Telehealth Visits During Pandemic Helped Young Patients With Type 1 Diabetes in Israel

By Carolyn Crist

February 23, 2021

NEW YORK (Reuters Health) - Children and young adults in Israel with type-1 diabetes had better glycemic control after a telehealth visit during pandemic restrictions, according to new findings.

Telehealth visits could be beneficial for young patients with diabetes, especially those with poor glycemic control, though face-to-face visits are still important for physical exams and relationship-building, researchers write in Acta Diabetologica.

"The game has changed. Telehealth is here to stay in some way, shape or form," said Dr. Satish Garg of the University of Colorado's Barbara Davis Center for Childhood Diabetes, in Aurora. Dr. Garg, who wasn't involved in the study, has researched telehealth and diabetes care during the pandemic.

"Telehealth allows us to bridge the gaps and economic barriers," he told Reuters Health by phone. "When we can reach people, their levels often show improvement."

The Israeli research team, which included pediatric endocrinologists and faculty at Tel Aviv University, Ben-Gurion University and four pediatric diabetes clinics at medical centers across the country, shifted their in-person visits to a telehealth visit during pandemic lockdowns in the country between mid-March to mid-April 2020.

They recorded time-in-range (70-180 mg/dl) levels from patients' continuous glucose monitoring devices for the two weeks before and two weeks after the telehealth visit. During the telehealth visit, they provided a real-time virtual consultation with medical, dietary and behavioral modifications relevant to children and teens.

Among 195 patients between ages 9 and 19, 121 decided to schedule a telehealth visit during the lockdown period in place of their regular in-clinic visit. Their average time-in-range was significantly higher for the two-week period after the telehealth visit than for the two-week period before the visit (62.9% vs. 59.0%), report Dr. Marianna Rachmiel of Tel Aviv University and her colleagues.

The percentage of time spent in hypoglycemic and hyperglycemic ranges decreased significantly as well.

Patients with the greatest improvements tended to start with higher average glucose levels, have lower time-in-range levels, use higher daily insulin doses and live in a single-parent household.

In a follow-up survey, 87% of parents and patients reported significant benefits from the telehealth appointment, and 74% said they were "very interested" in combining in-person and telehealth appointments in the future.

"For those enthusiastic about the approach, periodic telehealth visits could help maintain the frequency of follow-up in the non-COVID19 era, by mitigating for long distances from paediatric diabetes centres," the researchers write.

The study had several limitations and couldn't assess the efficacy of telehealth visits in terms of changing a patient's physical activity, nutrition or lifestyle behaviors, the team cautions. They were also unable to compare the benefits of face-to-face versus telehealth visits or telehealth versus no visit during the pandemic lockdown period.

In-person visits are still important, the authors add, but some patients frequently miss or cancel their appointments, especially among those with poor glycemic control.

Telehealth visits, when interspersed with in-clinic appointments, could help with in-person attendance and also improve time-in-range levels. Single-parent households, for instance, may appreciate the opportunity to be more involved with glucose control through telehealth appointments.

"Add-on telehealth visits in between in-clinic visits in a suitable setting for children and their families may be beneficial and should be part of our tool-box for management," Dr. Rachmiel and her colleagues write.

At the same time, telehealth appointments may not be beneficial for all patients and families, they note. Those who don't have access to technology or the skills to participate could face additional barriers, so personal tailoring is important. Post-pandemic policy changes regarding telehealth payment and reimbursement could affect the availability of virtual visits as well.

"Commercial insurance payers are beginning to realize that patients want a telehealth appointment, but it will require a different level of reimbursement in the future," Dr. Garg said. "What that should be is still up for debate, but we'll have to figure it out because telehealth is here to stay."

Dr. Rachmiel could not be reached for comments.

SOURCE: Acta Diabetologica, online January 28, 2021.