Efficacy of telemedicine in patients with type 1 diabetes over the second year by the COVID-19 pandemic spread

Introduction: During the lockdown due to the coronavirus disease, 2019 (COVID-19) pandemic, in-person outpatient visits were not possible, so telemedicine was rapidly adopted because of its potential to strengthen self-management support outside health care settings in the follow-up of patients with type 1 diabetes (T1D). Objectives: To investigate effectiveness of telemedicine in the follow-up of patients with T1D over the second year by the COVID-19 pandemic spread. Methods: Annual number of outpatient and telemedicine visits, insulin therapy, and HbA1c levels were collected in patients who performed the annual routine outpatients visits between Dec 2021 and Feb 2022 (T2) and were compared with those of the previous year 2020–21 (T1). Results: A total of 83 children and adolescents with T1D (65% male; median age 14.3 years; T1D duration 7.09 years) were enrolled. At T2, 28 subjects (Group A; 67.8% male) had ≥1 telemedicine visit, while other patients (Group B; 63.6% male) had not telemedicine visit; number of telemedicine visits were comparable between groups at T1. Patients of Group A, compared to Group B ones, were younger (13.7 vs. 14.9 years; p = 0.040). Insulin TDD and weekly physical activity were comparable. Insulin pump users were 53.6% in Group A and 20% in Group B; CGM users were 96.4 and 61.8%, respectively. Average of annual HbA1c levels was lower in Group A respect to Group B at T1 (52.6 vs. 65.4 mmol/mol; P < 0.0001) and T2 (52.8 vs. 63.1 mmol/mol; P < 0.0001). HbA1c values were longitudinally unchanged in Group A, while improved in Group B (p = 0.015). Rate of HbA1 ≤ 53 mmol/mol was 53.5% in Group A during both period; in Group B it was 9.1% at T1 and 10.9% at T2. Conclusions: Our data suggest that telemedicine over the second year by COVID-19 pandemic was effective to maintain a good glycemic control. Despite follow-up still indicate a preference for in-person diabetes care, we should consider an individual approach for telemedicine use, mainly for subjects with a good glycemic control and diabetes technologies users.