Adolescence and young adulthood are periods of transition when youth with DM typically experience poor outcomes. Programs that equip youth with confidence, support, and knowledge to foster successful ...lifelong DM management are needed. The DTP was developed to provide care and guided peer-discussions on pertinent topics with a multidisciplinary team over 4 clinic visits annually. To identify predictors for program completion, characteristics of patients who completed the program versus those who did not were examined. A total of 152 subjects were referred (prior to Covid) (53% male, 91% white, mean age at 1st visit 18.8±1.4 years, age at diagnosis 9.8±4.8 years, body mass index (BMI) %ile 74.6±20.6, HbA1c 8.9±2%, 54% on insulin pumps, 17% on continuous glucose monitors (CGM). Half (n=76) completed the program. Characteristics are presented below.
There were no differences between those that completed the program vs those that did not in depression score (measured by (PHQ-9)) (8.8±0.5 vs 8.8±0.4, p=0.87), history of visits to ED (3 vs 7%, p=0.44) or admissions (4.5 vs 7%, p=0.72) in the year prior to referral. Patients referred to the DTP appear to be a high-risk population which may explain why completion of the program was 50%. Moreover, identifying as non-white appears to be associated with non-completion of the program, emphasizing the need for different approaches to reach emerging adults.
Disclosure
W.Alnayem: None. J.S.Krall: Research Support; Sanofi, Becton, Dickinson and Company. L.M.Siminerio: Advisory Panel; Abbott, Research Support; Becton, Dickinson and Company, Sanofi. I.Libman: Advisory Panel; Novo Nordisk.
Diabetes mellitus (DM) -related hospitalizations are recognized as important opportunities for self-management intervention. Yet, there remains a need for practical delivery strategies.
Objective: To ...assess provider perspectives on DM mobile apps as a tool for self-management education and support in the inpatient setting.
Methods: Healthcare professionals (n=33) who oversee or provide DM care and education to hospitalized patients completed a validated survey about DM mobile apps.
Results: Only 21% of respondents had previously used an app for DM education. Of those who had never used a DM app, 100% indicated that they would consider recommending one to their patients. For 82% of respondents, patient access to and interest in app use were rated as the most important factors in their decision to recommend apps. Patient acuity and time were also noted as key considerations. In fact, 54% of respondents were only willing to spend 5 minutes to download and teach app use. Hospitalized patients considered best candidates for apps are those newly diagnosed with DM, new to insulin, admitted with a DM-related complication, or requiring additional education/support (change in treatment plan) . Perceived benefits of apps in relation to self-management were to reinforce education (71%) , support education with trustworthy information (62%) , and serve as a resource after discharge (56%) . Some respondents also foresaw a role for apps in teaching patients during hospitalization, especially younger patients generally viewed as more interested in apps. Most respondents agreed the following features are important for apps in education and support: Content is developed by DM experts (91%) , provide answer to basic DM self-management questions (96%) , user experience can be customized (91%) , and include features for logging/tracking glucose results (91%) .
Conclusions: Hospital-based providers offer valuable insights into DM app use. Exposing them to apps to support patient self-management warrants strong consideration.
Disclosure
J.S.Krall: Research Support; Becton, Dickinson and Company, Sanofi. J.Ng: Research Support; Sanofi. L.M.Siminerio: Advisory Panel; Abbott, Bayer AG, Research Support; Becton, Dickinson and Company, Sanofi.
Funding
Becton, Dickinson and Company
Introduction: DSMES is a critical component of diabetes (DM) care. Providers are expected to perform this service, but time for it is limited, especially for ongoing support. Digital tools, like ...mobile applications (apps) , show promise in extending efforts and supporting self-management, but have yet to be fully utilized. The purpose of this study was to examine provider insights on the role of mobile apps in DSMES delivery.
Methods: DM providers representing inpatient, outpatient, and community settings were invited to complete a validated survey about experiences with and perspectives on app use for DSMES. Survey results were recorded and summarized to capture dominant themes.
Results: Sixty providers (33% diabetes care and education specialists, DCESs, 21% endocrine clinicians) completed the survey. Of those, 17% (10/59) reported being very familiar with apps; 33% (20/59) had used an app to provide DM education while 25% (15/59) used an app for support. Respondents (77%, 46/60) primarily viewed apps as adjunct to DCES education, particularly for reinforcement. In terms of recommending apps, 90% of providers (54/60) rated patient app interest and access as most important factors to consider. In addition, 70% (42/60) agreed apps may be particularly useful to patients who use telehealth or live far from clinics. Specific to insulin, 70% agreed apps could serve as a helpful tool to prepare those new to insulin and aid with injection skills, dosing decisions and titration. Features they viewed as useful include clear set-up instructions, goal setting and digital coaching. Interestingly, outpatient DCESs reported willingness to use 15 or more minutes of visit on setting up/teaching app use, while hospital-based providers were willing to spend 5 minutes.
Conclusion: National standards recommend digital coaching as an effective method to deliver DSMES. These findings offer important feedback for introducing digital tools into clinical practice.
Disclosure
N.Mehrotra: None. J.S.Krall: Research Support; Becton, Dickinson and Company, Sanofi. J.Ng: Research Support; Sanofi. L.M.Siminerio: Advisory Panel; Abbott, Bayer AG, Research Support; Becton, Dickinson and Company, Sanofi.
Funding
Becton, Dickinson and Company
The number of people with DM continues to increase, with an inverse proportion of providers and specialists available to provide comprehensive care and support. This is especially troublesome for ...those at highest risk in underserved areas. Diabetes self-management education and support (DSMES) are critical to achieving quality outcomes. Yet reports show that patients are not participating in traditional DSMES approaches, subsequently DSMES programs are at risk of closure. In response, diabetes educators (DEs), now referred to as Diabetes Care and Education Specialists, are seeking new opportunities to provide services that include attention to behavioral and psychosocial issues. A coordinated care (CC) model was organized to address complex needs of those with DM in a disadvantaged community. The local endocrinologist sought assistance from a hospital-based program to provide coordinated care and DSMES on established clinic days. The DE was available for ongoing follow up and liaising to community services. Overarching goal was to lower mean A1C <8%. Of 80 patients who received care in the DM clinic, majority with type 2 DM (80%) 52.5% F, mean age 57.1±14.1 years, BMI of 34.1 49±10.4 kg/m2 and A1C 9.2%, 49 patients agreed to participate in the CC program while 31 patients received usual care (UC) (traditional visit with endocrinologist only). No statistical differences were found in age, sex, BMI, or mean A1C between groups at baseline. Percent of patients with A1C <8% in CC as compared to UC was 26.5% vs. 29% at baseline (p=0.8); 65% vs. 61.5% at 3 months (p>0.99), 59.3% vs27.8% at 6months(p=0.07); 66.7% vs. 35% at 12 months (p=0.03). The majority of patients in the CC group, maintained lower A1C levels, meeting the immediate target of <8%, while the UC group experienced a consistent rise in A1C over the course of the intervention. A provider-DE model offers a framework for providers and DEs to help a population of patients with complex needs to reach and sustain improved glycemia.
Disclosure
S. Mon: None. N. Mehrotra: None. D. Ren: None. C. DeJesus: None. L.M. Siminerio: Research Support; Self; Becton, Dickinson and Company.
Diabetes self-management education and support (DSMES) is known to improve diabetes treatment outcomes, but this limited resource is not always targeted toward the highest risk patients in current ...models of care. Predictive modeling, which relies on large data sets to predict outcomes, is one tool which can be used to direct resources to patients with the greatest need for these services.
University of Pittsburgh Medical Center (UPMC) diabetes care providers along with members of the clinical analytics team created a predictive model, including patient age, HbA1c, and insulin use among other factors, to assess individual patient risk of future poor glycemic control. The model was applied to patients who received DSMES via diabetes care and education specialists (DCES) from December 2018 to December 2020 to evaluate the impact of DSMES according to risk strata. Patients were categorized into high, medium and low risk groups based on clinical data prior their initial DSMES encounter. HbA1c change was calculated using the HbA1c prior to DSMES and most recent HbA1c.
Of 1,247 patients eligible for retrospective assessment, 50% were categorized as low risk (n=621), 4% (n=55) medium, and 46% high risk (n=571). Mean HbA1c change after DSMES was -0.54% for low risk, -0.72% for medium risk, and -1.19% for the high risk group. Mean HbA1c after DSMES was 7.6% for low risk, 9.7% for medium risk and 9.6% for high risk patients. 57.5% of low, 59% of medium and 46.6% of high risk patients were seen by an endocrinologist.
In this analysis, high risk patients who received DSMES had larger improvement in HbA1c and were less likely to be seen by an endocrinologist. To optimize utilization of diabetes care regarding DCES, predictive modeling can be used to target resources to the highest risk patients.
Disclosure
M. Zupa: None. J. S. Krall: Research Support; Self; Becton, Dickinson and Company, Sanofi. K. Collins: None. J. Ng: Research Support; Self; Sanofi-Aventis. L. M. Siminerio: Advisory Panel; Self; Abbott Diabetes, Bayer U. S., Research Support; Self; Becton, Dickinson and Company.
Funding
National Institute of Diabetes and Digestive and Kidney Diseases (5T32DK007052-45)
Objectives. To understand the practices, attitudes, and beliefs of type 1 diabetes (T1D) providers towards school-based diabetes care (SBDC), including counseling families and communicating with ...schools, and explore the barriers and facilitators which affect their support of SBDC. Research Design and Methods. We conducted a national survey of pediatric T1D providers about their perceived support of SBDC, including family counseling and school communication. We used descriptive statistics to analyze results and explored differences by practice size (<500, 500–999, and ≥1000 patients) and environment (academic vs nonacademic). Results. A total of 149 providers completed the survey. Nearly, all (95%) indicated SBDC was very important. Though most (63%) reported counseling families about SBDC multiple times per year, few (19%) spoke with school staff routinely, reporting that was a shared responsibility among different providers. Close to 90% agreed school feedback on T1D management plans would be helpful, yet only 31% routinely requested this input. Moderate to extremely significant barriers to SBDC communication included internal factors, such as staff resources (67%) and time (82%), and external factors, such as school nurse education needs (62%) and differing school district policies (70%). Individuals from large or academic practices reported more barriers in their knowledge of SBDC, including federal/state laws. Desired facilitators for SBDC included a designated school liaison (84%), electronic transmission for school forms (90%), and accessible school staff education (95%). Conclusions. Though providers universally agree that SBDC is important, there are multilevel internal (practice) and external (policy) barriers to facilitating a bidirectional relationship between schools and health teams.
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