Optimization of methods of dynamic observation of children with manifestation of type 1 diabetes mellitus in conditions of limited availability of medical care and evaluation of their effectiveness

BACKGROUND: With the onset of the COVID-19 pandemic, restrictions were introduced on the availability of planned medical care, which could negatively affect the compensation of children, especially with newly diagnosed type 1 diabetes mellitus (T1DM). During this period, there was a need to improve the methods of dynamic monitoring of children with the manifestation of type 1 diabetes using modern remote technologies from the first days of discharge from the hospital.

AIM: To evaluate the effectiveness of methods for dynamic observation of children with manifestation of T1DM, optimized in conditions of limited availability of planned medical care.

MATERIALS AND METHODS: A single-center, 12-month prospective comparative study was conducted in three populations of children under 17 years of age with manifestation of T1DM during the COVID-19 pandemic, who were monitored using a standard approach, as well as methods optimized with the use of telemedicine consultations (TMC) and CGM and assessment of the HbA1c level and the proportion of patients with HbA1c<7.0% at the endpoint of observation.

RESULTS: The study included 137 children: 61 — standard observation (SO) group; 25 — TMC group and 51 — TMC+CGM group, which were comparable with each other by age, gender, proportion of children in puberty, anthropometric data, as well as by the severity of T1DM manifestation and daily insulin doses (p>0.05). After 12 months of observation, a significant decrease in the HbA1c level was found in the TMC and TMC+CGM groups compared to the SO group (7.1% and 6.7% vs. 8.3%; p=0.000), while HbA1c did not differ between the TMC and TMC+CGM groups (p=0.642). The proportion of patients who achieved HbA1c<7.0% in the TMC and TMC+CGM groups statistically significantly exceeded the proportion of patients in the SO group at the endpoint of observation (48.0% and 56.9% vs. 27.9%; p<0.001), however, the TMC and TMC+CGM groups did not differ from each other (p=0.466).

СONCLUSION: Methods of remote dynamic monitoring of children with manifestation of T1DM demonstrated better efficiency in achieving and maintaining glycemic control compared to standard monitoring, which dictates the need for their wider use in clinical practice. The main factor contributing to the achievement of compensation of T1DM in children is the availability of specialized medical care and regular consultations with a doctor.

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