- Pilot program by UnitedHealth Group and
Children’s Hospitals and Clinics of Minnesota showed meaningful
improvements in blood glucose control and quality of life
measurements – particularly among teens
- Tech-based data collection system shows
promise as a scalable alternative to conventional care, making it
easier and more convenient for families and doctors to adhere to
clinically accepted standards for Type 1 diabetes care
- Results published in the Feb. 21, 2018,
issue of Pediatric Diabetes
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.”
Remote technology increases frequency and convenience of
communication between young patients and medical professionals,
which improves care outcomes
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.
Looking ahead: the future of IRT and technology-based
interventions
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.
About Children’s Hospitals and Clinics
of MinnesotaChildren’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.
About UnitedHealth
GroupUnitedHealth 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.
1
http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/a1c/
2
http://www.jdrf.org/about/fact-sheets/type-1-diabetes-facts/
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version on businesswire.com: http://www.businesswire.com/news/home/20180309005063/en/
UnitedHealth GroupTyler Mason,
424-333-6122Tyler.mason@uhg.comorChildren’s MinnesotaHayley Sitz,
952-992-5425Hayley.sitz@childrensmn.org
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