Abstract: Direct-to-consumer telehealth to support youth with Type 1 Diabetes (T1D) predicted to experience a rise in hemoglobin A1c (A1c): A pragmatic trial

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Authors: Emily L. DeWit, David D. Williams, Susana R. Patton, Colin Mullaney, Diana Ferro, Katie Noland, Lydia Skrabonja, Britaney Spartz, Rebekah Elliott, Robin L. Kenyon, Ryan McDonough, Sanjeev Mehta, Leonard D’Avolio, Mark A. Clements

Background and aims: One in five youth with T1D experience worsening HbA1c values between quarterly visits. We evaluated the effectiveness of KidCare Anywhere (KCA), a direct-to-consumer telehealth intervention offering problem-solving and education to identify and manage glucose patterns for youth predicted to experience a rise in A1c 70-110 days following routine clinical visits.

Methods: Patients received care at a tertiary diabetes clinic in the U.S. Midwest. Supervised machine learning was used to develop a random forest-based model to predict 90-day change in A1c. Clinic staff reviewed weekly lists of patients with a predicted 90-day rise in A1c of ≥3 mmol/mol. From these lists, 61 patients under 20yrs old with baseline A1c ≥55 mmol/mol were enrolled in KCA. Youth received 1-6 brief telehealth sessions with a trained interventionist over 90 days before their next routine clinic visit. During each session, families reviewed device data with the interventionist and received personalized insulin regimen adjustments and problem-solving support.

Results: Study cohort was 73% white, 3% Hispanic, 62% female, 53% on CGM, 64% on insulin pump, median age 13.97yrs (IQR=10.39,16.13), baseline A1c 64 mmol/mol (60,73), and follow-up A1c 66 mmol/mol (58,79). Actual 90-day A1c change was significantly lower than the predicted 90-day A1c change (p=0.0088). Of 61 KCA patients predicted to have A1c rise ≥3 mmol/mol, only 21 (34%) did.

Conclusions: Findings suggest KCA may lead to improved glycemic levels by preventing clinically significant 90-day rise in A1c. Future research should evaluate the efficiency of this intervention in a randomized controlled setting to better define factors associated with intervention efficacy.

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February 2022

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