PSUN281 Safety and Efficacy of Virtual Insulin Pump Initiation in Adults with Diabetes

BACKGROUND: Insulin pump therapy is an integral part of diabetes management. The COVID-19 pandemic posed challenges to the usual insulin pump initiation process, prompting an increased reliance on virtual training, but the effectiveness and safety of this approach is unclear. METHODS: In an academic urban diabetes clinic, we examined insulin pump initiations in 30 sequential patients who underwent virtual training between May 2020 and February 2021 and in 15 patients who received in-person training between October 2018 and April 2020. Patients met with a diabetes educator for 4 sessions either remotely in the virtual group, or in-person in the routine care group. All patients used a continuous glucose monitor (CGM) prior to insulin pump training. We compared glycemic control using the following CGM metrics at baseline and 6 months: percentage time in range (70-180mg/dL), hypoglycemia (BG <70), and hyperglycemia (BG >180). We calculated the time interval between decision to start and the day of insulin pump initiation (lead time). We used descriptive statistics to report baseline characteristics of patients. We plotted each measure and used Shapiro-Wilk Test to determine the distribution of each outcome. As these measures were non-normally distributed, we used medians and interquartile ranges to describe glycemic outcomes and Wilcoxon signed rank test to assess statistical differences between the groups. RESULTS: Overall both patient groups were predominantly white (77.8%), non-Hispanic (86.6%), male (60.0%), and with type 1 diabetes (80%); the average age was 43 years. Baseline time in range was 61.0% (IQR 34.0%, 78.4%) and 65.8% (IQR 35.0%, 78.0%) in the virtual and routine groups, and 70.9% (IQR 52.2%, 83.0%) and 65.0% (IQR 48.8%, 88.9%) at 6 months. Baseline time in hypoglycemia was 0.4% (IQR 0%, 1.6%) and 0.5% (IQR 0.1%, 2.0%) in virtual and routine groups, and 0.8% (IQR 0.2%, 1.75%) and 0.3% (IQR 0%, 1.0%) at 6 months. Baseline time in hyperglycemia was 40.0% (IQR 20.3%, 66.0%) and 34.1% (IQR 13.0%, 65.0%) in the virtual and routine groups, and 25.0% (IQR 16.9%, 43.0%) and 35.0% (IQR 11.1%, 50.9%) at 6 months. There was no statistically significant difference in glycemic outcomes between the groups at baseline or at 6 months. One case of diabetic ketoacidosis occurred in both groups after pump initiation; there were no hospitalizations in either group. The lead time for virtual group training was 45 days (IQR 35, 60), significantly shorter than routine care at 80 days (IQR 50, 123; p=0.026). CONCLUSION: Our study demonstrates timely initiation of pump therapy via virtual training without increased rates of hypo- or hyperglycemia. The data suggest virtual insulin pump training can be effective, efficient, and safe. Larger studies are needed to confirm these findings. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.