Study Finds Remote Patient Monitoring May Reduce A1c Rise

A study from Children’s Mercy in Kansas City, published in the Journal of Diabetes, suggests that remote patient monitoring may reduce an expected rise in A1c between office visits.

One key aspect of the study appears to be the role of trained interventionists — like our RPM365 Care Coaches — working directly with patients, in addition to gathering data via RPM.

Remote Patient Monitoring For Youth With Type 1 Diabetes (T1D) Predicted To Experience A Rise In Hemoglobin A1C (A1c)

Background/Objective: One in five youth with T1D experience worsening A1c values between quarterly visits. We evaluated the effectiveness of Remote Patient Monitoring (RPM), a direct-to-consumer telehealth intervention offering problem-solving and education to assess glucose patterns for youth predicted by a machine learning model to experience a significant rise in A1c 70-180 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, 69 patients under 20 years old with baseline A1c ≥55 mmol/mol were enrolled in RPM. Youth received 1-6 brief telehealth sessions with trained interventionists over 90-day before their next routine clinic visit. Families reviewed device data with interventionists during each session and received personalized insulin regimen adjustments and problem-solving support.

Results: Study cohort was 77% white, 8% Hispanic, 54% female, 36% on insulin pump & CGM, median age 14.32 years (IQR = 11.28, 16.41), baseline A1c 64 mmol/mol (58, 73), and follow-up A1c 67 mmol/mol (61,79). Sixty-two percent of the 69 RPM patients did not have A1c rise ≥3 mmol/mol compared to 53% of the 524 non-RPM patients (P = .155).

Conclusions: RPM might lead to improved glycemic levels by preventing clinically significant 90-day rise in A1c. Future research should evaluate the efficiency and effectiveness of this intervention, and the ideal dose, in a randomized controlled setting to identify factors associated with intervention efficacy and optimize care.”

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