Study title: Telehealth Delivery to Change the Paradigm of Care Delivery in Children with Type 1 Diabetes

Program: Structural Racism, Social Injustice and Health Disparities in Maternal and Child Health Pilot Awards

Research summary: Children with type 1 diabetes visit pediatric diabetes centers four times a year, often traveling at a distance for care, resulting in missed school for children and lost wages for families. The data indicates many families who are publicly insured struggle with making these visits. Priya Prahalad, MD, PhD, Clinical Associate Professor of Pediatrics, is conducting a study for publicly insured children with Type 1 diabetes to determine whether traditional, quarterly 45-60 minute in-person visits can be replaced by shorter, monthly telehealth visits without compromising outcomes. The study will evaluate the impact of a remote monitoring program for children with type 1 diabetes and its clinical outcomes. Dr. Prahalad is working with Professor of Pediatrics David Maahs, MD, PhD, and Clinical Professor of Pediatrics and Chief Medical Information Officer for Stanford Children’s Health Natalie Pageler, MD, MEd.

Q: What progress have you made to date?
A: We started talking to families about our MCHRI study in February. We want them to come in and enroll in person. We’re going to aim to enroll 10-15 participants.

We received funding from the Lucile Packard Children’s Hospital (LPCH) Auxiliaries Endowment about a year ago to help purchase continuous glucose monitors, which are small wearables that measure glucoses every five minutes. Those can share data to the cloud, and we can view that data remotely. Through the LPCH Auxiliaries Endowment funding, we’re able to provide families with those devices as well as iPod touches to share the device data with us. These devices will help us recruit participants for this study. 

Part of the MCHRI funding will go toward something called a home hemoglobin A1c kit. A test for hemoglobin A1c measures a person’s average glucose control for the last three months. For patients who did telehealth in the past, we used to ask them to go to a lab and get a blood draw, which was a deal-breaker for many people. Thanks to this grant, we’re able to send them hemoglobin A1c kits so that they can do this poke at home and send it off, and we get a result.

Q: How will this award impact your broader research goals related to healthcare disparities?
A: My broader research goals are to use technology to improve the care of children with diabetes and decrease the burden on families. I would like to expand telehealth or make it an option for all of our patients with diabetes, both privately insured and publicly insured. The goal of this MCHRI pilot award is to see if we can improve outcomes because we’re having these monthly touchpoints, we’re making dose adjustments, and we’re providing education to build independence among our participants.

Prior to COVID, I had been working on a program where I would partner with school districts to do telehealth visits with kids at their school to decrease some of the barriers that existed with internet access at home. I have already been doing it with one of my patients, and it works great. I had been hoping to speak with some school districts to set up programs with some of the schools that our patients attend to serve as an afterschool telehealth hub for the patients we support. That’s been on hold because our kids have not been back in school for the last year.

The project is currently in progress. This story is a complimentary piece to a larger article. To read the article, click here.

BY LAURA HEDLI

Laura Hedli is a writer for the Division of Neonatal and Developmental Medicine in the Department of Pediatrics and contributes stories to the Stanford Maternal and Child Health Research Institute.