Response to ‘Home-based video visits for pediatric patients with poorly controlled type 1 diabetes’

Abstract

We thank Sohrabi et al. for their comments on our recent article ‘Home-based video visits for paediatric patients with poorly controlled type 1 diabetes’. The study described in our article was a pilot aimed at testing feasibility and measuring potential benefits experienced by participants, and was not intended to be a definitive trial. However, our results were novel in several ways (as detailed in our article) and therefore potentially valuable to other clinicians and researchers working in this area. We agree that our study’s small sample size, high dropout rate, and use of a single provider may limit the generalisability of our findings. While these limitations could not be surmounted in this pilot study, as mentioned in the article, we plan to complete a larger, randomised trial in the near future. This randomised trial will also allow us to evaluate the influence of patient characteristics (such as age) on the effectiveness of the intervention, and explore whether the increased frequency of in-person clinic visits experienced by our pilot cohort is a replicable finding (and likely a result of the intervention itself) or an unrelated confounder. Finally, as mentioned in our article we are currently exploring patient-level barriers to study participation so that we can optimise the intervention for a broader population. There are a couple points on which we disagree with Sohrabi et al. based on our clinical experience with paediatric type 1 diabetes (T1D). In contrast to their suggestion, we do not plan in future studies to enroll an intervention group that receives only video visits, because (as Sohrabi et al. themselves have noted) some important symptoms and exam findings can only be detected in-person; current guidelines for paediatric T1D therefore recommend in-person visits every three months. We are interested in whether video visits can be used to supplement in-person care in order to achieve more frequent contact for high-risk patients. Similarly, we do not plan to look at the effectiveness of this intervention for patients with serious comorbid conditions such as paediatric heart disease due to the aforementioned limitations of video interaction, and the fact that heart disease is not a common comorbidity for paediatric T1D (unlike adult type 2 diabetes). Inclusion of these less healthy and rarer patients in our pilot study would in fact have made our analysis less robust, given the small sample size and nonrandomised design. We look forward to continuing our research in this area, and appreciate the thoughtful commentary by Sohrabi et al. regarding the implications of our recent work.