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Category: Type 1 Diabetes

Telemedicine Care Post-Pandemic in Type 1 Diabetes Patients 

The COVID-19 pandemic has forced providers and patients specialty-wide to shift to a model of virtual care in an effort to avoid unnecessary person-to-person contact; for some, telemedicine appointments were a completely novel concept. Digital healthcare delivery has proved vital to preserving the health of the population during an ongoing pandemic, allowing healthcare providers to continue the routine monitoring of their patients – which is especially important for those with chronic conditions. Of those, type 1 diabetes has proven to be one of the fields more suitable to telehealth visits with the support of remote glucose monitoring data and other novel technologies.

Type 1 Diabetes Telemedicine Appointments 

Per data from an emerging study published in Endocrinology, Diabetes & Metabolism reported that patients with type 1 diabetes who had attended a telemedicine appointment throughout the pandemic found them favorable and would consider future remote visits. Researchers distributed an online questionnaire between March 24 and May 5, 2020 and collected data from over 7,000 people in 89 countries across the world. The highest proportion of respondents were from the United States at 40.6% and 68% were women. Data were analyzed descriptively, while results were stratified according to age, sex, and HbA1C.

Overall, 75% of participants reported planning to use remote appointments in the future, with 86% reporting the visits useful with little variation across age groups and no differences by educational level were observed. The majority of respondents over the age of 65 viewed telemedicine positively.

However, patients with A1c greater than 9%, 45% of men and 20% of women felt that visits were not beneficial, revealing differences by glycemic control. Further study is needed to understand why this particular group was significantly more against telemedicine than others.

Telephone Appointments Versus Video Conferencing 

“Worldwide, 30% reported that the pandemic had resulted in canceled in-person medical appointments, while 32% reported no change in medical follow-up,” the researchers wrote. “Of the 28% reporting use of telemedicine, 72% were via telephone while just 28% were video calls.” Indicating that a large proportion of respondents may have not been able to utilize full potential of video technology, such as screen sharing of glucose monitoring data.

Experts believe that the high reported use of telephone calls over video technology may be a reflection of the global population cohort, as data in the United States reveals a preference for video appointments. This raises the question of health equity, making sure that certain populations are not left behind due to technological access. Further, the data was gathered electronically which may exclude certain groups and favor more tech-forward patients; additional study is needed as the sample was not representative of the whole population.

The future of telemedicine in the United States will largely depend on health insurance processes and reimbursement protocols, including making temporary Medicare waivers permanent and expanding access to virtual care nationwide. Despite the benefits of remote medical appointments, the choice between in-person and telehealth visits is a matter of individual preference; some patients and providers may be more open to maintaining a largely digital practice than others.

Obesity and Diabetes Accelerate Cognitive Decline

While the wide-ranging adverse health effects of obesity are well-known, recent evidence reveals that higher BMI levels may be associated with cognitive decline – in particular, in older adults. In addition, sustained elevated glucose contributes to many adverse health consequences, increasing risk for heart disease stroke, kidney disease, vision and nerve problems and can also lead to cognitive decline in older patients, according to new research published in Journal of the American Geriatrics Society.

Diabetes is a consistent risk factor for cognitive decline and dementia in both midlife and later life, which when coupled with obesity can raise the risk of poor physical and mental health outcomes. Long-term prior research indicates that diabetes, high blood pressure, and high BMI should be examined together to determine their contribution to adverse cognitive outcomes.

Assessing the Role of Metabolic Markers

In a ten-year prospective population-based cohort study, a team of researchers led by Mary Ganguli, MD, MPH, investigated the potential mechanisms underlying the well-established association between diabetes and obesity along with its relationship to cognitive decline. They evaluated a cohort of 478 individuals aged 65 years or above by analyzing fasting blood markers of glycemia (glucose and hemoglobin A1c), insulin resistance (insulin and homeostatic model assessment of IR), obesity (resistin, adiponectin, and glucagon-like peptide-1), and inflammation (C-reactive protein). The team modeled the metabolic indices as predictors of the slope of decline in global cognition, conducted multivariable regression analyses, and stratified by sex-specific median waist-hip ratio (WHR). Results were adjusted for sex, education, age, APOE-4 genotype, WHR, depressive symptoms and systolic BP.

Obesity, Diabetes Associated with Cognitive Decline

Dr Ganguli and her colleagues found that HbA1c measures were significantly associated with cognitive decline in those with higher waist-hip ratios in the entire sample – the connection persisted in participants with higher WHR after stratifying by median WHR. Conversely, metabolic indices were not associated with cognitive decline in participants with lower WHR.

Further, the team found that individuals under the age of 88 with abdominal obesity were more predisposed to faster cognitive decline in the presence of even mild hyperglycemia. In participants under the age of 87, faster cognitive decline was associated with adiponectin of 11 or greater in those with lower WHR as well as with an HbA1c measure of 6.2% or greater in those with higher WHR. The study also introduces evidence of the hormone adiponectin as a likely novel risk factor for cognitive decline in older adults under the age of 87 without abdominal obesity, the researchers reported.

Dr. Ganguli and her team’s results reveal that even mild degrees of hyperglycemia can independantly predispose individuals under the age of 88 with abdominal obesity to faster cognitive decline. Those below the age of 87 without central obesity may be more affected by the novel independent risk factor adiponectin. Their findings indicate that abdominal obesity can significantly affect neurological health in individuals under the age of 87, however, after that threshold there seems to be no correlation between diabetes, obesity, and cognitive decline.

“Clinicians need to pay more attention to abdominal obesity and be concerned about prediabetes in those individuals,” Ganguli told Healio Psychiatry. “In those who don’t have abdominal obesity, we should perhaps pay more attention to unexplained weight loss. I’d like to see the adiponectin relationship be investigated further before saying adiponectin should be measured in the clinical setting.”