Lack of adherence in pediatric chronic illness is estimated at 50-55%, and is a significant societal problem. Among the more common of these pediatric chronic illnesses is type 1 diabetes, having one of the more complex medical regimens. Adherence or the behaviors involved in following the doctors advice must be differentiated from health status or biological indices of health. While psychological research has not found a significant relationship between adherence and health status, more recent research has found diabetes specific family processes related to adherence are significant to health status. Indeed research has also found a variety of parental variables and family demographic characteristics are related to health status in pediatric type 1 diabetes as well as a variety of other chronic illnesses. Relatedly, research has shown the significance of intervening in the family with a variety of childhood and pediatric problems. The technology of telehealth offers promise for youth with difficult-to-manage diabetes. We offer a theoretical and conceptual model based on extant research of using telehealth to intervene on difficult –to-manage pediatric type 1 diabetes.