Glycaemic control in the paediatric and young adult population with type 1 diabetes following a single telehealth visit - what have we learned from the COVID-19 lockdown?
Glycaemic control in the paediatric and young adult population with type 1 diabetes following a single telehealth visit - what have we learned from the COVID-19 lockdown?
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DOI：
10.1007/s00592-021-01673-2
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发表时间：
2021-06
影响因子：
3.8
通讯作者：
Pinhas-Hamiel O
中科院分区：
文献类型：
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作者：
Rachmiel M;Lebenthal Y;Mazor-Aronovitch K;Brener A;Levek N;Levran N;Chorna E;Dekel M;Barash G;Landau Z;Pinhas-Hamiel O
患有慢性病的儿童在COVID-19封锁期间无法获得常规护理。我们评估了远程医疗访视对1型糖尿病（T1 D）儿科患者的时间范围（TIR）的可行性和影响。一项观察性多中心现实生活研究。在封锁期间安排门诊访视的患者可参加远程医疗访视。在远程医疗访视前2周和访视后2周记录社会人口统计学、临床、动态血糖监测仪和泵数据。主要终点是相对TIR的变化，即TIR的变化除以可能变化的百分比（TIR/（100-TIR之前）*100）。研究组包括195名T1 D患者（47.7%为男性），平均±SD年龄为14.6 ± 5.3岁，糖尿病病程为6.0 ± 4.6年。121例患者及其父母（62.0%）完成了远程医疗; 74例（38.0%）未传输完整数据。远程医疗访视后两周的平均TIR显著高于访视前两周（62.9 ± 16.0，p < 0.001 vs. 59.0 ± 17.2）;相对TIR改善5.7± 26.1%。初始较高的平均血糖水平、较低的TIR、在<54 mg/dl范围内花费较少的时间、在180-250 mg/dl范围内花费较长的时间、较高的每日胰岛素剂量和单亲家庭与改善的相对TIR相关。多元回归logistic分析显示，只有初始较低的TIR和单亲家庭具有显著性，比值比分别为：-0.506，95%CI-0.99，0.023，p=0.04和13.82，95%CI 0.621，27.016，p=0.04。儿童和年轻成人T1 D患者在COVID-19期间受益于远程医疗访视。然而，这种方式还不适合相当大比例的患者。
Children with chronic diseases were unable to receive their usual care during COVID-19 lockdown. We assessed the feasibility and impact of telehealth visits on the time-in-range (TIR) of paediatric individuals with type 1 diabetes (T1D). An observational multicentre real-life study. Patients scheduled for an in-clinic visit during the lockdown were offered to participate in a telehealth visit. Sociodemographic, clinical, continuous glucose monitor and pump data were recorded 2 weeks prior and 2 weeks after telehealth visit. The primary endpoint was change in relative-TIR, i.e. change in TIR divided by the percent of possible change (∆TIR/(100-TIRbefore)*100). The study group comprised 195 individuals with T1D (47.7% males), mean±SD age 14.6 ± 5.3 years, and diabetes duration 6.0 ± 4.6 years. Telehealth was accomplished with 121 patients and their parents (62.0%); 74 (38.0%) did not transfer complete data. Mean TIR was significantly higher for the two-week period after the telehealth visit than for the two-week period prior the visit (62.9 ± 16.0, p < 0.001 vs. 59.0 ± 17.2); the improvement in relative-TIR was 5.7±26.1%. Initial higher mean glucose level, lower TIR, less time spent at <54 mg/dl range, longer time spent at 180–250 mg/dl range, higher daily insulin dose, and single-parent household were associated with improved relative-TIR. Multiple regression logistic analysis demonstrated only initial lower TIR and single-parent household were significant, odds ratio: −0.506, (95%CI −0.99,−0.023), p=0.04 and 13.82, (95%CI 0.621, 27.016), p=0.04, respectively. Paediatric and young adult patients with T1D benefited from a telehealth visit during COVID-19. However, this modality is not yet suitable for a considerable proportion of patients.
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