A study by UnitedHealth Group (NYSE: UNH) and Children’s Hospitals and Clinics of Minnesota shows children and teens with Type 1 diabetes (T1D) enrolled in an intensive remote therapy (IRT) pilot program experienced improved blood glucose control and better quality of life during the six-month study compared to those who received conventional care.
The study, titled “Intensive remote monitoring vs. conventional care in type 1 diabetes: a randomized controlled trial,” was published in the Feb. 21, 2018, issue of Pediatric Diabetes.
Adolescents ages 13 to 17 enrolled in the IRT program achieved a lower mean hemoglobin A1c (HbA1c) level than other children their age and younger in the program. HbA1c is a critical measure of blood glucose control. Lower HbA1c levels help people with diabetes reduce their risk of complications such as kidney disease, or eye or nerve damage.
Controlling T1D becomes more challenging as children enter their teen years, due to a number of physiological factors and behaviors, including hormonal changes and growing independence from parents and caregivers.
In addition to achieving improved blood sugar levels, pediatric patients and their parents reported better health-related quality of life with regard to diabetes care, despite the additional time and attention required by IRT therapy.
This study leveraged the recent advent of blood glucose monitoring systems that let users store and share their data remotely, enabling T1D patients to provide information about their blood sugar levels to their health care providers quickly and consistently. Patient age and program adherence played a role in achieving positive outcomes. Also, IRT participants who uploaded their data more frequently experienced better outcomes.
“Managing Type 1 diabetes is a full-time job. It requires constant monitoring that can be disruptive to patients’ lives and be very challenging, particularly for children and teenagers,” said Dr. Laura Gandrud, a pediatric endocrinologist at Children’s Hospitals and Clinics of Minnesota McNeely Pediatric Diabetes Center who was involved in the study. “We are optimistic about the potential for IRT therapies to help patients take better control of their diabetes and their overall health. Even incremental change can make an important, positive impact on reducing the risks associated with diabetes, including heart disease, kidney damage and neuropathy. We were thrilled to see the improvements in patients’ reported quality of life.”
“By arming care providers with up-to-date information, families are no longer ‘flying in the dark’ with their diabetes care between appointments,” said Dr. Deneen Vojta, executive vice president of Research and Development at UnitedHealth Group. “With today’s technology, health care professionals can provide deeply informed, high-quality care, as frequently as needed. This detailed, near-real-time care will help patients in both the short term and the long term.”
Patients with T1D test their blood sugar levels several times a day and adjust their insulin dosage based on the results. However, patients meet typically with an endocrinologist only about four times per year, reviewing data retroactively and after treatment decisions may have been made. Frequent contact with diabetes care professionals is critical to reducing the risk of complications in patients and is known to improve blood sugar control. Unlike conventional models that require frequent in-person visits – which often conflict with school and work schedules – remote monitoring has the potential to make intervention from a health professional and subsequent adjustments more convenient, effective and efficient, and even reduce the frequency and length of clinical visits without sacrificing care.
All study participants had quarterly clinic visits, and uploaded and sent data on their blood glucose, insulin delivery and fitness activity weekly to their medical team. For the IRT group, the medical team sent a weekly email responding to the patients’ results and, if necessary would recommend a regimen adjustment. Through this ongoing communication, doctors and patients were able to identify issues and respond with care adjustments quickly, which can have significant long-term effects on patients’ health. In addition, IRT participants’ doctors noted that the clinic visits were substantially shorter than usual since issues, analysis and regimen changes were addressed on a weekly basis.
This study looked at patients’ HbA1c levels at the beginning and end of the six-month trial. People without diabetes have HbA1c levels below 5.7 percent. Studies have shown that people with diabetes can significantly reduce the risk of diabetes complications by keeping HbA1c levels below 7 percent.1 However, less than one-third of T1D patients in the United States achieve target blood glucose control levels.2 The IRT cohort reduced their HbA1c by 0.34 over the trial period, compared with 0.05 in the control group. IRT patients ages 13-17 reduced their HbA1c by 0.5.
Aylin Altan, senior vice president of research at OptumLabs, part of UnitedHealth Group, analyzed the project data.
“Innovations in diabetes technology and communications pathways allow patients to partner with their providers in Type 1 diabetes management like never before,” said Altan, who has lived with Type 1 diabetes for more than 40 years. “If we can find a way to make maximum use of technology and collaborative decision-making with care providers, the standard of care for young patients with Type 1 diabetes will better position them to manage the disease through adulthood.”
Researchers are carefully considering how to ensure the sustainability of the care model, particularly among adolescents, as it was most successful with this age group. It is worth noting that three months after the IRT treatment pilot was completed, there was a negligible change in blood glucose control across the IRT participant group.
Because this age group requires dynamic and engaging interactions to maintain long-term interest, researchers are considering incorporating gamification or rewards to encourage ongoing remote monitoring.
Dr. Vojta added, “We believe technology-based interventions like IRT are especially promising for people who already use technology in other aspects of their daily lives.”
Based on the study’s positive outcomes, health care professionals and researchers are looking to make IRT treatment more broadly available.
A short video featuring study participant Jackie Lamb and Dr. Gandrud is available here.
T1D patients are just one population of people with chronic diseases benefiting from connected technologies and real-time monitoring. A video on UnitedHealth Group’s work with children with asthma using remote technology is available here.
Children’s Minnesota is the seventh largest pediatric health system in the United States and the only health system in Minnesota to provide care exclusively to children, from before birth through young adulthood. An independent and not-for-profit system since 1924, Children’s serves kids throughout the Upper Midwest at two free-standing hospitals, 12 primary and specialty care clinics and six rehabilitation sites. Additionally, Children’s is Minnesota's only Level I pediatric trauma center inside a hospital dedicated solely to children. Children’s maintains its longstanding commitment to the community to improve children’s health by providing high-quality, family-centered pediatric services and advancing those efforts through research and education. This work is made possible in large part by generous philanthropic and volunteer support from individuals and organizations throughout the state and region. An award-winning health system, Children’s is regularly ranked by U.S. News & World Report as a top children’s hospital. Please visit childrensMN.org.
UnitedHealth Group (NYSE: UNH) is a diversified health and well-being company dedicated to helping people live healthier lives and to help make the health system work better for everyone. UnitedHealth Group offers a broad spectrum of products and services through two distinct platforms: UnitedHealthcare, which provides health care coverage and benefits services; and Optum, which provides information and technology-enabled health services. For more information, visit UnitedHealth Group at www.unitedhealthgroup.com or follow @UnitedHealthGrp on Twitter.