Catlin Dennis, MPH, explains the importance of securing internet and technology access among vulnerable youth with diabetes.
Having the flexibility for both in-person and telehealth visits for youth with diabetes will be a positive that comes out of COVID-19, said Catlin Dennis, MPH, the program manager of Novel Interventions in Children's Healthcare (NICH) at Doernbecher Children’s Hospital in Portland, Oregon. Dennis' research on “COVID-19’s Impact on the Most Medically and Socially Vulnerable Youth With Diabetes” was presented at the American Diabetes Association’s 81st Scientific Sessions.
What are some lessons learned from COVID-19 that can be implemented going forward to improve care for vulnerable youth with diabetes?
The importance of internet access and technology is critical. That's something that NICH will really be focusing on. Families have to have adequate Wi-Fi connections. And like I said, they have to have the devices to be able to use this Wi-Fi. So while we found that many of our families had at least 1 smartphone accessible to them in the household, things like telehealth were really best done when you have a tablet or a laptop, where can type messages to your provider or even just have the ability to set it down during an appointment so you weren't trying to hold that in your hand.
I really think digital equity, or rather digital inequity, is just another way that these families can really fall behind. That's an important tool for how they can best support their child's health, especially as we move into this new realm of a hybrid model for health care. I think health care will really need to intervene. One of the things we saw was the need for infrastructure, and that this kind of got passed around, because I think some hospitals were maybe less likely to want to invest in infrastructure, because you couldn't neatly package that the Wi-Fi connection they were providing was going to be used solely for telehealth. Which is true. Wi-Fi is going to be used for any number of things. I think what we found, though, is that really from a holistic and social-determinants-of-health perspective, it was still advantageous for health. Because even if that Wi-Fi gets used for maybe a couple of telehealth appointments, it may also help that parent get on the internet and apply for a job when they've been laid off, in the evening and their kids are sleeping, or maybe even to connect with a family member via video call or something like that. We do really feel like that's something important for health care to invest in.
Speaking of telehealth, that offers a really great bridge, especially for some of the families that we see that live several hours away from Doernbecher Children's Hospital, which is where they get most of their care. Having the ability to avoid that 3-, 4-hour drive is so important. Then again, for diabetes care, I think there's always going to be value in in-person appointments, particularly for things like meter downloads and just having a physician be able to really examine a child and make sure that they're where they should be. Having that flexibility of both options, I think will be really beneficial and a positive that comes out of this.
Then I think supervision is really important. Like I mentioned, we saw that some families didn't do well, but other families really made tremendous progress in terms of diabetes management. And that was partly due to just the bizarre circumstance of having everyone be confined to their house for a long period of time. We had parents that weren't working, which was stressful, but for the first time ever were actually able to supervise and support their child with shots and monitoring carbs and things like that, that they just haven't had the ability to do because they've been working or working multiple jobs. I think as we return to normal, it'll be really important to continue to loop in all those other critical adults that will have supervisory moments with children with diabetes. Things like school nurses, coaches, even that child's friends' parents who may be supervising a playdate, or maybe the adult in the home after school, just so that everyone can be on the same page and can be working to support that kid in managing their health.
Then I think the last thing I would say is just that the social determinants of health really matter. Even if diabetes management is going really well, there's all those other factors like housing, access to nutritious food, mental health, that really can't be ignored and have a tremendous impact on diabetes and also just on overall health and well-being for children.