School-centered telemedicine for type 1 diabetes mellitus

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Children and adolescents spend much of their time in school. This has the potential to make management of chronic disease difficult, but also provides opportunities to improve management if the appropriate infrastructure is in place. In this issue of The Journal, Izquierdo et al report on the use of telemedicine in school to improve the management of type 1 diabetes mellitus for children 5 to 14 years of age. The intervention group had a telemedicine unit in the school nurse's office to provide for a videoconference between the school nurse, the child, and the clinical diabetes team once a month. This also allowed the school nurse to see and exchange graphs and tables that displayed blood glucose measurements with the diabetes team. In addition, educational information was available through the portal. The telemedicine group had lower Hgb A1c levels and improvement of quality of life with fewer emergency department visits and hospitalizations during the school year. These differences tended to diminish during the summer months. This approach to chronic disease management has potential application to a variety of childhood illnesses, including asthma, cystic fibrosis, and cancer.

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