Skype Success: Videoconference Good for Diabetes Care in Teens

Veronica Hackethal, MD

June 16, 2015

Skype may be just as good as face-to-face interactions for delivering therapy aimed at improving blood glucose control in adolescents with type 1 diabetes, according to a new study published online June 1 in Diabetes Care.

"Conducting behavioral family systems therapy for diabetes [BFST-D] with teens with poorly controlled diabetes either face to face in the clinic or using videoconferencing with Skype appears to result in similar improvements in both adherence to the diabetes treatment regimen and glycemic control," commented first author Michael Harris, PhD, a professor and director of Novel Interventions in Children's Healthcare at Oregon Health & Science University in Portland.

Optimal management of type 1 diabetes can be particularly challenging during the teenage, so-called "transition," years, when adolescents begin to take on increasing responsibilities for their health.

Family functioning can be an important predictor of adherence to medication and glycemic control, according to background information in the article.

BFST-D is a form of family therapy that focuses on improving functioning and communication and has been designed to target optimization of diabetes care.

While BFST-D has been shown to significantly improve glycemic control, adherence, and family conflict, access to trained practitioners can pose a problem, especially for families in rural areas, Dr Harris and colleagues explain.

Both Ways of Delivering Therapy Provide Equivalent Outcomes

The researchers compared BFST-D in the clinic vs Skype to see whether different modes of delivery affected adherence and glycemic control in teens with inadequately controlled type 1 diabetes (HbA1c ≥9.0%).

Ninety teens aged 12 to 18 and at least one legal guardian for each adolescent were randomized to BFST-D delivered in the clinic or via Skype. Participants received up to 10 therapy sessions with trained therapists over the course of 12 weeks. Participants received reimbursements and/or laptop loans.

The study had a total dropout rate of 21%. The teen participants had a mean age of 15.04 years and were 55% male and 87.8% white.

The interventions both lead to statistically significant improvements in adherence and glycemic control (P < .001 and P < .01, respectively), which were maintained at 3-month follow-up.

Analyses found no significant differences between the face-to-face and Skype groups before, during, and after the therapy and at 3-month follow-up in terms of adherence or glycemic control (P = .77).

Obstacles in the Way of Videoconferencing/Telemedicine for Therapy

Several obstacles might lie in the way of using videoconferencing technology to deliver BFST-D to adolescents with type 1 diabetes, not least of which is obtaining insurance reimbursements for it, Dr Harris pointed out.

Most states, (with the exception of five), have telehealth laws requiring Medicaid and/or commercial insurance coverage for videoconferencing. The problem is that most telehealth laws do not specifically include delivery of behavioral health programs.

"More pediatric psychologists trained in BFST-D need to request coverage for BFST-D from insurance companies using the research suggesting that outcomes are just as effective using videoconferencing vs face to face in the clinic," Dr Harris urged.

Another problem concerns internet security. Medical centers may not trust the security of free videoconferencing platforms like Skype and FaceTime. These institutions will need to have their own secure videoconferencing platforms that patients and their families can access free of charge, he said.

Internet access, though, probably does not pose a problem, reassured Dr Harris.

Recent research by the Pew Internet and American Life Project has suggested that 75% of American adults and 90% of teens use the internet almost daily, and about 50% of American households have broadband.

Moreover, while racial and cultural disparities in internet access have been a problem in the past, this gap seems to be narrowing. Pew research now indicates that African American and white homes have similar access to broadband internet, Dr Harris said.

He also stressed that the quality of the therapeutic relationship between the patient, family, and psychologist strongly predicts treatment outcome, and videoconferencing does not seem weaken this relationship.

Additional work from his group has found that the therapeutic relationship is similar between clinic-based BFST-D and videoconferencing-based BFST-D, he explained.

"The findings from this study don't imply that practicing clinicians should deliver BFST-D only over videoconferencing," Dr Harris pointed out, "Instead, our findings suggest that for families who live more remotely from a tertiary-care center, BFST-D videoconferencing sessions can augment face-to-face clinic sessions and result in improvements in adherence and glycemic control."

The authors report no relevant financial relationships.

Diabetes Care. Published online June 1, 2015. Abstract

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