Type 1 Diabetes: Remote Monitoring and Digital Follow-up Study

Type 1 diabetes is an autoimmune disease in which the loss of endogenous insulin production necessitates lifelong daily insulin therapy. The disease requires a high degree of self-management, and comprehensive knowledge about the disease and its treatment is crucial for achieving optimal glycemic control. Chronic hyperglycemia remains a challenge in type 1 diabetes and is associated with an increased risk of cardiovascular disease and reduced life expectancy.

Over the past decade, there has been increasing availability and use of advanced diabetes technology. Continuous glucose monitors (CGMs) enable real-time glucose monitoring and provide alerts for glucose levels, while advanced insulin pumps, using data from CGMs and mathematical algorithms, help improve glycemic control by adjusting insulin delivery. Data from the Norwegian Diabetes Register for Adults indicate an improvement in glycemic control in recent years; however, 60% of Norwegian type 1 diabetes patients still do not meet their glucose management targets. In recent years, there has also been a growing focus on offering preventive treatment to reduce the risk of cardiovascular disease and diabetic kidney disease.

Approximately one in three individuals with type 1 diabetes experience varying degrees of psychological and emotional burden related to living with and managing their condition at some point in their lives. The term «diabetes distress» describes these diabetes-related concerns.

We are investigating whether user-controlled remote digital monitoring using a digital tool (application) with a traffic light model can contribute to improved glycemic control, better adherence to preventive pharmacological treatment for cardiovascular and kidney disease, and reduced diabetes distress, ultimately enhancing quality of life. As of today, there is limited scientific evidence supporting this approach.

Study Design and Implementation

The digital tool will integrate and analyze data from patients’ CGMs and insulin pumps every four months. Based on predefined thresholds, the traffic light model will categorize patients as:

  • Red: Requires contact within 48-72 hours by a diabetes nurse.
  • Yellow: Intermediate status, requiring monitoring.
  • Green: No immediate need for intervention.

Additionally, patients will complete a validated questionnaire to assess diabetes distress every four months, leading to categorization into green, yellow, or red, with follow-up by a diabetes nurse as described above. The digital tool will also allow patients to contact the diabetes outpatient clinic and request appointments.

Research Collaboration and Funding

Drammen Hospital, Department of Medicine, has received funding for the research project:
«User-controlled remote monitoring in patients with type 1 diabetes: Effects on metabolic control, healthcare utilization, distress, and self-care behavior.»

This is a collaborative project between:

  • All four hospitals in Vestre Viken,
  • AHUS,
  • Ålesund Hospital,
  • University Hospital of Northern Norway (UNN) – Harstad,
  • Norwegian Diabetes Register for Adults.

The study aims to determine whether user-controlled digital home monitoring leads to changes in glycemic control, healthcare utilization, diabetes distress, self-management, and quality of life. AHUS, Ålesund Hospital, and UNN-Harstad have already included type 1 diabetes patients in digital care pathways. In Vestre Viken, user-controlled digital home monitoring is scheduled to commence in January/February 2024. The goal is to include at least 2,000 type 1 diabetes patients across the participating hospitals.

The project is led by Postdoctoral Researcher Stina Therese Sollid, with PhD candidate Ine Solesvik Oppedal working on the study.