ± 2.02 mmol/l) for in-person and hybrid groups, respectively, with no statistical difference after adjusting for baseline A1C and distance to clinic (difference: –0.06; P = .73). Groups did not differ significantly in ED visits (odds ratio [OR] 0.67; P = .33), readmission rates (OR 0.58; P = .35), or clinic visit attendance (incidence rate ratio 0.97; P = .46). After adjusting for distance from the nearest diabetes clinic, the hybrid group had 89% higher odds of completing a visit via telemedicine (P < .001).
Conclusions:
New-onset DSME via telemedicine is a reasonable alternative to in-person education. Ongoing engagement with telemedicine suggests this modality may help reduce barriers to care.
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