title: Use of Telemedicine to Improve Adherence to American Diabetes Association Standards in Pediatric Type 1 Diabetes.
abstract: BACKGROUND
  The American Diabetes Association (ADA) recommends that children with type 1 diabetes (T1D) see a multidisciplinary team and have hemoglobin A1c (A1C) levels measured every 3 months. Patients in rural areas may not follow guidelines because of limited specialty care access. We hypothesized that videoconferencing would result in equivalent A1C compared with in-person visits and increased compliance with ADA recommendations.
  
  
  METHODS
  The Barbara Davis Center (BDC) (Aurora, CO) telemedicine program provides diabetes care to pediatric patients in Casper and Cheyenne, WY, via remote consultation with annual in-person visits. Over 27 months, 70 patients were consented, and 54 patients completed 1 year in the study.
  
  
  RESULTS
  Patients were 70% male, with a mean age of 12.1 ± 4.1 years and T1D duration of 5.4 ± 4.1 years. There was no significant change between baseline and 1-year A1C levels for patients with data at both time points. Patients saw diabetes specialists an average of 2.0 ± 1.3 times per year in the year prior to starting telemedicine and 2.9 ± 1.3 times (P < 0.0001) in the year after starting telemedicine. Patients and families missed significantly less school and work time to attend appointments.
  
  
  CONCLUSIONS
  Our study suggests telemedicine is equivalent to in-person visits to maintain A1C, whereas families increase the number of visits in line with ADA recommendations. Patients and families miss less school and work. Decreased financial burden and increased access may improve overall diabetes care and compliance for rural patients. Further study is needed to detect long-term differences in complications screenings and the financial impact of telemedicine on pediatric diabetes care.
authors: 1 Department of Pediatrics, Children's Hospital Colorado , Aurora, Colorado.
authors: Colleen L
authors: CL
authors: Wood
authors: 2 Department of Pediatrics, University of Utah , Salt Lake City, Utah.
authors: Scott A
authors: SA
authors: Clements
authors: 3 Colorado School of Public Health , Aurora, Colorado.
authors: Kim
authors: K
authors: McFann
authors: 4 Barbara Davis Center for Diabetes, University of Colorado School of Medicine , Aurora, Colorado.
authors: Robert
authors: R
authors: Slover
authors: 1 Department of Pediatrics, Children's Hospital Colorado , Aurora, Colorado.|3 Colorado School of Public Health , Aurora, Colorado.
authors: John F
authors: JF
authors: Thomas
authors: 4 Barbara Davis Center for Diabetes, University of Colorado School of Medicine , Aurora, Colorado.
authors: R Paul
authors: RP
authors: Wadwa
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D008297:Male; D010349:Patient Compliance; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D019114:Remote Consultation / Q000379:methods*; D049269:Videoconferencing; D014959:Wyoming; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human