Conclusions
diabetes
TYPE 1 DIABETES, DIABETES
The best findings of the present study were that the use of TH in persons with type 1 diabetes assisted in a rural area achieved similar metabolic control to conventional management, with a slight improvement in glucose metrics and HRQoL and a lower cost for the affected individuals.This is the first clinical trial aimed at comparing TH versus in-person visits among adults with type 1 diabetes treated with multiple insulin doses that includes a high percentage of participants using FGM. The development of new technologies in type 1 diabetes and the situation caused by the COVID-19 pandemic has precipitated the use of TH, although strategies have been tried for some time. Recently, advocating for prioritizing TH over in-person care and considering a hybrid model of in-person and TH for people with diabetes has been proposed (Beyond the results in metabolic control and safety, TH offers an alternative to persons in rural areas where geographic isolation represents an obstacle for traveling to hospital centers. Nonetheless, although some studies have included rural areas, none have assessed the efficiency of TH for type 1 diabetes care (Precisely the fact that the present study was conducted in a geographically dispersed area may have influenced a better perception of HRQoL, which was not reflected in all previous studies (Regarding TH acceptance, in the CoYoT1 pilot study, participants reported high levels of satisfaction with the virtual clinic compared to a traditional in-person visit through a nonstandardized satisfaction survey. However, the CoYoT1 pilot study only included young adults aged 18-25 with type 1 diabetes (The major strength of the current investigation is the prospective and randomized design used to describe causality relations in the presented findings. However, our study had some limitations that deserve mentioning: due to the study design, the time expended for endocrinologists in the TH group was higher than that for endocrinologists in the control group (100 minutes vs. 90 minutes, excluding extra visits), so the time spent on medical care is not directly comparable, and the results obtained in this sense must be carefully interpreted; the follow-up period may be too short to achieve significant differences in direct costs of transportation and indirect costs for participants; it may not be long enough to confirm that the advantages of TH on some glucose metrics and participant satisfaction are maintained over time; and finally, the participant satisfaction questionnaire used in this study was not standardized.To conclude, the TH model represents a safe and well-accepted alternative to conventional in-person visits for chronic care among adults with type 1 diabetes assisted in a rural area, which entails lower costs for affected individuals. It offers comparable care in terms of HbA