Telemedicine Intervention for Type 1 Diabetes

(REDCHiP Trial)

Not currently recruiting at 2 trial locations

Overseen By Amy Milkes

Age: < 18

Sex: Any

Trial Phase: Academic

Sponsor: Nemours Children's Clinic

Must be taking: Insulin

Disqualifiers: Conventional regimen, Allergy, Chronic condition, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 11

Duration: 14 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

The trial aims to help parents of young children with Type 1 diabetes manage stress and improve their child's blood sugar levels. It tests a new telemedicine program called REDCHiP, which provides video sessions to educate and support parents. The trial compares REDCHiP to standard education sessions to determine which is more effective in reducing stress and improving children's health. Families with children aged 2 to 6 years, who have had Type 1 diabetes for at least six months and use insulin pumps or multiple daily injections, might be a good fit. As an unphased trial, this study offers families the chance to contribute to innovative research that could enhance diabetes care for young children.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It focuses on a telemedicine intervention for managing stress and diabetes in children.

What prior data suggests that this telemedicine intervention is safe for families of young children with Type 1 Diabetes?

Research has shown that the REDCHiP telemedicine program, designed to assist parents of children with Type 1 Diabetes, is both practical and well-liked. Studies have found that parents using REDCHiP feel less worried about low blood sugar and experience reduced stress, indicating the program's ease of use. These studies have reported no major side effects. Since REDCHiP involves video sessions focused on teaching and problem-solving, it is considered low-risk. This makes it a safe option for parents seeking to reduce stress and support their children with diabetes. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the REDCHiP intervention for Type 1 Diabetes because it uses video-based telemedicine to deliver targeted education and training to parents. Unlike traditional in-person consultations or generalized educational programs, REDCHiP involves ten interactive sessions that enhance parents' problem-solving and behavioral skills, empowering them to better manage their child's diabetes. This personalized approach aims to improve parental knowledge and engagement, potentially leading to better long-term outcomes for children with Type 1 Diabetes. Additionally, the convenience of telemedicine makes this intervention accessible, reducing the need for frequent hospital visits.

What evidence suggests that this trial's treatments could be effective for Type 1 Diabetes?

Research has shown that REDCHiP, one of the video-based telemedicine programs tested in this trial, may help reduce parents' fear of low blood sugar in young children with type 1 diabetes. Parents using REDCHiP report feeling less stressed and worried about their child's condition. Early findings suggest these children might achieve better blood sugar control, as reflected in their HbA1c levels. The program offers education and problem-solving to boost parents' confidence and skills in managing their child's diabetes. While initial results are promising, further research is needed to confirm its effectiveness. Another arm of this trial, the Attention Control (ATTN) arm, provides general patient education specific to young children through similar video-based telemedicine sessions. ^{3 6 7 8 9}

Who Is on the Research Team?

Susana Patton, PhD, CDE

Principal Investigator

[e-mail]

Are You a Good Fit for This Trial?

This trial is for parents of young children aged 2-6.99 years with Type 1 diabetes on an intensive insulin regimen for at least 6 months. It excludes those whose children have other chronic conditions, are not on such a regimen, or have allergies to glucose monitoring adhesives.

Inclusion Criteria

My child is between 2 and almost 7 years old.

My child is between 2 and 6 years old.

My child uses an insulin pump or gets several insulin shots daily.

Exclusion Criteria

My child has a long-term health condition like kidney disease.

Parents of children using a regular treatment plan.

Kids who are allergic to the stick-on and skin prep for constant sugar monitoring.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive 10 video-based telemedicine sessions, focusing on T1D education and behavioral parent training

14 weeks

10 sessions (virtual)

Post-treatment Assessment

Parents and children repeat baseline assessments to evaluate changes in FH, parenting stress, and children's HbA1c

1 week

Follow-up

Participants are monitored for maintenance of treatment effects on FH, parenting stress, and child HbA1c

3 months

1 follow-up assessment (virtual)

What Are the Treatments Tested in This Trial?

Interventions

• ATTN
• REDCHiP

Trial Overview The study tests REDCHiP, a video-based telemedicine intervention aimed at reducing parental fear of hypoglycemia and stress, against ATTN (an attention control). It measures the impact on parents' stress levels and children's HbA1c both after treatment and at a 3-month follow-up.

How Is the Trial Designed?

Group I: REDCHiP intervention arm Experimental Treatment 1 Intervention

REDCHiP uses 10- video-based telemedicine sessions to deliver T1D education, behavioral parent training, and problem-solving to enhance parents' knowledge and skills. Sessions last about 45-60 minutes each.

Group II: Attention Control arm Active Control 1 Intervention

ATTN uses 10- video-based telemedicine sessions to deliver general patient education specific to young children. Similar to REDCHiP, all ATTN sessions last 45-60 minutes.

Who Is Running the Clinical Trial?

Nemours Children's Clinic

Lead Sponsor

Trials

128

Recruited

18,000+

University of Kansas Medical Center

Lead Sponsor

Trials

527

Recruited

181,000+

Children's Mercy Hospital Kansas City

Collaborator

Trials

261

Recruited

941,000+

University of Florida

Collaborator

Trials

1,428

Recruited

987,000+

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

Collaborator

Trials

2,513

Recruited

4,366,000+

Published Research Related to This Trial

A 9-month study involving 93 young adults with type 1 diabetes showed that telemedicine support, including real-time feedback and nurse assistance, led to a significant reduction in median blood glucose levels compared to a control group.

While both groups experienced reductions in HbA1c levels, the difference between the intervention and control groups was not statistically significant, suggesting that additional support for medication and lifestyle adjustments may be necessary for more substantial improvements in glycemic control.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A randomized controlled trial of the effect of real-time telemedicine support on glycemic control in young adults with type 1 diabetes (ISRCTN 46889446). Farmer, AJ., Gibson, OJ., Dudley, C., et al.[2022]

Patients with type 1 diabetes using telecare (which includes feedback from clinicians) showed a significant reduction in HbA1c levels after 6 months compared to those who only transmitted data without feedback (8.2% vs. 7.8%).

While telecare improved glycemic control, the overall effect was modest, with a meta-analysis indicating a 0.4% difference in HbA1c change compared to control groups, suggesting that while beneficial, telecare may not drastically change outcomes for all patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Telecare for patients with type 1 diabetes and inadequate glycemic control: a randomized controlled trial and meta-analysis. Montori, VM., Helgemoe, PK., Guyatt, GH., et al.[2019]

The Diabeo software, which allows for personalized insulin dose adjustments and includes telemedicine support, significantly reduced HbA1c levels in poorly controlled type 1 diabetes patients, achieving a mean HbA1c of 8.41% compared to 9.10% in the usual care group.

Patients using the Diabeo system experienced a 0.91% improvement in HbA1c over controls without an increase in hypoglycemic episodes or additional medical time, making it a cost-effective option for managing diabetes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Diabeo software enabling individualized insulin dose adjustments combined with telemedicine support improves HbA1c in poorly controlled type 1 diabetic patients: a 6-month, randomized, open-label, parallel-group, multicenter trial (TeleDiab 1 Study). Charpentier, G., Benhamou, PY., Dardari, D., et al.[2022]

In a 6-month study involving 100 adults with type 1 diabetes, the use of the iBGStar® glucose meter combined with an iPhone led to a significant reduction in A1c levels compared to traditional self-monitoring methods (-0.51 vs. -0.16, p = 0.04).

Both groups showed improvements in hypoglycemia fear scores, but the iBGStar® group did not experience an increased risk of hypoglycemia, indicating that this mobile technology can enhance glycemic control without compromising safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Role of Mobile Technology to Improve Diabetes Care in Adults with Type 1 Diabetes: The Remote-T1D Study iBGStar&#174; in Type 1 Diabetes Management. Garg, SK., Shah, VN., Akturk, HK., et al.[2020]

The Diabetes Research in Children Network (DirecNet) has conducted extensive research on type 1 diabetes since 2001, resulting in 28 published studies that evaluate various diabetes management technologies, including glucose meters and continuous glucose monitoring systems.

The network's research also focuses on factors affecting hypoglycemia, such as exercise and diet, and provides valuable data sets and psychosocial questionnaires to the public, enhancing the understanding and management of type 1 diabetes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Diabetes research in children network:availability of protocol data sets. Ruedy, KJ., Beck, RW., Xing, D., et al.[2023]

Citations

1. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/31517512/

An Intervention to Reduce Hypoglycemia Fear in Parents of ... This study examined the feasibility and acceptability of a novel group-based telemedicine intervention to reduce FH in parents of young children with T1D.

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7393613/

An Intervention to Reduce Hypoglycemia Fear in Parents of ... Our new video-based telehealth intervention appears to reduce hypoglycemia fear and parenting stress and may help parents of very young children with T1D.

3. clinicaltrials.gov clinicaltrials.gov/ct2/show/NCT03879642

NCT03879642 | Reducing Hypoglycemia Fear in Parents ... Pilot of a novel video-based telemedicine intervention to reduce fear of hypoglycemia in parents of young children with type 1 diabetes. Detailed Description.

4. researchprotocols.org researchprotocols.org/2020/8/e17877/

Reducing Emotional Distress for Childhood Hypoglycemia ... This paper outlines how we intend to examine the effectiveness of REDCHiP in reducing parenting stress and fear of hypoglycemia compared with an ...

5. diabetesjournals.org diabetesjournals.org/spectrum/article/35/1/26/144551/Peer-Support-Interventions-on-Digital-Platforms

Peer Support Interventions on Digital Platforms for Children ... An intervention to reduce hypoglycemia fear in parents of young kids with type 1 diabetes through video-based telemedicine (REDCHiP): trial ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6945796/

An Intervention to Reduce Hypoglycemia Fear in Parents ... This study examined the feasibility and acceptability of a novel group-based telemedicine intervention to reduce FH in parents of young children with T1D.

7. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/31610073/

Intervention to reduce hypoglycemia fear in parents of young ... Our new video-based telehealth intervention appears to reduce hypoglycemia fear and parenting stress and may help parents of very young children with T1D.

8. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/10.1111/pedi.12934

Intervention to reduce hypoglycemia fear in parents of ... Our new video-based telehealth intervention appears to reduce hypoglycemia fear and parenting stress and may help parents of very young children with T1D.

9. frontiersin.org frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2024.1513166/full

The impact of telemedicine on pediatric type 1 diabetes ... This narrative review examines the impact of TM on patient-provider relationships, glycemic control, and overall diabetes management in children ...