Ferber Christopher, Mittelman Steven D, Moin Tannaz, Wilhalme Holly, Hicks Rebecca
Division of Pediatric Endocrinology, University of California Los Angeles, Los Angeles, CA, United States.
Department of Pediatrics, Endocrine and Diabetes Center, Miller Children's and Women's Hospital Long Beach, Long Beach, CA, United States.
JMIR Diabetes. 2024 Oct 1;9:e58579. doi: 10.2196/58579.
Children and adolescents with type 1 diabetes require frequent outpatient evaluation to assess glucose trends, modify insulin doses, and screen for comorbidities. Continuous glucose monitoring (CGM) provides a detailed glycemic control assessment. Telemedicine has been increasingly used since the COVID-19 pandemic.
To investigate CGM profile parameter improvement immediately following pediatric outpatient diabetes visits and determine if visit modality impacted these metrics, completion of screening laboratory tests, or diabetic emergency occurrence.
A dual-center retrospective review of medical records assessed the CGM metrics time in range and glucose management indicator for pediatric outpatient diabetes visits during 2021. Baseline values were compared with those at 2 and 4 weeks post visit. Rates of completion of screening laboratory tests and diabetic emergencies following visits were determined.
A total of 269 outpatient visits (41.2% telemedicine) were included. Mean time in range increased by 1.63% and 1.35% at 2 and 4 weeks post visit (P=.003 and .01, respectively). Mean glucose management indicator decreased by 0.07% and 0.06% at 2 and 4 weeks post visit (P=.003 and .02, respectively). These improvements in time in range and glucose management indicator were seen across both telemedicine visits and in-person visits without a significant difference. However, patients seen in person were 2.69 times more likely to complete screening laboratory tests (P=.03). Diabetic emergencies occurred too infrequently to analyze.
Our findings demonstrate an immediate improvement in CGM metrics following outpatient visits, regardless of modality. While statistically significant, the magnitude of these changes was small; hence, multiple visits over time would be required to achieve clinically relevant improvement. However, completion of screening laboratory tests was found to be more likely after visits occurring in person. Therefore, we suggest a hybrid approach that allows patient convenience with telemedicine but also incorporates periodic in-person assessment.
1型糖尿病儿童和青少年需要频繁的门诊评估，以评估血糖趋势、调整胰岛素剂量并筛查合并症。持续葡萄糖监测（CGM）可提供详细的血糖控制评估。自新冠疫情以来，远程医疗的使用日益增加。
调查儿科门诊糖尿病就诊后即刻CGM概况参数的改善情况，并确定就诊方式是否会影响这些指标、筛查实验室检查的完成情况或糖尿病急症的发生。
对两个中心的病历进行回顾性分析，评估2021年儿科门诊糖尿病就诊期间的CGM指标达标时间和血糖管理指标。将基线值与就诊后2周和4周的值进行比较。确定就诊后筛查实验室检查的完成率和糖尿病急症的发生率。
共纳入269次门诊就诊（41.2%为远程医疗）。就诊后2周和4周时，达标平均时间分别增加了1.63%和1.35%（P分别为0.003和0.01）。就诊后2周和4周时，平均血糖管理指标分别下降了0.07%和0.06%（P分别为0.003和0.02）。远程医疗就诊和面对面就诊的达标时间和血糖管理指标均有改善，且无显著差异。然而，面对面就诊的患者完成筛查实验室检查的可能性是远程医疗就诊患者的2.69倍（P=0.03）。糖尿病急症发生频率过低，无法进行分析。
我们的研究结果表明，无论就诊方式如何，门诊就诊后CGM指标均会即刻改善。虽然这些变化在统计学上具有显著性，但变化幅度较小；因此，需要多次就诊才能实现临床相关的改善。然而，发现面对面就诊后完成筛查实验室检查的可能性更大。因此，我们建议采用一种混合方法，既方便患者进行远程医疗，又纳入定期的面对面评估。
