Telehealth Can Improve Glycemic Control in Adolescents with Type 1 Diabetes

Weekly telehealth intervention follow-up results in small but significant improvements in glycemic control metrics among children and adolescents with type 1 diabetes (T1D) using continuous glucose monitoring (CGM), according to a recent randomized, controlled crossover study.1

Glycemic control is a cornerstone of diabetes management, as clinical trials have long since confirmed. Because glycemic control is typically worse in adolescent patients, optimization during this period is critical. Given the recent increase in T1D prevalence among adolescents, accessible and effective care is needed to avoid substantial financial burden to patients.2

“We hypothesized that augmenting CGM with intensive follow-up with a structured telehealth intervention that integrates teleconsultation, tele-education, and digital data support (online CGM analysis) might improve diabetes control,” Asma Deeb, MB, MBBS, pediatric endocrine division, Sheikh Shakhbout Medical City, and colleagues wrote.1

The team enrolled patients from May to November 2023, with the last follow-up visit occurring in June 2024. The trial lasted 28 weeks, consisting of randomization and run-in over 2 weeks, 1 follow-up period of 12 weeks, washout for 2 weeks, and another follow-up period of 12 weeks. Patients were randomly assigned to telehealth intervention follow-up over 12 weeks in treatment period 1, followed by CGM with routine clinical care and no intensive telehealth intervention over 12 weeks in treatment period 2, or vice versa.1

The intensive telehealth intervention included intensified follow-up with a weekly teleconsultation and digital support. Individual sessions lasted around 20 minutes and were administered by a trained diabetes educator. The structured intervention included 8 items, delivered weekly. These included:

• Encouragement of CGM device adherence
• Troubleshooting issues with the mobile device
• Action to be taken in response to abnormal glucose readings
• Revision of insulin adjustments based on latest clinic visit
• Education on hypoglycemia prevention and management
• Reminding about upcoming clinic appointments and assisting with booking
• Ensuring CGM sensor supplies were available
• Digital support via reviewing records of LibreView1

For inclusion, patients were required to be ≤18 years of age, be diagnosed with T1D for ≥6 months, not be meeting individualized HbA1c goals with an HbA1c higher than target, be taking MDI insulin, and be attending the SSMC diabetes clinic for regular follow-up, among other conditions. Patients were excluded if they were on insulin pump therapy and on any glucose monitor other than FreeStyle Libre 2, avoiding the influence of known variability between sensors.1

A total of 105 patients were included in the study, with 50 assigned to ithe ntensive telehealth-normal care sequence and 55 to the no normal care-intensive telehealth sequence. Compared with normal care during follow-up, intensified follow-up with teleconsultation and digital support was associated with a decrease in HbA1c (-0.29%; 95% CI, -0.41 to -0.17; P <.001) and an increase in time-in-range (TIR) (6.2%; 95% CI, 4 to 8.3; P <.001).1

Intensive telehealth was also associated with a decrease in time above range (5.5%; 95% CI, -7.7 to -3.2; P <.001), decrease in average glucose level (0.73 mmol/L; 95% CI, -1 to -0.42; P <.001), decrease in glucose variability (1.25%; 95% CI, -1.96 to -0.55; P <.001), decrease in GMI (0.2%; 95% CI, -0.31 to -0.09; P <.001), and decrease in frequency of low glucose events (<70 mg/dL) (0.12 events; 95% CI, -0.22 to -0.03; P = .009). However, the intervention had no impact on time below range.1

“The intervention shifted the HbA1c and TIR distribution in the right direction to address the challenge of achieving glycemic control in children and adolescents,” Deeb and colleagues wrote. “Our study therefore has important implications for the way in which children and adolescents on [continuous glucose monitoring] should be followed up in routine practice.”1

References

1. Deeb A, Eldeeb L, Suliman S, et al. Effect of an Intensive, Integrated Telehealth Intervention on Glycemic Control in Children and Adolescents With Type 1 Diabetes Using Continuous Glucose Monitoring: A Randomized, Crossover Trial. Pediatr Diabetes. 2025;2025:7261998. Published 2025 Sep 27. doi:10.1155/pedi/7261998

2. Khadilkar A, Oza C. Glycaemic Control in Youth and Young Adults: Challenges and Solutions. Diabetes Metab Syndr Obes. 2022;15:121-129. Published 2022 Jan 10. doi:10.2147/DMSO.S304347