Opportunities and Challenges of Telemedicine: Observations from the Wild West in Pediatric Type 1 Diabetes

Abstract

R ecent data from the SEARCH Study in the United States have identified a 21.1% increase in the prevalence of type 1 diabetes (T1D) in youth <20 years old over the 8-year interval from 2001 to 2009, highlighting the need for adequate access to care for the growing numbers of affected pediatric patients. 1Furthermore, the overwhelming majority of pediatric patients with T1D fail to achieve the recommended A1c targets of <7.5% (<58 mmol/mol), indicating a need for increased diabetes follow-up care. 2,3Indeed, longitudinal analyses from the T1D Exchange clinic registry show that A1c deteriorates during adolescence and only begins to improve once patients reach the third decade of life. 3,4Moreover, the rapid expansion of advanced treatment technologies, such as pumps and sensors, creates additional need for expert diabetes management teams to provide care, education, and support for pediatric patients with T1D and their families.Thus, this combination of increasing numbers of youth with T1D, their suboptimal glycemic control, and complex technologies for management creates a perfect storm to overwhelm the traditional treatment paradigm of in-person diabetes visits.As a result, the report by Wood et al. 5 in this issue of Diabetes Technology and Therapeutics regarding the use of telemedicine visits for pediatric patients with T1D is timely.7][8] Since the Diabetes Control and Complications Trial, intensive insulin therapy has been the standard of care, delivered by an experienced, multidisciplinary team.However, access to specialty services is often limited, even in first world countries like the United States, because of size and nonhomogeneous geographic distribution of such services, which tend to be located in large urban areas.According to the 2010 Census, about 20% of the U.S. population lives in rural areas, 9 potentially yielding a large number of pediatric patients with T1D lacking access to subspecialty care.Patients with limited access to specialty care may be