ODP164 Asynchronous Diabetes Virtual Interventions, Support, & Empowerment (ADVISE) Program to Improve Glycemic Control in High-Risk Youth and Adults with Type 1 Diabetes
Authors: Alharthi Sahar , AlShirah Bashayer , BinMuneif Yasser , Ibrahim Eman , Education Health , Al-Sofiani Mohammed 
Published: November 2022

Abstract

Background
The use of personalized text messages to support and empower people with type 1 diabetes(T1D) has the potential to improve glycemic control, particularly in the parts of the world where access to high-quality diabetes care remains limited. Here, we examine the impact of the "Asynchronous Diabetes Virtual Interventions, Support, & Empowerment" (ADVISE) program on glycemic control in high-risk youth and young adults with T1D in Saudi Arabia.

Methods
We retrospectively coded all text messages, exchanged between healthcare professionals(HCPs) and patients with T1D enrolled in the ADVISE program between January and October 2020. Messages were categorized according to their direction ("outgoing" from HCPs to patients versus "incoming" from patients to HCPs) and type (problem-solving, coaching, encouraging, rapport building, strategic questioning, or appointment scheduling-related texts). Then, we examined: a) the change in patients’ A1C and CGM metrics from pre- to post-enrollment in the ADVISE program and b) the association between the type, direction, and frequency of the texts and change in glycemic control.

Results
The ADVISE program enrolled 74 high-risk youth and young adults with T1D [58% women, with a median(IQR) age of 20(16,27) years old and duration of diabetes of 8(4,14) years and an average pre-enrollment A1C of 10.1%]. Out of the 3,457 texts, exchanged between HCPs and patients with T1D, 2642 (76%) were outgoing from HCPs to patients, 815(24%) were incoming from patients to HCPs, and 2,203(83% of the outgoing texts) were coaching-related. Overall, A1C, TIR, and TAR have significantly improved throughout the study period. Patients who received virtual adjustments of insulin doses as part of the ADVISE program had significant improvements in TIR (from baseline: 41% to Month-3: 53% to Month-6: 55%) and TAR (Baseline: 52% to Month-3: 39% to Month-6: 37%). Whereas patients who received no virtual adjustments of insulin dose had no significant changes in any of the glycemic metrics. When examined by frequency of incoming texts, patients who sent ≥1 text/month to their HCPs noted significant improvements in TIR, TAR, and A1C, whereas those who sent &lt;1 text/month noted no significant changes in any of the glycemic metrics. Similarly, A1C has significantly improved (from 9.6% to 8.6%, p&lt;0. 01) in patients who received ≥8 texts/month from their HCPs, whereas those who received &lt;8 texts/month had no significant change in A1C (9. 05% to 9%, p=0.24).

Conclusion
Our ADVISE program applies the four principles "Ps" of precision medicine to diabetes care (Predictive, Preventive, Personalized, and Participative) and is associated with significant improvements in various glycemic metrics in high-risk youth and young adults with T1D. Our findings have implications to mitigate the health- and economic- burden of diabetes, particularly in parts of the world where diabetes is highly prevalent and access to high-quality care is limited.
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