Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Sep 16, 2020
Open Peer Review Period: Sep 16, 2020 - Nov 11, 2020
Date Accepted: Dec 8, 2020
Date Submitted to PubMed: Feb 11, 2021
(closed for review but you can still tweet)
Shaping Workflows in Digital and Remote Diabetes Care During the COVID-19 Pandemic: A Service Design Approach.
ABSTRACT
Background:
The COVID-19 pandemic poses new challenges to healthcare providers to deliver continuous care. Although diabetes technology is increasingly established today, data rarely gets assessed, and telemedicine has not been sufficiently integrated into clinical workflows.
Objective:
This project sought to remotely support children with type 1 diabetes and their caregivers to enhance clinical outcomes and quality-of-life, engage multiple stakeholders through a participatory approach, evaluate the feasibility of using an interoperable open-source platform in a university hospital setting, and analyze success factors and barriers in transitioning from conventional to digital care.
Methods:
Service design methods were used to adapt clinical workflows. Remote consultations were performed monthly and on-demand. Device data were uploaded from patients’ homes to an open-source platform. Clinical and patient-reported outcomes were assessed before, during and after the lockdown period in Germany due to COVID-19.
Results:
A total of 28 children with type 1 diabetes and their caregivers enrolled and completed 6 months of remote visits. Of them, 16 participants opted to perform at least one of their regular visits online. After 3 months, Time-in-Range and Time-in-Hyperglycemia significantly improved whilst Time-in-Hypoglycemia did not increase. These improvements were maintained during the COVID-19 related lockdown between month 3 and 6 of the study. Psychosocial health improved after 6 months.
Conclusions:
Remote consultations and data access can improve clinical outcomes and quality-of-life in children with type 1 diabetes even during challenging circumstances. Service design helped to deliver a comprehensive and holistic solution taking multiple stakeholders into consideration. These findings can inform further integration and use of digital tools into clinical care during the pandemic and beyond. Clinical Trial: Clinical Trial registration number: DRKS00016170, IRB: Charité ethics approval number: EA2/125/18
Citation
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