Conference Resources | Abstracts
September 3
rd
– 6
th
, 2014 | Toronto, Canada |
222
P131
Reducing health disparities: text messaging facilitates a transition to intensive insulin therapy
in underserved patients with poorly controlled type 1 diabetes
S.A. MacLeish
1
, P. Mcguigan
1
, L. Furman
2
1
Rainbow Babies and Children's Hospital, Pediatric Endocrinology, Cleveland, United States,
2
Rainbow Babies and Children's Hospital, Pediatrics, Cleveland, United States
Introduction:
Basal bolus insulin therapy improves glycemic control in children with Type 1 diabetes
(T1DM), but underserved children are less likely to receive this therapy. Reasons include the high
level of training and parental support required to use these technologies, and the need for patients to
have proficiency with basic diabetes care, such as testing blood glucose at least four times per day.
Methods:
Underserved children (e.g., receiving government health insurance) ages 8-17 years with
T1DM for > 12 months and HbA1c >8.5% were eligible. Patients already on pump therapy were
excluded. Patients were seen monthly for 5-7 months, and at each visit saw a pediatric
endocrinologist, diabetes educator, and dietician. After 1-3 visits, patients were transitioned per
patient/family choice to either basal/bolus MDI or insulin pump. Families were provided with a cellular
phone and given the option to communicate via text message with the diabetes care team.
Results:
Fifteen children have entered the program. In the first cohort of 11 patients, 9 completed and
2 were withdrawn per protocol. Four more are in progress with cohort #2. Mean participant age is 12.7
+/- 2.7 years and mean diabetes duration is 5.4 +/- 3.3 years. Eleven transitioned to pump therapy, 3
to basal/bolus MDI, and one non-completer remained on NPH. In the first cohort mean HbA1c was
10.4 +/- 2.4% at baseline and 9.9 +/- 2.1% at study completion; for those transitioned to pump therapy
mean HbA1c was 10.0 +/- 2.7% at baseline and 9.1 +/- 1.6% at completion. There were no episodes
of severe hypoglycemia. There were 3 episodes of DKA, all in the 2 children who were withdrawn from
the program. All patients and families utilized text messaging.
Discussion:
This monthly intensive education program pilot study with communication via text
messaging holds great promise for helping underserved children with T1DM succeed on intensive
insulin therapy, and in particular insulin pump therapy.
