Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA.
Diabetes Technol Ther. 2022 Jan;24(1):67-74. doi: 10.1089/dia.2021.0229.
Clinic-to-clinic telemedicine can increase visit frequency in pediatric patients with type 1 diabetes (T1D) living far from a diabetes specialty clinic, but the impact on adoption of diabetes technology is unclear. Pediatric patients with T1D in Colorado and surrounding states who received diabetes care using clinic-to-clinic telemedicine were enrolled. Medical records and surveys were reviewed to ascertain technology use, and data were compared to patients from the main clinic population. Patients ( = 128, baseline mean age 12.4 ± 4.2 years, median T1D duration 3.3 years [IQR 1.4-7.7], mean A1c 8.9% ± 1.8%, 60% male, 75% non-Hispanic white, 77% private insurance) who utilized telemedicine were included. Technology use among telemedicine patients was not associated with gender, T1D duration, insurance, distance from the main clinic or rural designation but was associated with ethnicity and A1c. Compared to the main clinic cohort ( = 3636), continuous glucose monitor (CGM) use and pump/CGM combination use was lower among patients participating in clinic-to-clinic telemedicine (CGM: 29.7% vs. 56.0%, < 0.001; CGM/pump combination: 27.3% vs. 40.3%, = 0.004). Technology use was associated with lower A1c regardless of cohort. Compared to patients attending in-person clinic, pediatric T1D patients who use clinic-to-clinic telemedicine due to their distance from the main clinic, have lower CGM and combination CGM/pump use. For both telemedicine and main clinic patients, CGM and CGM/pump combination was associated with lower A1c. Additional research is needed to explore reasons for this discrepancy and find methods to improve CGM use in this population.
远程诊所医疗可以增加居住在离糖尿病专科诊所较远的 1 型糖尿病（T1D）儿科患者的就诊频率，但对糖尿病技术采用情况的影响尚不清楚。科罗拉多州和周边州的接受远程诊所医疗的 T1D 儿科患者被纳入研究。回顾医疗记录和问卷调查以确定技术使用情况，并将数据与主要诊所患者进行比较。纳入了使用远程医疗的患者（ = 128 例，基线平均年龄 12.4 ± 4.2 岁，中位 T1D 病程 3.3 年 [IQR 1.4-7.7]，平均 A1c 8.9% ± 1.8%，60%为男性，75%为非西班牙裔白人，77%为私人保险）。远程医疗患者的技术使用与性别、T1D 病程、保险、与主要诊所的距离或农村指定无关，但与种族和 A1c 有关。与主要诊所队列（ = 3636）相比，参与远程诊所医疗的患者连续血糖监测（CGM）使用率和泵/CGM 联合使用率较低（CGM：29.7%比 56.0%， < 0.001；CGM/泵联合：27.3%比 40.3%， = 0.004）。无论队列如何，技术使用与较低的 A1c 相关。与到现场诊所就诊的患者相比，由于距离主要诊所较远而使用远程诊所医疗的儿科 T1D 患者 CGM 和 CGM/泵联合使用率较低。对于远程医疗和主要诊所的患者，CGM 和 CGM/泵联合与较低的 A1c 相关。需要进一步研究以探讨造成这种差异的原因，并寻找方法来提高该人群的 CGM 使用。
