The effectiveness of running virtual clinics as part of insulin pump services for patients with type 1 diabetes

Abstract

Aims: To evaluate the effectiveness of running virtual clinics as part of insulin pump services for patients with Type 1 Diabetes (T1D). Methods: 53 patients on insulin pump (Medtronic 640G) and suboptimal glycaemic control [HbA1c - > 53 and ≤ 86 mmol/mol (> 7% and ≤ 10%)] were supported through virtual clinics. Pumps were uploaded from home on Carelink website at 6-8 weekly interval on 5 occasions in addition to standard visit(s). Advice was provided by health care professionals (HCPs) virtually after review by telephone. Glycaemic control, hypoglycaemia rates and admissions/attendance rates were recorded. Results: Pumps were uploaded at mean interval of 49.3 ± 9.4 days. HbA1c (measured within 3-6 months after 5th review) improved by 5.3 mmol/mol [∼0.5%; p=0.01]. Hypoglycaemia rates improved with each virtual input. It dropped from 303.2 episodes per 1000 person days at baseline to 171.4 episodes per 1000 person days at 5th review (p for trend 0.01). Hospital admission/attendance rates dropped from 37.7 per 100 patient year (in last 3 years up to first review) to 18.9 per 100 patient year within 2 years following recruitment in the study. Conclusions: Face to face visits may be insufficient to address multiple needs of insulin pump users. Digital diabetes care with virtual clinics offer greater time and analytical ability to HCPs for them to extend tailored advice and support to patients who need them most. Virtual clinics and telehealth improves measures of glycaemic outcomes and should be routinely incorporated in all insulin pump services.

Keywords

• Type 1 diabetes
• Insulin pump
• Virtual clinics
• Glycaemic outcomes