The VIDIKI (Virtual Diabetes Outpatient Clinic for Children and Youth) study was a controlled study conducted in 240 young people with type 1 diabetes in Germany to evaluate the feasibility and effects of monthly video consultations to review continuous glucose monitoring (CGM) data, in addition to their regular 3-monthly outpatient clinic visits. In this substudy, conducted between March and December 2018, 34 families were invited to interviews to determine their expectations prior to starting the intervention and again after 1 year of the intervention. Thirty families attended the first interview and 24 attended the second one; in total, 54 interviews were analysed qualitatively.
The children of the interviewed families had a mean age of 10 years, a mean diabetes duration of 5 years and a mean HbA1c of 62 mmol/mol (7.8%). After 12 months of video consultations, the parents felt more confident and less stressed, both in everyday life and in terms of dealing with their children’s diabetes. Overall, 58% of parents thought the increased number of healthcare contacts was a benefit, whereas prior to the study only 30% thought this would be helpful. The key benefits of more frequent contacts were the ability to make short-term therapy adjustments and an increased ability to adjust therapy independently. One third of families reported improved metabolic control after 1 year, and 54% felt more confident to change insulin doses.
The convenience of virtual consultations was often cited, with 79% reporting time-saving benefits and 46% appreciating the greater flexibility that virtual consultations afforded. The principal barriers to implementing remote consultations were internet issues (46% of interviewees) and difficulties with CGM and insulin pumps (29%).
After 1 year, 51% of parents wished to have video consultation appointments every 4, 4–6 or 6 weeks. Regarding clinics, 25% of parents wished to have in-person consultations every 3 months in addition to the video consultations, while 29% would have been happy to reduce visits to 6-monthly intervals.
The authors conclude that their findings indicate a need to restructure the medical management of children with type 1 diabetes to incorporate greater use of telemedicine. In the age of the COVID-19 pandemic, such restructuring will have accelerated; however, the benefits of having more regular virtual reviews are interesting.
von Sengbusch S, Doerdelmann J, Lemke S et al (2020) Parental expectations before and after 12-month experience with video consultations combined with regular outpatient care for children with type 1 diabetes: a qualitative study. Diabet Med 24 Sep [epub ahead of print]. https://doi.org/10.1111/dme.14410
Attempts to achieve remission, or at least a substantial improvement in glycaemic control, should be the initial focus at type 2 diabetes diagnosis.
9 May 2024