Aims: The COVID-19 pandemic has caused strain on hospital systems and potential delay in diagnosis of type 1 diabetes (T1D). Outpatient diagnosis and treatment of metabolically stable young persons with new-onset T1D have been shown to be equivalent to inpatient . We describe an approach to outpatient management of newly diagnosed T1D during the COVID-19 pandemic using an interdisciplinary team, telemedicine, and diabetes technologies including rapid implementation of continuous glucose monitoring (CGM).
Methods: Following the onset of the COVID-19 pandemic, new-onset cases of T1D were tracked . After laboratory confirmation of diagnosis and metabolic stability, patients and families were referred for ambulatory initiation of insulin therapy and diabetes education . These cases were reviewed using data extracted from the electronic health record, comments from multidisciplinary team members, and cloud-based glucose data .
Results: We report on seven young people with new-onset T1D without diabetic ketoacidosis from April to June 2020, during the COVID-19 pandemic . Ages ranged 9-23 years with presenting hemoglobin A1c (HbA1c) values 10-14.5% . Initial evaluation was generally face-to-face, followed by frequent telemedicine visits . Five patients had a family history of T1D . Two patients had access to at-home HbA1c kits prompting evaluation in the absence of symptoms . Four patients required emergency department evaluation . Five patients presented with ketosis . All patients were prescribed CGM at the first visit, most starting within 1 month .
Conclusions: Technology is extraordinarily useful for the care of young persons with new-onset T1D in the ambulatory setting during the COVID-19 pandemic . Large observational studies are needed to better understand outcomes of an outpatient, technology-focused approach.