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Study to assess benefit of using telemedicine in schools to monitor children's diabetes

SYRACUSE, N.Y. — A SUNY Upstate Medical University study to assess the effectiveness of using telemedicine in Onondaga County schools as a way to improve the medical care of children with diabetes is showing early success.

Twenty-three students, ages five to 14, in 12 schools throughout the county, are having their diabetes monitored monthly via telemedicine equipment by medical staff at SUNY Upstate's Joslin Diabetes Center. Funding for the telemedicine equipment was made possible through $500,000 in federal funding secured by U.S. Rep. James Walsh.

"Time is of the essence when managing childhood diabetes, and it requires the coordination of parents, school nurses and physicians," said Walsh. "The amazing breakthrough of telemedicine provides time and expertise when and where it's needed most. We'll watch this study with great interest, because if it works with diabetes, it could work in other areas such as food allergies."

Since January, these students have been keeping monthly appointments with school nurses who use a telemedicine monitoring system, complete with a computer-mounted camera, to speak with physicians and nurses, record blood sugar levels and other vital information. The technology even allows physicians to write prescriptions for the school nurse should additional insulin or other medication be needed to better manage the diabetes.

"Diabetes management requires frequent finger stick glucose monitoring, multiple daily insulin injections or the use of an insulin pump and frequent adjustments of insulin doses, and with students in schools seven hours a day, this is an intense process," said Ruth Weinstock, M.D., Ph.D., SUNY Upstate professor of medicine and director of the Joslin Diabetes Center. "If telemedicine can assist the decision-making about diabetes care, we're helping everyone—students, school nurses and other school personnel."

The study compares diabetes management of the telemedicine group with 21 students in 12 schools who receive the standard diabetes care that consists of a doctor's appointment every three months.

Early results from the study show the telemedicine monitoring to be working. "We've been very pleased by what these early results show," she said. "Students participating in the monthly telemedicine intervention are achieving improved blood sugar control."

Another indicator of progress, Weinstock said is the decline in urgent calls to the Joslin Center—traditionally about 70 a week—from school nurses asking for help with a student's diabetes care. "The telemedicine monitoring really empowers school nurses and provides them with greater support in making diabetes management decisions that they must do with growing frequency in the school setting."

The study, which began last January, will continue through the end of December.

If the use of school-based telemedicine monitoring to manage diabetes continues to prove successful, similar links with other medical providers may become a reality.

"There could be usefulness for doing consultations from remote locations in specialties such as genetics, where seeing a child's appearance is a major part of the evaluation," said Thomas Welch, M.D., SUNY Upstate professor and chairman of the Department of Pediatrics. "There have even been attempts to diagnose ear infections via telemedicine. Connections between remote emergency departments and base hospitals could help in the assessment of critically ill children prior to transport."

Progressive Expert Consulting designed the kiosk and interface and provided the school telemedicine units. Glucose meters and supplies were provided by Lifescan. Operations support is provided by state Department of Health and the Central New York Children's Miracle Network.