At the Diabetes Congress 2021, Dr. Simone von Sengbusch, diabetologist and head of the study Virtual Diabetes Outpatient Treatment for Children and Adolescents (Studie zur Virtuellen Diabetesambulanz für Kinder und Jugendliche, ViDiKi), presented advances in telemedicine. In this esanum interview, she reports on the near future of type 1diabetes care.
esanum: Dr. von Sengbusch, the proportion of modern technological aids in the therapy of children with type 1 diabetes is high and increasing. What still needs to be improved?
von Sengbusch: The proportion of young patients who use a glucose sensor for continuous glucose monitoring (CGM) is very high. Most children also already use an insulin pump. The insulin pump can be combined with CGM. Software, which can be in the insulin pump or in a handheld device, for example, then controls the insulin delivery based on the sensor readings. This is called an AID system (Automated Insulin Dosing). This technology makes insulin therapy safer and supports the patient, but it is not a technical cure. For some years now, the basal insulin delivery of the insulin pump can be stopped by a glucose sensor when the sugar drops. For about 1.5 years, there have been insulin pumps that do more and automatically control the basal insulin delivery of the insulin pump. We now expect systems in the near future that can additionally correct elevated glucose levels that occur mainly around meals. Especially children, who have to live with the disease for the longest time, are dependent on such technologies that help to achieve a stable and good metabolic situation. I expect the new AID insulin pumps to come onto the market this year. Such systems are already on the market in other European countries.
esanum: And how will the new technology become widespread?
von Sengbusch: First, we as diabetes teams have to be trained on each new AID pump and then find the most suitable AID pump system for the families and their affected child. But if a child or adult with type 1 diabetes is doing very well with their current therapy, they can stay on it. But for those who are not meeting the therapy target, where glucose is fluctuating or the HbA1c target range is not being met, these new highly automated AID systems are quite ideal.
esanum: What are the decisive advantages?
von Sengbusch: The algorithms already available in sensor-controlled insulin pumps ensure that the basal rate is automatically delivered appropriately via the pump. The pump decides every few minutes how much insulin is now needed to maintain a set target range. This is an enormous advantage, especially at night. The new algorithms of the AID insulin pumps then additionally react with a supportive insulin correction if, for example, the glucose rises quickly during a meal and automatically compensate for this rise to a certain extent. That is an enormous advance.
esanum: What are the advantages of video consultation for children and adolescents with type 1 diabetes?
von Sengbusch: I led the ViDiKi study from 2017 to 2020, which investigated this. Our study showed: The children's metabolic situation improves and the families are relieved. The diabetes team still needs to see a stable and well-controlled child with type 1 diabetes maybe once or twice a year, everything else is done by video. For the children who need more contact with the entire diabetes team, we will have more time in the special outpatient clinic.
The documents are now with the Federal Joint Committee. And we hope that there will be a recommendation to introduce video consultations into standard care and to create corresponding billing possibilities.
esanum: How satisfied are the parents of the young patients?
von Sengbusch: The parents were enthusiastic about this type of care. Appointments for data discussion and insulin adjustment can be carried out perfectly in this way. You don't have to travel anywhere to look at the data with the diabetes team, which is in the cloud anyway.
esanum: How do you envision the future of type 1 diabetes care?
von Sengbusch: For example, the child will be set up with a highly automated AID insulin pump. Of course, such a therapy start must be accompanied and followed up. These appointments can be offered via video consultation. Or a child is newly diagnosed with type 1 diabetes. This is initially a shock for the family. Many questions arise every day. So in the beginning, after the child is discharged from hospital, you could make a short video appointment every week to give reassurance. Another option would be a digital clinic. This is also what most of the study participants wanted. They would like to have a virtual contact every month with always the same contact person and come to the outpatient clinic once or twice a year. They would also like to receive prescriptions by post or electronically. Experts will have to come up with a way to scan the health insurance cards but I'm quite confident that a solution will be found.
esanum: Do all patients and doctors have a good command of this video consultation technology?
von Sengbusch: Corona has given a lot of impetus to this. Everyone has learned. When we started the study four years ago, there were three video portal systems. Today, there are three narrowly printed pages on the website of the Federal Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, KBV) from which one can choose a certified portal. But the problem at the beginning was not the technology of video consultations, but the weak internet coverage in rural areas. In the meantime, we have solutions for that, too. There has been a digital and technical quantum leap in a very short time, which will benefit overall health.