Abstract: Direct-To-Consumer Telehealth To Support Youth With Type 1 Diabetes (T1D) Predicted To Experience A Rise In Hemoglobin A1c (A1c): A Pragmatic Trial

Background and aims: One in five youth with T1D experience worsening HbA1c values between quarterly visits. We evaluated the effectiveness of KidCare Anywhere (KCA), a direct-to-consumer telehealth intervention offering problem-solving and education to identify and manage glucose patterns for youth predicted to experience a rise in A1c 70-110 days following routine clinical visits.

Methods: Patients received care at a tertiary diabetes clinic in the U.S. Midwest. Supervised machine learning was used to develop a random forest-based model to predict 90-day change in A1c. Clinic staff reviewed weekly lists of patients with a predicted 90-day rise in A1c of ≥3 mmol/mol. From these lists, 61 patients under 20yrs old with baseline A1c ≥55 mmol/mol were enrolled in KCA. Youth received 1-6 brief telehealth sessions with a trained interventionist over 90 days before their next routine clinic visit. During each session, families reviewed device data with the interventionist and received personalized insulin regimen adjustments and problem-solving support.

Results: Study cohort was 73% white, 3% Hispanic, 62% female, 53% on CGM, 64% on insulin pump, median age 13.97yrs (IQR=10.39,16.13), baseline A1c 64 mmol/mol (60,73), and follow-up A1c 66 mmol/mol (58,79). Actual 90-day A1c change was significantly lower than the predicted 90-day A1c change (p=0.0088). Of 61 KCA patients predicted to have A1c rise ≥3 mmol/mol, only 21 (34%) did.

Conclusions: Findings suggest KCA may lead to improved glycemic levels by preventing clinically significant 90-day rise in A1c. Future research should evaluate the efficiency of this intervention in a randomized controlled setting to better define factors associated with intervention efficacy.