title: Impact of telemedicine assessment on glycemic variability in children with type 1 diabetes mellitus.
abstract: BACKGROUND
  Experimental and in vitro studies have related glycemic variability (GV) with activation of oxidative stress, which could be involved in the micro- and macrovascular damage found in diabetes mellitus and in acute complications such as hypoglycemia. Some GV indexes are currently integrated in specialized Web sites for the analysis and assessment of diabetes patients through telemedicine. We aimed to identify the impact of telemedicine on metabolic control and GV in prepubescent patients with type 1 diabetes mellitus (T1DM).
  
  
  METHODS
  Eighty patients between 6 and 10 years old were eligible for enrollment. Participation was accepted by the parents of only 15 (18%) patients, of whom 13 (86%) completed the study. These 13 patients were assessed fortnightly for 3 months through Accu-Chek (Roche, Mannheim, Germany) Smart Pix software; this period was compared with a subsequent 4-month period without telemedical support. The variables analyzed were mean glycated hemoglobin (HbA1c), mean blood glucose (MBG), and indexes of GV (SD, low blood glucose index [LBGI], high blood glucose index [HBGI], and the average daily risk range [ADRR]). In both periods, the patients attended their regular appointments. The statistical analysis was carried out with nonparametric tests (the Wilcoxon and Friedman tests, P<0.017).
  
  
  RESULTS
  At the end of the assessment phase, mean HbA1c levels were significantly reduced (P=0.012) with no significant reductions in the LBGI (P=0.115), ADRR (P=0.552), or SD (P=0.700). No significant increases were observed in MBG (P=0.861) or the HBGI (P=0.807). HbA1c and the LBGI, ADRR, and SD indexes increased when telemedical assistance was suspended, whereas MBG and the HBGI showed a nonsignificant reduction.
  
  
  CONCLUSIONS
  Telemedical assessment for 3 months in children improved metabolic control, by reducing HbAlc values and, to a lesser extent, by decreasing GV, without increasing acute complications. Metabolic control was reduced when the advice was suspended.
authors.affiliation: Endocrinology Unit, Sant Joan de Déu Hospital, Barcelona, Spain. nancyvp@hotmail.com
authors.forename: Nancy Villarreal
authors.initials: NV
authors.lastname: Peña
authors.forename: Marisa
authors.initials: M
authors.lastname: Torres
authors.forename: José Arnoby Chacón
authors.initials: JA
authors.lastname: Cardona
authors.forename: Raquel
authors.initials: R
authors.lastname: Iniesta
mesh_terms: D000704:Analysis of Variance; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring / Q000379:methods; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D007003:Hypoglycemia / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D018384:Oxidative Stress; D010353:Patient Education as Topic; D010865:Pilot Projects; D012648:Self Care / Q000379:methods; D013030:Spain / Q000453:epidemiology; D017216:Telemedicine; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human