Telehealth to Promote Adoption of Automated Insulin Delivery Systems in Youth With Risk Factors for Adverse Diabetes Outcomes

PurposeThe purpose of this study is to assess the effects of an intensive telehealth intervention on technology adoption and glycemic control in historically marginalized youth with diabetes mellitus on Medicaid.MethodsThis quality improvement project included youth (ages 12-18) with diabetes utilizing insulin therapy. Eligible participants were diagnosed at least 12 months prior to enrollment and had an A1C ≥9%, Medicaid insurance, and willingness to use a continuous glucose monitor (CGM) and an insulin pump. Participants received scheduled weekly contact (phone/video) with a certified diabetes care and education specialist and monthly video visits with a nurse practitioner.ResultsYouth (N = 18, 61% female, 78% non-White, diabetes duration 4.6±3 years) had baseline mean A1C of 11.4% ± 2.0%; 22% were on pump therapy. There was a sustained improvement between baseline A1C (mean 11.4% ± 2.0%) and 3 months (mean 10.5% ± 2.7%; <i>P</i> = .01) and 6 months (mean 9.8% ± 2.4%, 83.6 mmol/mol; <i>P</i> = .003). Significantly more participants used pump therapy by the end (n = 16) compared to baseline (n = 4; <i>P</i> < .0001). Participants wore CGMs more at 3 (<i>P</i> = .04) and 6 months (<i>P</i> = .0004) during the intervention compared to 3 and 6 months prior.ConclusionsThis telehealth intervention provided interim improvement in A1C and increased adoption of diabetes technology in a low socioeconomic status cohort from a historically marginalized population. Ongoing monitoring is needed to evaluate the durability of this intervention.