title: Telemedical care reduces hypoglycemias and improves glycemic control in children and adolescents with type 1 diabetes.
abstract: Education programs for intensive insulin therapy were found to be valuable in improving glycemic control, but, due to low prevalence of type 1 diabetes in children and adolescents, access to those programs varies considerably in rural areas. We report on a telemedical care program that overcomes geographical isolation of patients on intensive insulin therapy. Sixty-one children and adolescents under the age of 26 participated in a telemedical care program. They stored daily information on blood glucose, injected insulin, meals and exercise in a glucosemeter with electronic memory and transferred the data via modem go a remote diabetes center outside of the region. By individual telephone consultations from home, they reviewed the data with a diabetologist at the diabetes center and adjusted their intensive insulin therapy in order to achieve predefined treatment goals. Patients were trained for 19 (6-48) weeks in the program and measured blood glucose 4.9 (1.7-4.9) times daily. Compared to the run-in-period, mean blood glucose had decreased (167 to 158 mg/dL, p < 0.01), standard deviation of blood glucose had decreased (81 to 70 mg/dL, p < 0.001), and frequency of hypoglycemia had decreased (5.2 to 3.3 in 4 weeks, p = 0.01) at the end of the program. The proportion of blood glucose values within the target range (80-180 mg/dL) had increased (47-55%, p < 0.001). HbAlc was reduced by 0.4% (-3.8 to +2.2%, p < 0.05). Telemedical care for intensive insulin therapy is safe, can improve glycemic control, and reduce the number of hypoglycemias in children and adolescents with type 1 diabetes.
authors.affiliation: Diabetes Center, II Department of Medicine, Brüderkrankenhaus, Trier, Germany. b.liesenfeld@gmx.de
authors.forename: B
authors.initials: B
authors.lastname: Liesenfeld
authors.forename: R
authors.initials: R
authors.lastname: Renner
authors.forename: M
authors.initials: M
authors.lastname: Neese
authors.forename: K D
authors.initials: KD
authors.lastname: Hepp
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000032:analysis* / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D017028:Caregivers / Q000193:education; D002648:Child; D002675:Child, Preschool; D003376:Counseling; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy / Q000534:rehabilitation*; D005194:Family Practice; D005260:Female; D005858:Germany; D006801:Humans; D007223:Infant; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007388:Internal Medicine; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D018579:Patient Selection; D012424:Rural Population; D012648:Self Care; D017216:Telemedicine / Q000379:methods*; D013689:Telephone; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007328:Insulin