Shaping workflows in digital and remote diabetes care during the COVID-19 pandemic via service design: Prospective, longitudinal, open-label feasibility trial

Katarina Braune*, Karina Boss, Jessica Schmidt-Herzel, Katarzyna Anna Gajewska, Axel Thieffry, Lilian Schulze, Barbara Posern, Klemens Raile

*Corresponding author for this work

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Abstract

Background: The COVID-19 pandemic poses new challenges to health care providers and the delivery of continuous care. Although many diabetes technologies, such as insulin pumps and continuous glucose monitors, have been established, the data from these devices are rarely assessed. Furthermore, telemedicine has not been sufficiently integrated into clinical workflows. Objective: We sought to remotely support children with type 1 diabetes and their caregivers, enhance the clinical outcomes and quality of life of children with diabetes, increase multiple stakeholders' engagement with digital care via a participatory approach, evaluate the feasibility of using an interoperable open-source platform in a university hospital setting, and analyze the success factors and barriers of transitioning from conventional care to digital care. Methods: Service design methods were used to adapt clinical workflows. Remote consultations were performed on a monthly and on-demand basis. Diabetes device data were uploaded from patients' homes to an open-source platform. Clinical and patient-reported outcomes were assessed before, during, and after the COVID-19 lockdown period in Germany. Results: A total of 28 children with type 1 diabetes and their caregivers enrolled in this study and completed 6 months of remote visits. Of these 28 participants, 16 (57%) also opted to attend at least one of their regular visits remotely. After 3 months of remote visits, participants' time in range (P=.001) and time in hyperglycemia (P=.004) significantly improved, and their time in hypoglycemia did not increase. These improvements were maintained during the COVID-19 lockdown period (ie, between months 3 and 6 of this study). Participants' psychosocial health improved after 6 months. Conclusions: Remote consultations and commonly shared data access can improve the clinical outcomes and quality of life of children with type 1 diabetes, even during challenging circumstances. A service design approach helped with the delivery of comprehensive and holistic solutions that accounted for the needs of multiple stakeholders. Our findings can inform the future integration of digital tools into clinical care during and beyond the pandemic.

Original languageEnglish
Article numbere24374
JournalJMIR mHealth and uHealth
Volume9
Issue number4
ISSN2291-5222
DOIs
Publication statusPublished - Apr 2021

Bibliographical note

Funding Information:
We would like to thank all children with diabetes, their families, and all professional diabetes team members from the Interdisciplinary Social Pediatric Center and the Department of Paediatric Endocrinology and Diabetes of Charit? - Universit?tsmedizin Berlin, who greatly contributed to this study. Furthermore, we would like to thank the team members of Tidepool, Diabeloop, and Sensotrend for their advice on implementing the Tidepool platform and uploader in our study setting. We also acknowledge the German Research Foundation and the Open Access Publication Funds of Charit? - Universit?tsmedizin Berlin for their support with the publication of this study.

Funding Information:
We would like to thank all children with diabetes, their families, and all professional diabetes team members from the Interdisciplinary Social Pediatric Center and the Department of Paediatric Endocrinology and Diabetes of Charité – Universitätsmedizin Berlin, who greatly contributed to this study. Furthermore, we would like to thank the team members of Tidepool, Diabeloop, and Sensotrend for their advice on implementing the Tidepool platform and uploader in our study setting. We also acknowledge the German Research Foundation and the Open Access Publication Funds of Charité − Universitätsmedizin Berlin for their support with the publication of this study.

Funding Information:
The DDC project was funded by the Berlin Institute of Health. The project also received nonfinancial support from the service design company Designit. The funding source was not involved with this study.

Funding Information:
All authors completed the Unified Competing Interest form. KBraune received research grants from the Berlin Institute of Health Junior Clinician Scientist program for conducting this study. Outside of this study, KBraune received research grants from the Berlin Institute of Health Digital Clinician Scientist program, the European Commission’s Horizon 2020 Research and Innovation program, Wellcome Trust, Stiftung Charité, and the German Diabetes Association. Outside of this study, KBraune served as a speaker and advisory board member for Medtronic Diabetes and received fees for medical consulting and public speaking from Roche Diabetes Care, Dexcom, Medtronic Diabetes, Diabeloop, and Bertelsmann Stiftung. JSH is employed as a part-time diabetes coach at mySugr. KR received grants from the European Commission's Horizon 2020 Research and Innovation Program (grant agreement number: 823902). Outside of this study, KR is an advisory board member of Lilly Diabetes Care and Abbott Diabetes Care. All other coauthors have no conflicts of interest to declare.

Publisher Copyright:
© 2021 Katarina Braune, Karina Boss, Jessica Schmidt-Herzel, Katarzyna Anna Gajewska, Axel Thieffry, Lilian Schulze, Barbara Posern, Klemens Raile.

Keywords

  • COVID-19
  • Diabetes
  • Digital care
  • Digital health
  • Open source
  • Pediatric diabetes
  • Remote care
  • Service design
  • Telehealth
  • Telemedicine
  • Type 1 diabetes
  • Workflow

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