Our expert answers 3 Questions
As a clinician and researcher who has been working with the families of children with type 1 diabetes for more than 20 years, I am interested in helping the parents of children living with pediatric diabetes improve their metabolic control. This can be achieved by carefully adhering to a complex treatment plan that includes insulin injections and blood glucose monitoring, followed by a prescribed meal plan, exercise, and close follow-up with the family’s pediatric endocrinology team to prevent long-term complications. As children grow, their insulin needs frequent adjustment, since it’s based on body weight, and the American Diabetes Association recommends these children be evaluated by pediatric endocrinology every three months to keep their metabolic control in range. For families in rural areas, this can be a huge burden to travel to urban areas to access specialty care, so I’m interested in the potential for completing some of these visits remotely.
In the first year following a pediatric diabetes diagnosis, the families have a lot to learn: how to test blood sugars, how to read labels, measure food, and give insulin injections, and they need a lot of close, one-on-one contact with their providers. But after a year, most families have developed the necessary self-management skills, so face-to-face encounters are less critical, and there are ways to provide high-quality care remotely through various distance-based options and monitoring technology rather than have families travel hundreds of miles several times each year. Family-centered care that includes a comprehensive assessment of the diabetes management, including interpreting blood glucose monitoring, HgbA1C , growth and development, nutritional assessment, and insulin adjustments could be offered as a telehealth service every 3 months alternating with on-site visits at a medical center.
Michigan currently lacks a coordinated system of care between rural primary care providers, local community resources, and specialty care providers in urban areas for children and youth with diabetes and other chronic conditions. Options such as telehealth have the potential to cut the burden for families living in rural and underserved communities by 50%, saving them time, gas, and missed school and work. The telehealth model of care, while it faces a number of implementation and reimbursement challenges, is a viable solution and could be offered to families of children and youth with type 1 diabetes to provide safe and accessible care.