PSUN325 Provider Time Required for Effective Remote Glucose Monitoring Among Patients with Type 1 Diabetes
Authors: Crossen Stephanie , Glaser Nicole , Romero Crystal 
Published: November 2022

Abstract

Background
Recent advances in digital health technology have accelerated interest in remote patient monitoring (RPM) for chronic disease management. Diabetes management – which has a long history of utilizing patient-generated health data (PGHD) – is well-suited to RPM innovation. However, building RPM programs requires designing new workflows for providers, who are accustomed to accessing PGHD only at scheduled visits. We conducted a pilot study of RPM in a pediatric population with type 1 diabetes (T1D) to estimate the frequency and duration of contact between patients and providers that would be needed in such a program.

Methods
Patients who met these criteria were approached for participation: 1) age 1-20 years, 2) diagnosis of T1D with a duration of ≥12 months, 3) use of a glooko-compatible continuous glucose monitoring (CGM) device for ≥3 months. After providing informed consent, participants’ CGM data were linked to a research team account on the glooko platform and followed for a one-month baseline period to ensure the data relay was consistently functioning, with technical assistance provided by research staff as needed. CGM data were then analyzed using the glooko population analytics platform once per month during a six-month intervention period. Participants meeting high-risk criteria, defined as &gt;15% of glucose values &gt;250 mg/dl or &gt;5% of glucose values &lt;70 mg/dl, in the prior 30 days were contacted by a pediatric endocrinologist with individualized recommendations for diabetes management. Time spent communicating recommendations to the participant by phone or electronic messaging was recorded by the provider on each date of contact.

Results
Of 39 participants who were enrolled and linked to the research team via glooko, 35 (90%) were successful in establishing consistent data-sharing during the baseline period and moved on to the intervention period. To date, 20 participants have completed at least 3 months of the intervention. In preliminary analyses, an average of 47% have met high-risk criteria monthly (range 40 to 55%). Contact from the pediatric endocrinologist has required a median of 10 minutes (range 5 to 25 minutes) per participant contacted each month. Of the 20 participants who have completed 3 months of intervention, 14 have repeat hemoglobin A1c (HbA1c) data available thus far, which demonstrate a median HbA1c change of -0.55% from baseline (range -1.5 to +0.5%). Complete data analysis will be available in April 2022.

Discussion
This pilot study indicates that RPM is feasible and potentially beneficial in a population of pediatric patients with T1D. Our data also provide preliminary estimates for provider time required to deliver effective remote assistance to patients with concerning glycemic profiles. This study and others of its type are essential so that endocrinologists can design RPM programs which efficiently provide individualized care to high-risk patients without over-burdening a limited supply of providers.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.