Telehealth Intervention for Youth With T1DM

Hospitalization of youth with established diabetes is both costly and frequently preventable. Poor glycemic control is a risk factor for hospitalization and is also associated with adolescent age and lower socioeconomic status. This is a randomized, controlled trial for high-risk adolescent youth with T1DM and suboptimal glycemic control with an intervention arm and usual care control arm matched for frequency of contacts. There will be 110 subjects with T1DM and HbA1c>8%, aged 13 to 17 years, recruited from the Diabetes Program at Boston Children's Hospital and followed for 6 months. The intervention will be implemented by a diabetes nurse educator and social worker, who will each have monthly contact with the adolescent and a parent/guardian through a telehealth (videoconference) visit. Care will be guided by a diabetes action plan. Telehealth interventions have been utilized successfully in both adults and youth with diabetes. They facilitate frequent contact with the care team allowing barriers to adherence to be addressed, education to be reinforced, care plans to be updated, and diabetes-specific family support to be provided.

Monthly videoconference with diabetes nurse educator; Monthly videoconference with social worker; Diabetes action plan;

Standard diabetes care- typically a visit with a diabetes health care provider every 3 months and referrals to a dietitian or mental health specialist as deemed appropriate; Study participation reminder cards twice per month

proportion of patients meeting the American Diabetes Association target for optimal glycemic control in this age group, which is <7.5%

Direct medical costs include planned intervention costs and medical costs that are expected to change as a result of the intervention.

Inclusion Criteria: Age 13 to 17 years Type 1 diabetes for ≥1 year HbA1c>8% Able to speak and read English (Child) Able to speak and read English (Parent) Parent agrees to participate Parent and child each have email addresses Exclusion Criteria: Plan to transition diabetes care to a center other than Boston Children's Hospital No visit to Boston Children's Hospital Diabetes Program in year prior to recruitment Current participation in another diabetes-related study with an intervention Living with or related to another study participant Significant psychopathology or medical illness that would limit the subject's ability to provide assent and/or participate in the study procedures as determined by the PI. No internet access