Highlights
The transition toward digital healthcare in chronic disease management has accelerated, yet high-quality evidence regarding its long-term efficacy in specialized populations remains limited. A recent randomized controlled trial published in Diabetologia investigated the effectiveness of video consultations for adults with Type 1 Diabetes (T1D) using insulin pumps. The key findings include:
- The primary outcome, Time in Range (TiR), showed no significant difference between video consultations and traditional in-person care (64.3% vs. 63.5%).
- Video consultations were associated with a significant improvement in treatment satisfaction and a modest reduction in HbA1c levels compared to the control group.
- Surprisingly, the intervention group reported a lower impact on quality of life (QoL) compared to those receiving physical consultations, suggesting a complex psychosocial trade-off.
Background: The Digital Shift in Diabetes Care
Type 1 Diabetes management has been transformed by therapeutic technologies, specifically continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII), or insulin pumps. These technologies generate vast amounts of data that can, in theory, be reviewed remotely. As healthcare systems strive for efficiency and patient-centeredness, video consultations have emerged as a promising alternative to the traditional outpatient clinic model.
The clinical rationale for telemedicine in T1D is strong: it reduces travel burden, minimizes time away from work, and allows for more frequent, data-driven touchpoints. However, the ‘gold standard’ for assessing glycemic control has shifted from the three-month average of HbA1c to Time in Range (TiR), which provides a more granular view of daily glucose fluctuations. Until now, there has been a lack of long-term (1 year) superiority trials comparing video and physical consultations specifically focusing on TiR in pump-treated populations.
Study Design and Methodology
The study was a 52-week, open-label, randomized, controlled superiority trial conducted at the Hospital of Southern Jutland. It included adult patients diagnosed with T1D who had been utilizing an insulin pump for at least six months.
Participants and Randomization
A total of 76 participants were randomized in a 1:1 ratio to either the intervention (video consultations) or the control group (physical consultations). Randomization was stratified based on the type of glucose sensor used (CGM vs. Flash Glucose Monitoring). The Intention-to-Treat (ITT) population consisted of 38 participants per group, with a median age of 49 years and a balanced gender distribution.
Intervention and Primary Endpoint
Participants in the intervention group received their scheduled outpatient consultations via a secure video platform for one year. The control group followed the standard of care with physical visits. The primary endpoint was the percentage of TiR (defined as glucose levels between 3.9 and 10.0 mmol/l) during the final two weeks of the study (weeks 51 to 52), measured by CGM. Secondary endpoints included HbA1c levels, treatment satisfaction (measured via the DTSQ), and Quality of Life (measured via the ADDQoL).
Key Findings: Glycemic and Patient-Reported Outcomes
The results provide a nuanced view of how telemedicine influences both physiological and psychological parameters in diabetes care.
Primary Outcome: Time in Range
At the 1-year mark, the least square means for TiR were 64.3% in the video group and 63.5% in the physical consultation group. The difference of 0.8 percentage points (95% CI -5.3, 6.9; p=0.25) was neither statistically significant nor clinically relevant. This suggests that video consultations are at least as effective as in-person visits in maintaining glycemic stability over the long term.
Secondary Outcomes: HbA1c and Satisfaction
Interestingly, the video group showed a superior reduction in HbA1c compared to the control group. This might be attributed to the ease of data sharing and the potential for more focused, data-centric conversations during video calls. Furthermore, treatment satisfaction was significantly higher in the video group. Patients appreciated the convenience and the modern interface of care delivery.
The Quality of Life Paradox
Despite higher satisfaction and better HbA1c, the video group reported an inferior impact on quality of life. This paradox is a critical finding. It suggests that while patients ‘like’ the convenience of video calls, the lack of physical presence and the potential isolation from the clinical environment may negatively affect their overall sense of well-being or the perceived support system provided by the physical clinic.
Expert Commentary: Interpreting the Data
This trial highlights that for technologically proficient T1D patients—those already using insulin pumps—video consultations are a safe and effective medium for clinical management. The lack of superiority in TiR suggests that the ‘mode’ of communication may be less important than the ‘content’ of the data review.
However, the decline in Quality of Life scores warrants further investigation. Clinical medicine is not merely the adjustment of insulin basal rates; it is also a human interaction that provides psychological scaffolding. The physical clinic visit may offer a form of ‘social validation’ or a more comprehensive ‘safety net’ feeling that digital platforms currently struggle to replicate. Clinicians should consider a ‘hybrid’ model—alternating between video and physical visits—to maintain the benefits of convenience while preserving the therapeutic alliance formed in person.
Conclusion
The 52-week RCT demonstrates that video consultations are a viable alternative to physical visits for insulin pump-treated T1D patients, offering comparable glycemic control (TiR) and potentially superior HbA1c and satisfaction. Nevertheless, the negative impact on quality of life suggests that telemedicine should not be viewed as a total replacement for in-person care. Future research should focus on identifying which patients benefit most from digital interventions and how to better integrate psychosocial support into virtual platforms.
Funding and Trial Registration
This study was funded by Knud and Edith Eriksens Mindefond, with support from the Oak Foundation through the Parker Institute. The trial is registered at ClinicalTrials.gov under the identifier NCT04612933.
References
Schultz ANØ, Christensen R, Bollig G, Kidholm K, Brandt F. Effectiveness of video consultations in type 1 diabetes patients treated with insulin pumps in the outpatient clinic: a randomised controlled trial. Diabetologia. 2026 Feb;69(2):321-329. doi: 10.1007/s00125-025-06585-2.
