Children with diabetes and telemedicine access attend more visits during COVID-19
Children with diabetes from four Latin American countries with access to telemedicine had more medical visits and recorded HbA1c compared with those without access to telemedicine, according to study data.
“Even in Latin American countries, access to telemedicine is of great importance for controlling chronic diseases in pediatrics, such as type 1 diabetes,” Valeria Hirschler, MD, principal researcher in the department of nutrition and diabetes at the University of Buenos Aires in Argentina, told Healio. “Due to the COVID-19 pandemic, telemedicine was implemented in Latin American countries, positively impacting the health system. Telemedicine could result in economic savings, avoiding transportation expenses, loss of classes and parental working hours, time loss for transportation to distant referral health centers, improving the quality of life and the socioeconomic level and environment.”
Hirschler and colleagues analyzed data from pediatric diabetes clinics in Argentina, Chile, Peru and Ecuador on children aged 18 years and younger with type 1 diabetes since at least 2017 who attended at least one medical visit in 2018 and had a follow-up visit in 2020. Telemedicine visits were defined as video, telephone or email consultations with physicians from diabetes specialist teams. Age, sex, weight, height, duration of diabetes, number of medical visits, number of HbA1c determinations, telemedicine access and type of insulin therapy from 2018 to 2020 were extracted from medical records. The findings were published in Diabetes Technology & Therapeutics.
The study included 227 children (59% girls, mean age; 12.7 years) of whom 145 had access to telemedicine during the pandemic in 2020. Nearly 90% of participants were prescribed multiple-dose insulin therapy, 3.4% received conventional treatment and 6.6% used an insulin pump.
Children with telemedicine access had more medical visits in 2020 compared with those without access (mean annual visits, 6.9 vs. 2.6; P < .01). No significant difference in the number of visits was observed between the two groups in 2018 and 2019. There were 23 children with access to telemedicine who had three or more visits in 2020 compared with three children without telemedicine access who had three or more visits. Children without telemedicine access had fewer visits in 2020 compared with 2019 (2.6 vs. 5.5) and 2018 (2.6 vs. 5.1).
For children with telemedicine access, 2.1% had no HbA1c records in 2020 compared with 32.9% in children without telemedicine access (P < .01). The number of HbA1c determinations among children with telemedicine access was higher than for those without access (mean annual determinations, 1.79 vs. 0.99; P < .01). Children with telemedicine access had fewer HbA1c records in 2020 than 2019 (1.79 vs. 2.44), but a similar number compared with 2018. For children without access to telemedicine, the number of HbA1c determinations was lower in 2020 compared with 2019 (0.99 vs. 1.89) and 2018 (0.99 vs. 2.01).
“Our study showed that children who have a chronic disease such as type 1 diabetes, which requires regular and continuous monitoring by health professionals, are more easily accessed through telemedicine,” Hirschler said. “Research should continue during the post-pandemic years to determine what happened to children without access to telemedicine during the pandemic and compare it with those with access.”
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Valeria Hirschler, MD, can be reached at firstname.lastname@example.org.