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
E. Dewit1, D. Williams1, S. Patton2, C. Mullaney3, D. Ferro1,K. Noland1, L. Skrabonja3, B. Spartz1, R. Elliott1, R. Kenyon1,R. Mcdonough1, S. Mehta4, L. D’Avolio3, M. Clements1
1Children’s Mercy Kansas City, Pediatrics, Kansas City, United States of America,2Nemours Children’s Health System, Pediatrics, Jacksonville, United States of America,3Cyft, Inc., Data Science, Cambridge, United States of America,4JoslinDiabetes Center, Pediatrics, Boston, United States of America
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 inA1c. Clinic staff reviewed weekly lists of patients with a predicted 90-day rise in A1c of‡3 mmol/mol. From these lists, 61patients 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 de-vice 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 age13.97yrs (IQR=10.39,16.13), baseline A1c 64 mmol/mol(60,73), and follow-up A1c 66 mmol/mol (58,79). Actual 90-dayA1c change was significantly lower than the predicted 90-dayA1c change (p=0.0088). Of 61 KCA patients predicted to haveA1c 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 inA1c. Future research should evaluate the efficiency of this intervention in a randomized controlled setting to better define factors associated with intervention efficacy.