Summary: In a crossover trial in children and adolescents with poorly controlled type 1 diabetes on CGM and injections, adding weekly structured telehealth consultations produced a small but significant fall in HbA1c and better time in range, without increasing hypoglycaemia.
PICO Summary
| Element | Detail |
|---|---|
| Population | 105 children and adolescents (mean age 11.8) with type 1 diabetes on FreeStyle Libre 2 CGM and multiple daily injections, baseline HbA1c 9.4%; randomised crossover trial, UAE. |
| Intervention | Weekly 20-minute teleconsultations with a diabetes educator and structured glucose-profile review for 12 weeks. |
| Comparison | Routine care for 12 weeks (participants served as their own controls), 2-week washout. |
| Outcome | Weekly telehealth reduced HbA1c by 0.29% (95% CI -0.41 to -0.17; p<0.001), increased time in range, and decreased time above range, average glucose, variability, glucose management indicator, and low-glucose events. Time below range was unchanged. The authors note the clinical impact of these changes needs prospective study. |
Weekly telehealth in paediatric type 1 diabetes
Crossover RCT · paediatric T1D on CGM+MDI · 12 weeks
Weekly structured telehealth produced a small but significant HbA1c reduction with more time in range and no extra hypoglycaemia. The effect is modest and the 12-week crossover design risks carryover, so prospective confirmation is needed.
Expert Commentary
This is a well-designed crossover trial that tests a sensible idea, that the quarterly clinic rhythm is simply too slow for childhood diabetes, where growth, activity, and adolescence keep shifting insulin needs. The most clinically reassuring finding is not the HbA1c number itself but its character: improvement came with better time in range and crucially no rise in time below range, meaning control improved through more precise management rather than by pushing insulin and risking hypoglycaemia, which is exactly the right goal. The structured, protocol-driven nature of the contact also matters and makes it reproducible. I would keep the effect size in proportion, and the authors themselves are admirably candid here, a 0.29% HbA1c reduction is real but modest, the trial ran only twelve weeks, and a crossover design risks carryover since knowledge gained during the intervention can bleed into the control period. Can I use this with my patients? Yes, selectively. For paediatric patients above target on injections and CGM, this supports offering intensified, structured remote review as a scalable adjunct between clinic visits, while being honest that the glycaemic gain is incremental and that the most engaged, highest-risk patients are likeliest to benefit.
References
Deeb A, Eldeeb L, Suliman S, et al. Effect of an intensive, integrated telehealth intervention on glycemic control in children and adolescents with type 1 diabetes using continuous glucose monitoring: a randomized, crossover trial. Pediatr Diabetes. 2025;2025:7261998. doi:10.1155/pedi/7261998