1 Department of Surgery, Division of Ophthalmology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California , Los Angeles, California.
2 Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado , Aurora, Colorado.
Diabetes Technol Ther. 2018 May;20(5):370-379. doi: 10.1089/dia.2017.0450. Epub 2018 Apr 19.
Young adults with type 1 diabetes (T1D) experience poor glycemic control, disengagement in care, and are often lost to the medical system well into their adult years. Diabetes providers need a new approach to working with the population. The goal of this study was to determine whether an innovative shared telemedicine appointment care model (CoYoT1 Clinic [pronounced as "coyote"; Colorado Young Adults with T1D]) for young adults with T1D improves care engagement, satisfaction, and adherence to American Diabetes Association (ADA) guidelines regarding appointment frequency.
CoYoT1 Clinic was designed to meet the diabetes care needs of young adults (18-25 years of age) with T1D through home telemedicine. Visits occurred every 3 months over the 1-year study (three times by home telemedicine and one time in-person). Outcomes were compared to patients receiving treatment as usual (control).
Compared with controls, CoYoT1 patients attended significantly more clinic visits (P < 0.0001) and increased their number of clinic visits from the year before the intervention. Seventy-four percent of CoYoT1 patients were seen four times over the 12-month study period, meeting ADA guidelines, but none in the control group met the ADA recommendation. CoYoT1 patients used diabetes technologies more frequently and reported greater satisfaction with care compared with controls.
Delivering diabetes care by home telemedicine increases young adults' adherence to ADA guidelines and usage of diabetes technologies, and improves retention in care when compared to controls. Home telemedicine may keep young adults engaged in their diabetes care during this challenging transition period.
患有 1 型糖尿病（T1D）的年轻人血糖控制不佳，不参与护理，并且经常在成年后很久就脱离医疗系统。糖尿病提供者需要一种新的方法来为该人群提供服务。本研究的目的是确定针对 T1D 年轻患者的创新共享远程医疗预约护理模式（CoYoT1 Clinic[发音为“coyote”；科罗拉多州的 T1D 年轻成年人]）是否可以改善患者的护理参与度、满意度和对美国糖尿病协会（ADA）关于预约频率指南的依从性。
CoYoT1 Clinic 的设计目的是通过家庭远程医疗满足 T1D 年轻患者（18-25 岁）的糖尿病护理需求。在为期 1 年的研究中，每 3 个月进行一次就诊（3 次远程医疗，1 次面对面）。将结果与接受常规治疗的患者（对照组）进行比较。
与对照组相比，CoYoT1 患者就诊次数明显增加（P<0.0001），并且在干预前一年就诊次数增加。在 12 个月的研究期间，74%的 CoYoT1 患者接受了 4 次就诊，符合 ADA 指南，但对照组中没有患者符合 ADA 建议。CoYoT1 患者更频繁地使用糖尿病技术，并报告说与对照组相比，他们对护理的满意度更高。
通过家庭远程医疗提供糖尿病护理可提高年轻人对 ADA 指南的依从性以及对糖尿病技术的使用，与对照组相比，还可以提高护理保留率。与对照组相比，家庭远程医疗可能会使年轻人在这个充满挑战的过渡时期保持对糖尿病护理的参与度。
