Remote Monitoring Provides Advanced Care

By Ellen Goldbaum and Megan Veirs

When Ryan Morlock’s seven-year-old daughter, Charlotte (“Charlie”), was diagnosed with Type 1 diabetes a year ago, she said she was “dumbfounded.” 

“I knew nothing about it before Charlie was diagnosed; I mean, I knew some people who had it, but I had never asked questions.”

Today Morlock and her husband, Michael, have lots of questions, but they also have certified diabetes care and education specialists available to answer them via text, email, phone or telehealth visits. The South Buffalo family has access to these resources through a new program at UB that provides “virtual” support to children with Type 1 diabetes and their parents in an effort to help achieve better control of blood sugar levels.

The program confronts the fact that a majority of children living with Type 1 diabetes in the United States are not meeting their hemoglobin A1c (HbA1c) goals, a measure of average blood sugars, and a leading indicator of both short- and long-term disease state complications. Current research indicates that this trend is particularly prevalent in underserved communities.

In an effort to address this problem, pediatric endocrinologists at UBMD Pediatrics and the Jacobs School of Medicine and Biomedical Sciences have launched a collaboration to provide remote care management and physiological monitoring for children living with Type 1 diabetes. The team is evaluating the financial viability of providing these services as well as their impact on diabetes-related outcomes. 

A $1.43 million grant awarded to UBMD Pediatrics from The Leona M. and Harry B. Helmsley Charitable Trust is making this program possible.

Despite recognition of the benefits of remote care programs that deliver support in between physician visits, most primary care and specialty providers lack the financial resources to deploy them effectively. Moreover, the COVID-19 pandemic has exacerbated gaps among underserved communities primarily due to limited access to remote care services and community-based resources.

By working with Cecelia Health, a “virtual-first health care provider,” UBMD Pediatrics is supplementing the in-person patient care it provides with care from an experienced remote diabetes and chronic care management team. Cecelia Health provides patients with a spectrum of support in managing their diabetes to ease the daily burden, help improve health outcomes and free up care resources for providers.

A key goal of the program is to explore how improving access to remote support and the internet to manage chronic conditions will improve outcomes. In particular, the program is examining whether access to fully supported cellular-enabled tablets and remote counseling enables patients to take full advantage of their existing diabetes technologies, such as continuous glucose monitors and insulin pumps. In return, this should improve A1c levels and reduce hospital admissions for diabetic ketoacidosis, a life-threatening condition that develops when the body doesn't have enough insulin to allow blood sugar into cells for use as energy. 

“Using telehealth to improve care of youth with Type 1 diabetes is at the forefront of clinical care,” says Lucy Mastrandrea, MD, PhD, professor and chief of the Division of Pediatric Endocrinology/Diabetes at the Jacobs School and UBMD Pediatrics. “We expect to show that utilizing diabetes care specialists to deliver virtual support and education to our patients and families is financially sustainable. We are also taking this further by studying the clinical outcomes of patients with limited internet access who are provided tablets with cellular service and full technical support.” 

“Our Division of Pediatric Endocrinology/Diabetes cares for about 1,000 patients with diabetes,” says Kathleen Bethin, MD, PhD, principal investigator of the study and clinical professor of pediatrics at the Jacobs School. “We have many years of experience with both basic and clinical research to improve the lives of our patients.” 

Cecelia Health has worked with several university and hospital diabetes specialty clinics during the COVID-19 pandemic. 

“During the first year of the COVID-19 pandemic, thanks to the support of the Helmsley Charitable Trust, we were fortunate to leverage the expertise of Cecelia Health and its team of specialists to provide telehealth support services to our diabetes patients who were unable to be seen in-person at regular intervals,” says Bethin, also a member of UBMD Pediatrics’ Division of Endocrinology/Diabetes.

Additionally, the researchers are interested to see how video care support along with the improved ability to share data from pumps and blood glucose devices compares to phone-only support.

For the Morlock family, the impact of the program has been immediate and positive. Charlie visits Mastrandrea, her UBMD endocrinologist, every three months, and in between visits, she and her family have the team at Cecelia Health to look to for guidance and support in addition to monthly telehealth appointments.

“It’s very helpful,” Morlock says. “It’s nice to have extra hands. We have four children and Charlie is our only girl, so she’s taking it all in and loving the attention when it comes to having extra resources. When I don’t know the answer, it’s amazing to be able to reach out for help because it definitely takes a village these days.” 

Morlock explains that working with their Cecelia Health contact, they have “come up with a game plan to essentially make Charlie’s numbers steady because she’s had a lot of ups and downs with everything. She’s very, very active. She’s in dance and soccer and she’s outside all the time with her brothers, but there are times, like yesterday, when her numbers were high for the majority of the day and it took a lot to bring them down.”

For the telehealth visits, Morlock says “Charlie is there, present and speaking.” In addition, the team at Cecelia Health has secure access to data on Charlie’s insulin pump and can further monitor her glucose levels. “So, it’s like she’s standing right there in front of them,” Morlock notes.

The Helmsley Charitable Trust, the funder of this project, is one of the largest private foundation funders of Type 1 diabetes research in the nation.

“Telehealth has the unparalleled ability to meet patients where they are, but for these services to be used, they must be reimbursed properly” says Sean Sullivan, PhD, program officer for the Helmsley Charitable Trust’s Type 1 Diabetes (TD1) Program. “This innovative work aligns with our goal at Helmsley to better understand the impact and viability of programs that can expand access to quality care for all people with Type 1 diabetes, regardless of their zip code.”

The grant will support this collaboration for three years.

The Leona M. and Harry B. Helmsley Charitable Trust aspires to improve lives by supporting exceptional efforts in the U.S. and around the world in health and select place-based initiatives. Its Type 1 Diabetes Program is focused on understanding the disease, developing better treatments and improving care and access in the U.S and low- and middle-income countries. For more information on Helmsley and its programs, visit helmsleytrust.org.

To learn more about how to support children with Type 1 diabetes through medical discovery and advances at the Jacobs School, contact Kathy M. Swenson, senior director of advancement, at kswenson@buffalo.edu or by calling 716-829-5052.

—S.A. Unger contributed to this article