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Our objective was to determine the impact of telemedicine (TM) interventions on the management of type 1 diabetes (T1DM) in youth. We performed a systematic review of randomized trials that evaluated TM interventions involving transmission of blood glucose data followed by unsolicited scheduled clinician feedback. We found no apparent effect of the TM interventions on hemoglobin A1c (HbA1c), severe hypoglycemia, or diabetic ketoacidosis. The limited data available on patient satisfaction, quality of life, and cost also suggested no differences between groups. It is unlikely that TM interventions, as performed in the assessed studies, had a substantial effect on glycemic control or acute complications. However, it remains possible that there are other benefits of TM not adequately reported, that newer TM strategies may be more effective and that interventions may benefit subgroups of youth, such as those with the poor glycemic control, adolescents, or those living in remote areas. [ABSTRACT FROM AUTHOR]

For treatment of type 1 diabetes mellitus (T1DM), the American Diabetes Association advocates intensive insulin regimens in which premeal insulin doses are based on carbohydrate (CHO) content and blood glucose (BG) level. Such regimens allow greater flexibility and potentially improved metabolic control, but require accurate CHO counting and multiple calculations which are potentially subject to error. Methods to assess and improve patients' ability to enact such regimens currently are not standardized or widely available. We hypothesized that a standardized tool to assess CHO knowledge and insulin dosing ability would be beneficial in the care of youth with TIDM. Through discussions with diabetes and nutrition experts, literature review, survey of patient dietary choices, and pretesting for clarity and ease of administration, we developed a novel questionnaire, the "PedCarbQuiz." The PedCarbQuiz is a 39-item self-administered questionnaire requiting 10-20 minutes for completion. It contains 7 domains: CHO recognition, CHO counting in food items, CHO counting in meals, nutrition label reading, use of insulin:CHO ratio, use of BG correction scale, and calculation of insulin dose. To date, a convenience sample of 30 subjects presenting to a pediatric diabetes clinic have completed the questionnaire. The PedCarbQuiz exhibited internal consistency (Cronbach's alpha 0.80). Parallel forms of the test, administered simultaneously, had a correlation coefficient of 0.78 (p<0.0001). Validity was shown by positive correlation of PedCarbQuiz score with frequency of diabetes clinic visits (correlation coefficient 0.39, p=0.03). Though not statistically significant, PedCarbQuiz scores showed the expected inverse correlation with patient's hemoglobin A1C. In the current patient sample, participants scored lower (p <0.0001 by paired t-test) in the carbohydrate knowledge domains (mean score 86%± 10) than in the insulin dosing domains (mean score 95% ±9). Our results suggest that the PedCarbQuiz is a promising instrument for evaluating the capacity of children and families to implement intensive insulin regimens and that it may identify specific areas of weakness that can be improved with education. Therefore, we conclude that the PedCarbQuiz has potential for broad application in the management of T1DM in pediatric populations. [ABSTRACT FROM AUTHOR]