Renée Paijmans-Hovenier (Department of Internal Medicine, Anna Ziekenhuis, Geldrop, the Netherlands), Walter van der Weegen (Department of Orthopedic Surgery, Sports & Orthopedics Research Centre, Anna Ziekenhuis, Geldrop, the Netherlands), Auke Post (Department of Internal Medicine, Anna Ziekenhuis, Geldrop, the Netherlands), Sjaam Jainandunsing (Department of Internal Medicine, Anna Ziekenhuis, Geldrop, the Netherlands), r.paijmans@st-anna.nl
Background: Diabetes care faces increasing pressure due to rising patient numbers and limited healthcare capacity. Telemonitoring, facilitated by modern glucose sensors and hybrid closed-loop systems which continuously generate large amounts of clinical data, may support a transition from fixed-interval follow-up towards a more personalized and data-driven model of care. We evaluated the impact of a redesigned, telemonitoring-supported, type 1 diabetes care process including a novel risk stratification model.
Methods: Clinical data of 109 individuals with type 1 diabetes treated with a hybrid closed-loop system were evaluated over two consecutive 12-month periods; before and after implementation. Routine follow-up was reorganized from multiple in-person check-ups to continuous remote monitoring combined with one annual comprehensive diabetes review. In a subgroup of 105 individuals with complete longitudinal telemonitoring data, risk stratification using a conventional average model was compared with a weighted recent-months model. Agreement was assessed using cross-classification and Cohen’s kappa.
Results: Outpatient contacts decreased from 4.92 to 2.49 visits per patient-year (~50% reduction), while glycemic outcomes (HbA1c 56.3±1.0 vs. 56.2±1.0 mmol/mol; Time in Range 74.6±0.7 vs. 72.4±1.0%) and safety events (1 vs. 1) remained stable. Treatment satisfaction improved (median DTSQc 11.5) with high satisfaction for telemonitoring and digital messaging. Agreement between stratification models was high (94.3%, κ=0.912). Individuals classified as higher risk had higher HbA1c levels (62 vs. 50 vs. 50 mmol/mol, p<0.000001) and lower self-management capacity (1 vs. 2 vs. 2, p=0.0006).
Discussion/Conclusion: Telemonitoring enabled a substantial reduction in routine outpatient visits while maintaining glycemic outcomes, safety, and patient satisfaction. In addition, the weighted recent-months stratification model successfully differentiated patients into three categories (green, amber, red) with distinct differences in glycemic outcomes and self-management capacity, reflecting varying support needs. These findings support the safe transition to dynamic, data-driven diabetes care to reduce health care pressure, thereby monitoring patients based on individual risk profiles while improving patient satisfaction.