Improvement of Care & Outcome


Agata Chobot, Stefanie Lanzinger, Hessa Alkandari, Todd Alonso, Nicole Blauensteiner, Nicole Coles, Luisa De Sanctis, Dick Mul, Banshi Saboo, Carmel Smart, Meng-Che Tsai, Bedowra Zabeen, Klemen Dovc for the SWEET Study Group

Diabetes care practices and outcomes in 40.000 children and adolescents with type 1 diabetes from the SWEET registry during the COVID-19 pandemic. Diabetes Res Clin Pract. 2023 Jun 27;110809.

During the COVID-19 pandemic, routine T1D care was forced from care delivered in person to various “care at a distance” solutions (also known as ‘telemedicine’, ‘telecare’, ‘digital/virtual clinic’, ‘remote monitoring’). Advances in and use of technology like insulin pumps, continuous glucose monitoring and cloud-based data-exchange, were already increasing before the pandemic. As a result of COVID-19-related lockdowns this process accelerated out of necessity. After initial worries about how these forced changes would impact care and glycemic outcomes, most studies on the subject have shown stable glycemic outcomes and even improvements during the pandemic. Furthermore, both people with T1D and healthcare providers seem to appreciate telemedicine. This study, co-authored by Dick Mul of Diabeter, aimed to assess COVID-19-induced changes (e.g. implementation of telemedicine and psychological support) in pediatric T1D care and possible associations with glycemic outcomes and complications.


Data on almost 27,000 individuals with type 1 diabetes aged ≤21 years and with >3 months diabetes duration were extracted from the SWEET database. Also a questionnaire about diabetes care and telemedicine was sent to almost 67,000 individuals receiving care in all 97 centers active in the SWEET registry at the time of the study.

Key findings:

  • Insulin pump and CGM use significantly increased by 7.8% and 22.3 %, respectively
  • Number of data uploads decreased (from 3 to 2 annually)
  • Half of the centers which did not offer telemedicine before the pandemic, started providing remote visits during COVID-19
  • Lack of reimbursement/financial loss did not prevent many centers from implementing telemedicine
  • Providing telemedicine before the pandemic was associated with lower HbAc levels and DKA rates during the pandemic, while not offering telemedicine led to increased HbA1c levels
  • The association with HbA1c levels remained significant even after adjusting for treatment modality
  • Offering psychological support due to COVID-19 was associated with lower HbA1c levels, DKA and severe hypoglycemia rates


Concluding, the authors state

"It may be that a hybrid diabetes care model with telemedicine may be adopted in routine diabetes care in the future and may also play a role in reducing disparities. However, diabetes clinics showed some hesitancy to maintain the use of telemedicine when reimbursements were inadequate, and therefore, a hybrid model could depend on sufficient reimbursement from payers " -

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